Stop Living Around Your Migraines

Understanding Migraine in the Indian Context

Migraine—severe, disabling headaches often with nausea, light sensitivity, and aura—affects 1 in 7 people globally, yet remains underdiagnosed and undertreated. At Ajuda Hospitals, our Headache Clinic delivers precision care: trigger mapping, evidence-based preventive therapy, nerve blocks, and cutting-edge CGRP inhibitors for chronic cases.

Indians face unique triggers: irregular sleep from shift work (IT professionals), hydration neglect, meal skipping, and high-stress lifestyles. Women experience menstrual migraines due to hormonal fluctuations. Our culturally tailored approach addresses these factors while respecting work demands and family responsibilities.

Migraines are not "just headaches"—they are a neurological condition with genetic roots. Untreated, they erode quality of life, productivity, and mental health. With proper diagnosis and treatment, 75% of patients achieve significant reduction in attack frequency and severity.

When to Consult Our Headache Specialists

Schedule a consultation if migraines occur ≥4 days/month, interfere with work/school, or current medications are ineffective or cause side effects (dizziness, weight gain, cognitive slowing).

Our Diagnostic Approach

Headache Classification

Detailed history: onset age, frequency, duration (4-72 hrs typical for migraine), location (unilateral 60%), quality (pulsating), severity (0-10 scale), aggravating factors (activity, light, sound), associated symptoms (nausea, aura—visual zig-zags, numbness).

Headache Diary: Record attacks for 4 weeks—date, time, triggers (food, sleep, stress), severity, medications used, relief achieved. Reveals patterns invisible in single-visit history.

Red Flag Screening

Rule out dangerous secondary headaches (aneurysm, tumor, meningitis):

• SNOOP10 Criteria: Systemic symptoms, Neurological deficits, Onset sudden, Older age (>50), Pattern change, Positional, Papilledema, Precipitated by exertion/Valsalva, Progressive, Pregnancy.
• Imaging: MRI brain if red flags present; CT if thunderclap headache (subarachnoid hemorrhage).

Trigger Mapping

Common precipitants in Hyderabad patients:

• Sleep: Irregular schedule (shift work), insufficient sleep (<7 hrs), oversleep (weekends).
• Diet: Skipped meals (hypoglycemia), dehydration, aged cheese (tyramine), chocolate, alcohol (red wine), MSG (Chinese food).
• Hormonal: Menstrual migraine (drop in estrogen pre-period).
• Stress: Work deadlines, family responsibilities—but also stress let-down (weekend migraines).
• Environmental: Bright lights (computer screens), strong smells (perfumes), weather changes.

Disability Assessment

MIDAS Questionnaire: Quantifies days lost to headache in work, household, social/family activities over 3 months. Score ≥11 indicates substantial disability—warrants aggressive preventive therapy.

Treatment Pathways

Acute Attack Management

Goal: Abort attack within 2 hours; restore function.

First-Line: Triptans (sumatriptan 50-100mg, rizatriptan 10mg) within 1 hour of onset. Mechanism: serotonin receptor agonist, vasoconstricts cranial vessels, inhibits pain pathways.

Adjuncts:

• NSAIDs: Ibuprofen 400mg, naproxen 500mg (if triptans contraindicated or mild attack).
• Antiemetics: Ondansetron 4mg, metoclopramide 10mg (for nausea; also enhances analgesic absorption).

Caution: Limit acute meds to <10 days/month. Overuse → medication-overuse headache (MOH)—daily headaches requiring detoxification.

Preventive Medications

Indications: ≥4 migraine days/month, ≥8 headache days/month, or attacks causing severe disability despite acute treatment.

First-Line Options:

• Beta-Blockers: Propranolol 40-120mg bid, metoprolol 50-200mg/day. Contraindicated in asthma, depression.
• Anticonvulsants: Topiramate 50-100mg/day (weight loss, cognitive side effects—"dopamax"), valproate 500-1000mg/day (avoid in women of childbearing age—teratogenic).
• Antidepressants: Amitriptyline 10-75mg at bedtime (sedation, dry mouth; good if comorbid insomnia/anxiety).

Titration: Start low, increase every 2-4 weeks. Full effect at 6-8 weeks. Trial for 3-6 months; taper if attack frequency drops >50%.

CGRP Inhibitors (Monoclonal Antibodies)

Second-Line: For patients unresponsive to/intolerant of traditional preventives, or chronic migraine (≥15 headache days/month).

Options:

• Erenumab (Aimovig): Monthly subcutaneous injection.
• Fremanezumab (Ajovy): Monthly or quarterly injection.
• Galcanezumab (Emgality): Monthly injection.

Mechanism: Block calcitonin gene-related peptide (CGRP), key migraine mediator. Specific to migraine pathway—fewer systemic side effects than beta-blockers/anticonvulsants.

Outcomes: 50-60% achieve ≥50% attack reduction. Well-tolerated; main side effects: constipation, injection site reaction.

Nerve Blocks

Indications: Chronic daily headache, refractory migraine, cluster headache, cervicogenic headache.

Procedure: Local anesthetic (lidocaine) + steroid (methylprednisolone) injected at greater occipital nerve (back of head) or supraorbital nerve (above eyebrow). Office procedure, 5-10 minutes.

Outcomes: Rapid relief within hours; lasts 2-8 weeks. Repeat as needed; safe for long-term use.

Botulinum Toxin (Chronic Migraine)

FDA-Approved Protocol: 31 injections (155 units onabotulinumtoxinA) across 7 head/neck muscle groups. Repeated every 12 weeks.

Eligibility: ≥15 headache days/month for >3 months, with ≥8 migraine days.

Outcomes: Reduces headache days by 8-9/month after 2-3 cycles. Insurance-covered for chronic migraine (prior authorization required).

Lifestyle & Behavioral Therapy

• Sleep Hygiene: 7-8 hours nightly; consistent wake time (even weekends); dark, cool room.
• Meal Regularity: Don't skip breakfast; hydrate 2L/day (Indian climate + AC causes dehydration).
• Stress Management: Yoga, progressive muscle relaxation, cognitive-behavioral therapy (CBT) for comorbid anxiety/depression.
• Exercise: Aerobic activity 30 min, 5 days/week (but not during attack—worsens pain).
• Trigger Avoidance: Based on diary—if wine triggers, avoid; if bright screens trigger, use blue-light filters, take breaks.

What to Expect: Your Care Journey

First Visit (60 min)

Complete headache history, neurological exam, MIDAS disability score. Review prior medications and treatments. Initiate headache diary (paper or app). Start acute treatment optimization.

4-Week Follow-Up

Review diary—identify triggers, assess acute treatment response. Discuss preventive therapy if ≥4 attacks/month. Baseline labs if starting topiramate or valproate (CBC, liver function).

Month Check-In

Evaluate preventive medication—titrate dose based on side effects and efficacy. If <30% improvement, consider switching preventive class or adding CGRP inhibitor.

6-Month Review

If ≥50% reduction achieved, maintain current regimen. If refractory, consider botulinum toxin or nerve blocks. Reassess lifestyle adherence.

Annual Assessment

If stable 1 year, attempt taper of preventive medication. Continue diary to detect early relapse. Reinforce non-pharmacological strategies.

Technology & Innovation

Digital Headache Diary

Mobile App Features:

• Log attacks: date, time, severity, triggers, meds taken, relief achieved.
• Weather tracking: barometric pressure changes correlate with attacks.
• AI pattern recognition: "Your migraines cluster on Mondays—stress? Caffeine withdrawal?"
• Medication overuse alerts: "You've used sumatriptan 11 days this month—risk of rebound headache."

CGRP Pathway Targeting

Traditional preventives (beta-blockers, anticonvulsants) were repurposed from other conditions—side effects common. CGRP inhibitors are migraine-specific—designed to block the key peptide that triggers attacks. Result: better tolerability, no sedation/weight gain/cognitive slowing.

Telemedicine Headache Clinic

For patients in Warangal, Karimnagar, Nalgonda:

• Initial in-person visit for diagnosis and baseline exam.
• Monthly video consults for medication titration, side effect management.
• Diary shared via app; physician reviews trends remotely.
• In-person visits for nerve blocks or botox injections (quarterly).

Outcome: 85% adherence to preventive therapy vs 50% with standard care.

Preventing Complications

Medication-Overuse Headache (MOH):

• Using acute meds >10 days/month → daily or near-daily headaches.
• Treatment: Structured withdrawal (stop offending drug), bridge with preventive, short-term steroids for withdrawal symptoms.
• Prevention: Limit triptans/NSAIDs; start preventive early.

Chronic Migraine Transformation:

• Episodic migraine (≤14 days/month) → chronic (≥15 days/month) over months to years.
• Risk factors: Medication overuse, obesity, depression, stressful life events.
• Prevention: Aggressive early preventive therapy; treat comorbid depression/anxiety; weight management.

Stroke Risk:

• Migraine with aura increases ischemic stroke risk 2x (especially in smokers on oral contraceptives).
• Mitigation: Smoking cessation; consider progestin-only contraceptives; aggressive vascular risk factor control (BP, cholesterol).

Why Ajuda for Headache Care?

Take the First Step

If frequent migraines: Call 9010550550 to schedule comprehensive headache evaluation. Preventive therapy can cut attacks by 50-75%.

If current treatment fails: Request second opinion. Newer options (CGRP drugs, botox, nerve blocks) may help when traditional meds don't.

If medication overuse suspected: We offer structured withdrawal programs with bridge therapy—break the rebound cycle.

Ajuda Hospitals: Where migraines meet precision medicine, and life beyond headaches begins.