Migraine

What is this condition?

Migraine is a neurological disorder with repeated attacks of headache and related symptoms. Pain is often throbbing and one-sided but can occur on both sides. Nausea, sensitivity to light, sound or smell, and worsening with activity are common. Some people have aura—temporary visual, sensory or speech symptoms—before or during the attack. Migraine is real, disabling and usually treatable without surgery.

What symptoms can it cause?

• Attacks lasting hours to days, often with nausea or sensory sensitivity
• Aura usually develops gradually and resolves, but a first or unusual aura needs assessment
• Neck discomfort, fatigue, poor concentration and mood change may accompany attacks
• Frequent analgesic use can produce medication-overuse headache

How is it assessed and diagnosed?

Diagnosis is based on a careful history and normal or expected neurological examination. A headache diary records frequency, duration, menstrual association, triggers and medicines. MRI or CT is not routine for every stable migraine; it is selected when red flags, a major pattern change or abnormal examination suggests another cause.

Treatment without surgery

Treatment has two parts. Acute treatment is taken early in an attack and may include an appropriate simple painkiller, anti-nausea medicine or a migraine-specific drug. Preventive treatment is considered when attacks are frequent, prolonged or disabling. Regular sleep, meals, hydration, exercise, stress management and limiting caffeine help many patients, but strict unproven food bans are rarely useful.

When is surgery or a procedure considered?

Migraine is not ordinarily treated by neurosurgery. A neurosurgical opinion is relevant only when symptoms or imaging reveal a structural condition such as haemorrhage, hydrocephalus or a mass. Procedures marketed as a universal migraine cure should be approached critically and discussed with a headache specialist.

Treatment and procedure options

• Lifestyle regularity and trigger management
• Early acute medicine selected for the patient
• Preventive tablets, injections or other therapies for frequent disability
• Treatment of medication overuse
• Assessment of anxiety, sleep, menstrual and other associated factors

Risks from the disease and from treatment

Migraine itself does not usually damage the brain, but uncontrolled attacks can severely affect education, work, mood and family life. Missing a secondary dangerous headache is the main clinical concern, which is why a new pattern or red flag deserves assessment. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

A realistic goal is fewer and milder attacks with less disruption—not necessarily zero headache immediately. Preventive medicine may need a proper trial and gradual adjustment. A written rescue plan helps patients treat early and avoid repeated emergency visits. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• NINDS — Migraine: https://www.ninds.nih.gov/health-information/disorders/migraine