What is Migraine?
Migraine is a clinical syndrome characterized by pain attacks that persist for several hours to several weeks, occurring over many years in a patient’s life, with no headache symptoms between attacks. Migraine headaches, which may be influenced by genetic factors, are generally defined as unilateral headaches accompanied by nausea and sensitivity to light and sound.
Migraine is a condition influenced by both genetic and environmental factors rather than being purely hereditary. There are two main subtypes of migraine: migraine with aura and migraine without aura. Accounting for approximately 10% of migraine attacks, migraine with aura manifests with temporary sensory symptoms such as hallucinations in the form of zigzag lines, blurred vision, flashes of light, or scotomas (blind spots in the visual field) that appear about an hour before the headache develops. If migraine headaches occur at least 15 days per month for a period of three months and are accompanied by other migraine-related symptoms on at least eight days per month within the same timeframe, the condition is classified as chronic migraine.
What Causes Migraine?
Migraine is a type of headache that results from changes in the nerves and blood vessels of the brain. Individuals with migraine have a nervous system that is sensitive to attacks, which can be triggered by certain environmental factors. When an attack is triggered, the so-called “migraine generator” in the brain is activated. This leads to the dilation of blood vessels and inflammation of the nerves in the brain. Consequently, the activation of the trigeminal nerve in the brain occurs, leading to the pain and other symptoms associated with a migraine attack.
Various factors can trigger migraine headaches, including:
• Hunger
• Skipping meals
• Stress
• Sleep disorders and irregularities
• Bright lights
• Menstrual period
• Altitude changes
• Weather changes and pollution
• Southwesterly wind (Lodos)
• Strong odors such as perfumes
• Alcohol and tobacco consumption
How is Migraine Treated?
There is no definitive cure for migraine. Physicians generally focus on preventing symptoms and attack frequency in migraine patients. The treatment plan varies depending on factors such as the patient's age, attack frequency, migraine type, severity of symptoms, and overall health condition. Migraine treatment is divided into two categories: medication-based and non-medication-based therapies.
1. Medication Treatment:
Medications used for acute attacks aim to provide effective and rapid relief by reducing or completely eliminating the severity of pain and associated symptoms, shortening the duration of the attack, and improving quality of life. In addition, if severe accompanying symptoms are present, the physician may prescribe prophylactic (preventive) treatment to reduce the frequency, duration, and severity of attacks and prevent the occurrence of acute attacks. Preventive treatment is recommended for patients who experience two or more attacks per month, have at least four headache days per month, experience increasingly frequent attacks, or suffer from reduced quality of life due to prolonged pain.
Medications used for migraine attack treatment, as prescribed by neurologists, typically include:
• Simple and combination analgesics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Triptans
• Ergot derivatives
• Antiemetics (anti-nausea drugs)
• Neuroleptics (medications that inhibit nerve activation)
Preventive treatments may include:
• Beta-blockers
• Antidepressants
• Antiepileptics (seizure-preventing medications)
• Serotonin antagonists
• Calcium channel blockers
• Botulinum toxin type A
2. Non-Medication Treatments
Migraine Botox
One of the most advanced treatment options for migraine, which significantly impacts individual and public health, is migraine Botox. This treatment is particularly beneficial for chronic migraine cases resistant to medical therapy. In migraine Botox treatment, the injected toxin inhibits the release of a neurotransmitter chemical called acetylcholine at the neuromuscular junction, leading to temporary sensory loss in the affected muscle tissue. Additionally, botulinum toxin reduces pain sensitivity by inhibiting superficial muscle fibers, thereby decreasing pain signals transmitted from the surface to the central nervous system.
Migraine Botox significantly improves the quality of life for patients by reducing attack frequency, weakening pain perception, and eliminating additional symptoms such as nausea, vomiting, and light sensitivity. It is applied bilaterally at 31 points in the head and neck area. The first effects appear around the 10th day after the procedure. The duration of a single Botox application varies depending on the type of Botox used but generally lasts for approximately 12 weeks.
Migraine Botox typically does not cause serious complications. Common side effects following the injection include mild allergic reactions at the application site, temporary hypertension, muscle weakness and stiffness, sudden headache, and back muscle pain. These side effects are usually mild and resolve spontaneously after the injection.
Greater Occipital Nerve Block
When medications are ineffective and headaches begin to interfere with daily activities, an alternative treatment option for migraine is the occipital nerve block. This method involves blocking the sensory nerves responsible for pain perception in the head using local anesthetic agents, reducing the excitability of the nerve. As a result, the pain signals are blocked, and the headache is alleviated.
The procedure is simple and involves injecting a local anesthetic agent with a fine needle into the greater occipital nerve area at the back of the head while the patient is in a seated position. This local treatment causes numbness in the neck for approximately 4-5 hours, but side effects such as dizziness or neck pain are rare. The procedure is considered safe, as it generally does not cause systemic side effects. The effectiveness of this treatment can be observed within approximately five minutes.
Preventive medications used in migraine treatment reduce the frequency, severity, and duration of pain by 40-70%, and treatment typically requires at least six months of medication use. Occipital nerve block, on the other hand, provides an average pain reduction of 50-70% and can be effective after just 1-3 sessions without the need for continuous medication use. This treatment can be safely administered to pregnant and breastfeeding mothers.
Dr. Didem ER
Neurology Specialist
