When the first edition of this book was published 26 years ago we thought that in a few years there will be clear cut knowledge on the cause of migraine and specific treatment will be found out. Our hopes have been belied and today we know it a little better but have not fully understood it. The drugs used in the treatment are more effective but no cure has been found out.

It is a natural phenomenon that we suffer more from disease as we grow older, but migraine is a peculiar disease in the sense that it occurs at a young age (20-40 years) and wears off at old age. Another peculiarity is that it is more common in females (18 per cent females suffer as against 6 per cent of males). Does it mean that it has some relation to female sex hormones or to menstruation? We do not know yet. Let us see what this much talked about disease means. What is its cause? Is it a hereditary disease? What can we do about it?

Symptoms: Migraine is a recurring and intense headache which may not be relieved by conventional pain relievers. However, every severe type of headache which is not relieved by conventional pain relievers is not migraine? Migraine is a disease characterized by a pulsating or throbbing pain usually on one side of the head, and associated with one or more of the following symptoms: nausea, giddiness, vomiting, abdominal cramps, visual disturbances such as flashing of light, speech disturbances, sensory disturbances, or changes in mood. It is generally preceded by a peculiar warning signal (prodromal symptoms) known as sensory aura, which gives an indication of the onset of the attack. It may occur at any age and has been reported that over half of the migraine patients have close relatives who also have headache. Migrainous headache is more severe than tension headache.

Causes: The cause of migraine is not known. It is generally believed to be due to the pulsating dilation of the arteries of the head which activate pain percepting nerve twigs. It is uncommon in old age becouse of the narrowing of the arteries. Drugs which constrict blood vessels provide relief in migraine. A neurochemical substance, serotonin, has also been implicated as a causative factor of migraine. Most patients can know about an impending attack should start treatment immediately.

Precipitating Factors: The factors which may trigger off an attack are given below. Every possible effort should be made to avoid these.

Psychological Factors: Prolonged emotional strain due to fear, frustration, isolation and or physical stress such as fatigue or excessive heat may trigger an attack of migraine personality is characterized by compulsive perfectionism, rigidity, and achievement orientation.

Foods: Contrary to the belief that periodic fasting improves health, missing meals for more than 5 hours during the day or 13 hours at night may precipitate an attack of migraine. Certain foods such as cheese, chocolate, alcohol, citrus fruits, flavouring agents like ajinomoto (monosodium glutamate) used in Chinese foods, instant and canned soups, roasted nuts, processed meat, and instant gravies, may be the precipitating factors. An excessive amount of coffee or its sudden withdrawal may trigger an attack. The cumulative effect of caffeine in tea, chocolates, and cola beverages, together with widely used caffeine-containing relievers like Cafergot, Duoflam and Zimalgin must be considered.

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