Cause and Treatment

At present, there is no known etio - patho - physiology (cause) of migraine, though; various theories have been proposed by leading scientists in past decades. Similarly, there is no specific laboratory investigation for the diagnosis of migraine. However, certain factors are known to trigger it. Common triggers of migraine include genetic and environmental factors, tyramine containing food, sulphites, nitrites and hormones. There are few other factors which might trigger attacks of migraine among individuals differently.

These are:

  • Stress due to time constraint, major hassles or losses, anger and conflict
  • Fumes, certain smells and smoke
  • Dazzling light, weather changes
  • Sustained exertion, travelling
  • Menstrual cycle, birth control pills, hormone therapy
  • Hunger, fasting, specific foods like cheese, chocolate and specific beverages like red wine
  • Too much, too little or interrupted sleep
  • Certain medicine including (prolonged use of) painkillers

The current treatment of migraine s aimed to control the pain by using analgesics. There are many migraine specific drugs which should be taken as soon as the headache component of the attack is recognized. Treatment should not be delayed till headache becomes unbearable. Besides, there are triptans – selective 5 – HT receptors agonists. More emphasis is given by prescribing prophylactic treatment in the form of beta – blockers, anti – convulsant, tricyclic antidepressants, calcium – channel blockers, riboflavin and magnesium.

The recurring attacks of migraine may also be reduced by using the following:

  • Stress reduction
  • Elimination of certain foods from the diet
  • Regular excercise such as swimming or vigorous walking

Temporary relief is obtained by using cold packs or by pressing on bulging arteries sighted in front of the ear or on the painful side of the head.

Current preventive therapies for Migraine and its limitations:

Headache ought to be a public – health concern. Yet there is good evidence that very large numbers of people troubled by headache do not receive effective care. Thus, there remains a significant unmet need in its treatment. Less than one – third of patients reported their medication consistently effective and only 36% satisfied with their current therapy.

Approaches to treat migraine can be divided into non – pharmacologic and pharmacologic therapies. The agents currently approved for migraine prophylaxis are characterized by inconsistent effectiveness and in some patient’s unacceptable side effects.

Recent studies suggest that habitual over use of acute medications, including triptans, ergots and other analgesics can lead to development of chronic daily headaches.

Repeated use of analgesics, especially ones containing caffeine or barbiturates can lead to rebound headaches or medication Overuse Headaches (MOH) as each dose wears off and patients then takes another round of medication.

Patients, who were surveyed about their treatment expectations for acute migraine, reported a need for therapy that is rapidly effective, relieves pain completely, has low recurrence rate and is well tolerated. Although triptans offers many of these attributes, a recent survey from the National Headache Foundation indicates that patient’s remains dissatisfied. Thus, triptans though the major contributors of migraine management in many patients provide partial relief.

Sumatriptan despite its great utility has certain limitations for example low oral bio – availability, high headache recurrence and contraindication in patients with coronary artery diseases.