BIOLOGY ASSIGNMENT

2019-20

Migraine
BY SANDIP KUMAR
11-D
ACKNOWLEDGEMENT

I am over helmed in all humbleness and gratefulness to acknowledge

my depth to all those who have helped me to put these ideas, well above the
level of simplicity and into something concrete. I would like to express my
special thanks of gratitude to my teacher, Mrs. Bindu Manojkumar who
gave me the golden opportunity to do this wonderful project on the topic
“Migraine”, which also helped me in doing a lot of Research and I came
to know about so many new things.
I would like to express my deep and sincere gratitude to Dr.Sanjay
Bhaumik whose opinions helped me in shaping my project and also to the
people who spent their valuable time to answer my survey. Any attempt at
any level can’t be satisfactorily completed without the support and
guidance of my parents and friends. I would also like to thank my parents
who helped me a lot in gathering different information, collecting data
and guiding me from time to time in making this project, despite of their
busy schedules, they also gave me different ideas in making this project
unique.

Thanking you,
Sandip Kumar
11-D
Table of contents

Certificate …………………………………………………………… I
Acknowledgement ..…………………………………………………… II
Table of Contents …………………………………………………….. III
1. Introduction ………………………………...................................... 1
2. Doctor’s Interview ...………………………………………………... 9
3. Newspaper Articles ……………………………………………….. 13
4. Case Study ………………………………………………………… 17
5. Survey Sheets ..…………………………………………………… 21
6. Conclusion …………………………………………………………. 81
Bibliography ……………………………...……………………….. IV
DOCTOR’S INTERVIEW

1) How can we diagnose

migraine? How is it different
from tension headache?
We can diagnose it as migraine
if it fulfills certain criteria like
the patient should have more
than five attacks, throbbing
nature, restriction of activities,
increase in movement, severe
pain, nausea, vomiting,
photophobia, phonophobia and lasting from 4-72 hours. MRI and
CT scan are effective in diagnosing migraine if the condition is
unusual. Tension headache mimics migraine headache but is more
common than migraine. It may have nausea and vomiting but
photophobia, phonophobia and restriction of activities are not
there in tension headaches.
2) Why are women more at risk of having migraine?
Migraine has some relation with the hormone estrogen. Women
mainly start have migraine during the ovulation period because the
estrogen goes up. If women take oral contraceptive pills, they have
a higher chance of getting migraine. After menopause, most of
them are free from the symptoms.

3) Is migraine more common nowadays or is it the same as it was

before?
Yes, migraine is more common nowadays because of increase in
stress and lifestyle changes. The hot and humid air in the
environment also triggers migraine.

4) What can frequent migraine lead to?

Some patients may develop hemiparesis while some might get
familial hemiplegic migraine. Sometimes if you have very frequent
attacks, it can cause cognitive dysfunction. Migraines can also
cause ophthalmoplegia (visual disturbances). But we can recover
from most of them. When migraine continues for long time and
there are complications, we need to think whether it is associated
with any other disease.

5) What are some common drugs that can trigger migraine

headache?
Taking oral contraceptive pills, consuming red wine and substance
abuse can trigger migraine. Also taking stimulant drugs facilitates
migraine headache.
6) How effective is the Botox
treatment? In what case is it
being suggested?
It is usually prescribed for chronic
migraines when there are more
than 15 attacks in a month and
when patients are not
responding to other medicines.
They are also quite effective.
Monoclonal antibodies (Aimovig)
are even more effective in
treating migraine headache. It is
injected once a month.

7) Can hypnosis, biofeedback or other nondrug treatments help?

First line of treatment for migraine is non pharmacological. Lifestyle
modifications, prevention of precipitating factors, biofeedback are
used before starting the pharmacological treatment.

8) What are the side effects of the drugs prescribed for migraine?
How is it prevented?
Migraine treatment starts with the acute treatment where pain
relieving drugs are prescribed. Aspirin when taken frequently in a
month leads to a headache, called drug abuse headache. If the
patient is having side effects like gastric problems, we usually
prescribe medicines to prevent it. Triptans are specific for migraine
headache, there are 8-9 types of triptans. They are available in oral
form, nasal spray and some in the form of injections. The patients
are prescribed whichever they are comfortable with.
9) What are some lifestyle changes you would suggest to prevent
migraine?
1. Sleeping at proper time
2. Eating at proper time
3. Avoid eating ice cream, chocolate, red wine etc
4. Avoiding strong perfumes can prevent migraine headaches.

10) Generally, people do not take migraine seriously. Do you feel the
same stigma within the medical community?
Yes, GPs and routine medical practitioners usually do not take
migraine or other headaches as a serious issue. They take pain
killers and do not check with a neurologist or a headache specialist.
Getting treated by a specialist can help them get an overall picture
of the problem and take suitable medications and therapy.
NEWSPAPER ATICLES
Case Study
CASE STUDY 1: Acute Confusional Migraine

CASE
Curtis is a 12-year-old boy who started having migraines at the age of 8.
His headaches generally occur every few months and are well treated
with over-the-counter medications. However, one year ago, while he
was in the middle of watching television, he became confused. His
mother said he was agitated and holding his head. She also said that he
was speaking nonsense, as if talking in another language. She called 911
and Curtis was taken to the ER where tests were done. A
comprehensive toxicology screen was normal as was an MRI of the
brain. An EEG was performed to look for seizure activity. While no
seizure activity was noted, Curtis’s brain waves did have some non-
specific slowing. There were no recent stressors in his life and no
history of psychological problems. No clear cause was detected. Curtis’s
agitation and confusion continued until he fell asleep that evening. He
awoke in the morning feeling fatigued, but otherwise back to normal.
Curtis had no recollection of the event. He did, however, remember
feeling a mild headache with nausea earlier in the day. The episode has
not reoccurred.

DISCUSSION
 Acute confusional migraine is considered by many to be a “migraine
variant” and occurs in children of school age.
 In the typical scenario, a child will have a sudden onset of agitation,
language problems, amnesia and confusion. Most routine studies,
such as those performed in Curtis’s case, will be negative. The
symptoms almost always resolve with sleep or within 24 hours. The
child will not remember the event. Acute confusional migraine may
 reoccur but often does not. About a third of children will report a
mild head injury, such as bumping their head, prior to the event.
The vast majority of children will have a personal or family history of
migraine, or will later develop typical migraine headaches.
 Approximately a third of children will have a reoccurrence of
symptoms. Once other conditions have been ruled out, it can be
treated in a similar fashion to migraine. Often a dark, quiet room,
pain control and, perhaps, a sleep aid are all that is needed. In
certain situations, the best treatment is to start preventive
headache medications to decrease the chance of reoccurrence.

CASE STUDY 2: Ophthalmic Migraine

CASE
A 42-year-old woman with migraine was referred by her eye doctor to a
headache clinic because she was having recurrent episodes of visual
loss in one eye. Her migraine headaches were severe, pulsating and
left-sided. Associated features included nausea, vomiting and increased
sensitivity to lights, sounds and odors. Her headaches occurred
approximately six times monthly and lasted 24 to 72 hours. One-third
of her headaches began with transient spells of visual loss in the left
eye consisting of black spots and flashing lights. The visual phenomena
always began in the outer edge of the woman’s left eye and expanded
to engulf the entire eye within a few minutes. Alternately covering each
eye during an attack and comparing their views confirmed that the
visual disturbances were confined to the left eye. Complete visual loss
in the left eye lasted for five minutes, then fully resolved, and was
followed immediately by a migraine headache. The woman’s general
medical and neurological examinations were normal, as were repeated
eye examinations by several ophthalmologists. Other tests, which
included an MRI of the brain, ultrasound examination of the carotid
arteries, echocardiography and extensive blood testing, were within
normal limits. The patient was treated with a gradually escalated dose
of nortriptyline, a medication used for headache prevention. The
episodes of visual loss completely stopped and the woman experienced
a significant reduction in headaches (down to one per month).

DISCUSSION
 The features in this case suggest a diagnosis of opthalmic migraine,
as long as other causes of visual loss involving one eye are
excluded. Opthalmic migraine is most common in women with a
history of migraine with aura who are in their twenties and thirties.
It is characterized by episodes of fully reversible positive and/or
negative visual disturbances within one eye, associated with
migraine headache.
 Once opthalmic migraine is suspected, the patient should be
referred to an ophthalmologist and a neurologist who specializes in
the treatment of headache. Although retinal migraine has usually
been viewed as a benign condition, it appears that partial or
complete permanent visual loss of one eye may occur. No specific
factor has been identified to account for this occurrence. Therefore,
preventive drug therapy for migraine seems prudent, even if attacks
are infrequent.

CASE STUDY 3: Basilar Migraine

CASE
A 32-year-old woman was referred to the headache clinic by her
internist. She has been suffering from severe headaches since the age
of 15. The attacks have become more frequent and occur two to three
times a month. Her headaches were usually unilateral (one-sided) and
were always preceded by colorful zigzag lines on one side of her visual
field. The visual disturbance lasted 30 minutes and was followed by
dizziness, which she described as room spinning, nausea and difficulty
speaking. The dizziness and difficulty speaking lasted for an hour, while
the headache, which started while she was still having difficulty
speaking and dizziness, persisted for the rest of the day. Ibuprofen and
acetaminophen were not very effective, while a caffeine combination
prescribed by her internist worsened the nausea. The internist did not
prescribe a triptan because of the neurological symptoms. The patient
was in good general health with no significant past medical history. She
was not taking any medications. Her family history was positive for
similar headaches in her mother, until she reached menopause. The
patient was working fulltime and was married with two children. She
did not drink excessive amounts of caffeine (one cup of coffee a day)
and did not smoke. Her physical examination was normal. An MRI scan
of her brain was also normal. At the headache clinic, she was prescribed
rizatriptan (Maxalt), which provided excellent relief of her headache,
although she still had an hour of disability while waiting for the aura
symptoms to resolve. To prevent her attacks, the patient was advised
to start regular aerobic exercise.

DISCUSSION
 This woman’s headaches fit the diagnostic criteria for a rare type of
migraine, called basilar migraine. The term basilar migraine comes
from the fact that the basilar artery supplies blood to the brainstem
where symptoms of vertigo and dysarthria (difficulty speaking)
originate. For many years it has been assumed that narrowing of
this artery with resultant drop in blood flow to the brainstem was
responsible for the symptoms.
 However, in the past few years we have learned that while
constriction of the blood vessels in the brain does occur, it is not the
cause of symptoms, but rather the result of dysfunction of the nerve
cells. When these nerve cells don’t function fully, they need less
blood supply and the blood vessels constrict.
 SURVEY: MIGRAINE
NAME: __________________________ AGE:_____
OCCUPATION:______________________
CONTACT( E-MAIL/PHONE NO.): ________________________

SYNOPSIS
Migraines are a recurring type of headache. They cause moderate to severe pain that is
throbbing or pulsating. The pain is often felt on one side of your head. You may also
have other symptoms such as nausea, weakness and sensitivity to light and sound.

DISCLAIMER
This following information provided by you is purely for my school project. This will remain
confidential and will not be disclosed under any circumstances.

SANDIP KUMAR 11 D (2019-20)

SANDIP KUMAR 11 D (2019-20)
CONCLUSION
 Migraine is a surprisingly common neurological disorder that affects
a sizeable minority of the U.S. population. It is more common in
adults than children and in women than men.
 Its the third most common disease in the world (behind dental caries
and tension-type headache) with an estimated global prevalence of
14.7% (that’s around 1 in 7 people). Migraine is more prevalent than
diabetes, epilepsy and asthma combined.
 Migraines seem to run in families. Four out of 5 people with the
condition have other family members who have them, too. If one
parent has a history of migraines, their child has a 50% chance of
getting them, and if both parents have them, the risk jumps to 75%.
 While researchers have some idea of what happens within the brain
during migraine attacks, much remains to be discovered about its
underlying causes and
mechanisms. There is no cure,
but lifestyle adjustments (such
as getting enough exercise, not
skipping meals, getting
adequate sleep and moderate
and spaced use of caffeine) can
help reduce the likelihood of
migraine.
 One of the most frequently
cited health problems treated
with alternative therapies is
headaches. In addition,
treatment focuses on avoiding
those things that seem to
trigger attacks, identifying drugs
that prevent or reduce the
 severity of attacks and drugs that reduce the intense pain of a severe
attack.
 Migraine remains undiagnosed and undertreated in at least 70% of
patients, and less than 50% of migraine patients consult a physician.
In the UK, 3% of GP consultations and 30% of neurology
consultations are for headache, with migraine the most common
diagnosis.
 The greatest single advance in migraine management in the last half
of the 20th century was the triptan class of drugs, which emerged in
the 1990s and the first (sumatriptan) was developed at Glaxo in
Stevenage, UK.
 Less than 50% of migraine patients are satisfied with their current
treatment. The majority self-medicate using non-prescription (over-
the-counter) medication and do not seek medical help.
 Migraine sufferers (85%) and non-sufferers (61%) agree that
exposure to excessive light is associated with greater risk of
migraine. This is consistent with scientific evidence that people with
migraine tend to have recurring attacks triggered by a number of
different factors, including stress, anxiety, hormonal changes, bright
or flashing lights, lack of food or sleep, and dietary substances.
Sudden changes in weather or environment also increases the risk of
migraine.
 Aimovig can be used to prevent both episodic migraine and chronic
migraine headaches. Neurologists recommend Aimovig for people
who:
 can’t reduce their number
of monthly migraine
headaches enough with
other drugs
 can’t take other migraine
medications because of side
effects or drug interactions
 Half of migraine sufferers (50%) and plurality of non-sufferers (38%)
say migraines are most likely caused by a combination of genetic and
environmental factors, and stress. The National Institute of
Neurological Disorders cites evidence that migraines are genetic,
with most migraine suffers having a family history of the disorder.

 Some of the steps I would suggest to prevent migraine headaches

are:-

 Find a calm environment

At the first sign of a migraine, retreat from your usual activities if
possible.
 Sleep well
Migraines may keep you from falling asleep or wake you up at
night. Likewise, migraines are often triggered by a poor night's
sleep.
 Eat wisely
Your eating habits can influence
your migraines.
 Exercise regularly
During physical activity, your body
releases certain chemicals that
block pain signals to your brain.
 Manage stress
Stress and migraines often go hand
in hand. You can't avoid daily stress,
but you can keep it under control to
help manage your migraines.
 Strive for balance
Living with migraines is a daily
challenge. But making healthy
lifestyle choices can help.
Bibliography
https://medlineplus.gov/migraine.html

https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-
20360201

https://www.healthline.com/health/migraine

https://headaches.org/2008/02/21/case-studies-in-headache-issue-januaryfebruary-2008/

https://headaches.org/2007/11/02/case-studies-issue-septemberoctober-2006/

https://www.askdrmakkar.com/migraine_homeopathic_treatment.aspx

https://www.colonialhealthcare.com/Blog/TabId/34453/PostId/3933/headache-or-migraine

https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/

https://www.practicalpainmanagement.com/pain/headache/migraine/migraine-treatment-
what-old-what-new

https://www.chistlukeshealth.org/resources/migraines-vs-tension-headaches

https://askdrgil.com/simple-cure-stubborn-migraine/

https://www.slideserve.com/roxanne/what-you-can-do-for-your-migraine-headaches

https://www.healthcentral.com/article/botox-for-chronic-migraine-knowledge-of-anatomy-is-
critical

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symptoms/

https://americanmigrainefoundation.org/resource-library/move-migraine-interview-dr-
dodick/

https://www.npr.org/sections/health-shots/2012/04/16/150525391/why-women-suffer-
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https://www.practo.com/health-wiki/migraine-headache-causes-symptoms-and-
treatment/68/article