MEDICINE: MIGRAINE

MIGRAINE!

• ​A migraine is a strong headache that often comes with nausea, vomiting, and sensitivity to light.

• It can last hours or days.

The ultimate cause of migraine is not very clear but different factors might trigger migraine.

Let's​ watch this video to understand the triggers and types of migraines:

​You have joined the Department of Neurology as an intern, at the Max Super Specialty Hospital.

​The Head of the Department wants to assess your understanding of Migraine, which is the 2nd most disabling medical condition in the world.

​You have been provided with the data of 2 migraine patients, Ruby and Rohan. Your task is to analyze their records and share your diagnosis.

So let's get started!​

Multiple Choice

Who amongst the following has chronic migraine?

• Ruby

• Rohan

​Rohan.

As explained earlier in the video, ​migraine is characterized as chronic if the person experiences headaches more than 15 times a month. Thus, Rohan has a chronic migraine condition as he's experiencing headaches 17 times a month, while Ruby experiences only 13 times a month.

​Rohan has chronic migraine and if not treated now will get even worse.

So let's analyze his case ASAP!​

Migraine patients are asked to maintain logs, that help doctors identify the triggers of migraine headaches for the patient.

Let's review Rohan's logs!​

Multiple Choice

Which of the following according to you might be the trigger for Rohan?

• Television

• Green tea

• Office work

• Paneer

​Paneer.

Migraine is often triggered by certain food items. Rohan consumed paneer on both days he had the migraine headache. Thus, paneer might have been the trigger for his migraine.

Your diagnosis for Rohan:

​Well done! Your HOD is very happy with your diagnosis. She has made you in charge of an important celebrity case.

​Your patient is Mira Rajput, wife of Bollywood actor Shahid Kapoor.

Let's have a look at her records!

Multiple Choice

Based on the patient's records what is your initial diagnosis?

• Mira has episodic migraine

• Mira has chronic migraine

• Mira doesn't have migraine

​Mira has episodic migraine.

Mira has experienced headaches only 8 times a month. Thus, she has episodic migraine and not chronic migraine as chronic migraine patients suffer headache more than 15 days a month.

Multiple Choice

Considering she has episodic migraine, what would be your advice to Mira?

• Take headache medicines everyday

• Avoid taking paneer in diet

• Sleep well and stay indoors

• Maintain a migraine logbook

Maintain a migraine logbook.

Before we recommend a treatment, it is important to identify what triggers the migraine. Maintaining a logbook will help understand the common triggers across different days of the headache.

​

Every person's trigger is different. So, we cannot recommend Mira to avoid Paneer or outdoors as that may have nothing to do with her migraine. ​

​

​As per your advice, Mira started a migraine logbook.

Let's evaluate her log!​

Multiple Choice

Upon evaluating her log, what according to you is triggering headaches for Mira?

• Salad and fruit juice

• Fruits and vegetables

• Exercising during the afternoon

• Walking in the garden

Exercising during the afternoon.

Whenever we want to identify the trigger for migraine, we should look out for any pattern in the patient's log. In Mira's log​, we can observe that whenever she does some form of exercise in the afternoon time, she gets a headache. Thus, the trigger for Mira's migraine pain is exercising during the afternoon time.

Mira also complained of blind spots, dizziness, and weakness. Thus, before making the final diagnosis, it's important to find out what these additional symptoms are.

This video might be of help:

Multiple Choice

After watching the video, which phase of migraine matches with the additional symptoms experienced by Mira?

• Prodrome

• Aura

• Headache

• Postdrome

Aura.

The additional symptoms experienced by Mira, i.e. dizziness, blind spots, and weakness are all part of the aura stage of migraine. They usually start gradually, over a 5 to 20-minute period, and last less than an hour. Patient may:

• See black dots, wavy lines, flashes of light, or things that aren’t there.

• Experience dizziness and muscle weakness.

​

Here is your final diagnosis for Mira:

Multiple Choice

What would be your line of treatment for Mira?

• Take medicine when there is headache to improve her quality of life

• Avoid exercising in the afternoon

• Take vitamins and a healthy diet to strengthen muscles

• All of these

All of these.

Your treatment plan for Mira should include:

• Medication to help her with the extreme headaches.

• ​Avoid exercising in the afternoon as it triggers migraine for Mira.

• ​Since she is experiencing Aura, she needs to take a healthy diet and vitamins to strengthen her muscles.

Hurray!​

Your​ treatment has been of great help. She has been doing much better now.

Your HOD is super impressed by your hard work and is looking forward to promoting you soon!​

In​ reality...

​Mira Rajput shared her migraine story on Instagram. She has been facing migraine headaches, that are triggered by mid-day training. Thus, she has been taking medication for the same alongside home remedies to manage her condition.

Poll

Would you like to be a Neurologist in the future?

• YES

• MAYBE

• NO

Poll

On a scale of 1-5 stars (1 being the lowest and 5 highest), how much would you rate this challenge on fun and learning?

Open Ended

What changes would you suggest for this challenge?