Migraine

Migraine is not a condition limited only to headache; it is a complex neurological disease that develops in the brain’s sensory processing, pain control, and autonomic system. The World Health Organization (WHO) shows migraine among the top diseases worldwide causing the most workforce loss and affecting a person’s life the most, causing disability.

Migraine affects an individual’s daily life in multiple ways. During an attack, the person becomes intolerant to light, sound, and even smells; social relationships, work productivity, and sleep patterns are disrupted. In patients who develop chronic migraine, this situation becomes a constant threat and can prepare the ground for additional problems such as anxiety and depression. Therefore, migraine is an important health burden both at the individual and societal level.

The effects of migraine are not limited to pain alone; patients have to reshape their lives to avoid attacks. Planned activities are postponed, work efficiency decreases, and this situation creates pressure on self-confidence over time. Therefore, correct recognition of migraine, effective treatment, and ensuring lifestyle management are of great importance.

What is Migraine?

Migraine is a neurological disease that occurs in attacks, mostly unilateral, throbbing, and accompanied by moderate-severe level headache. Attacks can last between 4 and 72 hours if left untreated and are often accompanied by symptoms such as nausea, vomiting, light and sound sensitivity, smell intolerance.

Migraine develops as a result of hypersensitivity and neuroinflammation in the brain’s pain control systems. Genetic predisposition plays an important role; the risk increases significantly in people who have migraine in first-degree relatives. The disease can be activated by external environmental triggers (stress, hormonal fluctuations, sleep irregularity, certain foods, etc.) and has its own unique attack pattern in each individual.

Migraine is characterized by increased sensitivity in the brain’s pain and sensory systems not only during attacks but also in the period between attacks. This situation brings with it the risk of the disease becoming chronic and more frequent.

What Causes Migraine?

Although the cause of migraine is not fully known, the brain’s pain processing system becoming hypersensitive constitutes the basic mechanism. More than one biological process plays a role in the development of this sensitivity:

Migraine occurs as a result of the interaction of genetic predisposition and environmental triggers. The rate of migraine occurrence in first-degree relatives of migraine patients is high; this situation results from the inheritance of sensitivity in genes that control ion channels and pain signals in particular.

One of the most critical neurobiological targets of migraine is the trigeminal nerve system. As a result of excessive activation of this nerve, neuropeptides such as CGRP (calcitonin gene-related peptide) and substance P are released and neurogenic inflammation develops in the brain membranes (meninges). This process leads to vasodilation, intensification of pain signals, and hypersensitivity to peripheral senses.

Sudden drop in serotonin levels plays an important role in the onset of attacks. This change in serotonin triggers headache and accompanying symptoms by affecting both vascular functions and pain pathways.

Migraine is three times more common in women than in men. The main reason for the increased frequency of migraine in women is estrogen fluctuations. Migraine attacks can significantly increase during periods of hormonal change such as menstrual period, postpartum, and menopause. Additionally, stress, sleep irregularity, skipping meals, bright light, sharp odors, and some foods are also common triggers that activate migraine.

What Happens in the Brain During a Migraine Attack?

A migraine attack occurs with a series of neurochemical and electrical events that develop sequentially:

Cortical Spreading Depression
The initial phase is mostly associated with migraine with aura. Sudden increase in electrical activity in the brain cortex, followed by wave-like spreading suppression occurs. This process can lead to temporary neurological symptoms related to vision, sensation, or speech, called aura.

Activation of the Trigeminal System
After CSD, inflammatory neuropeptides, primarily CGRP, are released from trigeminal nerve endings. These neuropeptides initiate inflammatory reaction and vasodilation in meningeal vessels and throbbing headache occurs.

Brainstem and Pain Modulation Disruption
Pain control centers (periaqueductal gray, brainstem nuclei) become overstimulated. Light, sound, and smell sensitivity increase. Nausea and vomiting may occur during the attack.

Sensory System Hypersensitivity
Sensitivity to pain signals increases → even small stimuli such as patients touching their scalp are perceived as pain (allodynia)

What Are the Symptoms of Migraine?

Migraine is not just a headache. It is a multi-stage neurological process that affects the brain’s pain and sensory systems. Although symptoms vary from patient to patient, attacks often progress in four stages. However, not every patient may experience all stages.

Prodrome Phase: Early Warning Signs of a Migraine Attack

The prodrome phase, the first harbinger of a migraine attack, is seen in approximately 60-80% of migraine patients. This period, which occurs hours or even 1-2 days before the headache starts, gives the person an opportunity to notice the approaching attack. The “apparently migraine is coming…” feeling often starts during this period.

During this period, patients mostly experience:

Mood changes (irritability, restlessness, depressive feeling)
Excessive energy or marked fatigue
Difficulty concentrating, blurred thinking
Food craving (especially tendency toward sweet-salty foods)
Frequent urination, constipation or diarrhea
Yawning attacks
One of the most prominent complaints that occurs in this phase is neck pain.
Patients often express “my neck is stiff,” “my nape hurts a lot” and mistakenly associate this situation with muscle stiffness or stress. However, this neck pain is an early signal of migraine. Trigeminovascular activation in the brainstem creates sensitivity in neck and shoulder muscles.

Why is Neck Pain Important in the Prodrome Period?

It comes before the headache (warning sign)
It can lead to wrong treatments (unnecessary muscle treatments, tests)
Provides an opportunity to stop the migraine attack with early intervention
(early intake of triptan/NSAID, avoiding triggers, rest, etc.)

Aura Phase

Seen in only 20-30% of migraine patients and refers to temporary neurological symptoms that occur immediately before/at the onset of headache. Aura is like a “warning signal” given by the migraine attack before it starts. This period generally lasts 5-60 minutes and starts gradually. During aura, the electrical activity of some areas in the brain is temporarily affected. Therefore, brief disruptions can occur in neurological functions such as vision, sensation, and speech.

Visual Aura: Visual aura occurs in most patients. Suddenly, in a corner of your eye, flashing lights, zigzag lines, wavy images may appear. There may be gaps in the visual field, appearing as if part of it is erased. Some patients describe an image that undulates as if looking at water.

Sensory Aura: In some patients, numbness-tingling occurs. This sensation usually starts from the hand and progresses to the arm and face. Sometimes tongue tingling also accompanies this.

Dysphasic Aura: Aura can sometimes lead to speech disorder; the person has difficulty finding words or the words they say may become unintelligible.

Motor aura: Motor aura is a rarer type of migraine aura and is usually associated with hemiplegic migraine. In this case, during aura, weakness on one side of the body, difficulty moving the arm or leg is seen. The person may sometimes have difficulty controlling facial muscles as well. These symptoms generally completely resolve within 5 minutes – several hours and do not leave permanent damage. Since motor aura symptoms can be confused with stroke, especially when they occur for the first time, emergency medical evaluation is required.

During aura, no permanent brain damage develops and symptoms completely pass. However, if experienced for the first time, it can be very frightening for the patient.

Headache Phase

Typical migraine headache:

Is unilateral (can be on both sides)
Felt as throbbing/pulsating
Lasts 4-72 hours
Worsens with movement and exertion

Frequently accompanying symptoms in this phase:

Hypersensitivity to light, sound, and smell
Nausea and sometimes vomiting
Dizziness with head movement
Touch sensitivity (allodynia)
Cognitive slowing

Patients generally want to rest in a dark and quiet environment.

Postdrome Phase – After Migraine Attack – Residual Symptoms

Even if the headache passes, the brain does not completely return to normal. The postdrome period can last 24-48 hours. Patients often describe this period as follows:

“It’s like there’s a balloon inside my head, I can’t think.”

During this period:

Extreme fatigue, exhaustion
Difficulty focusing
Still mild light and sound sensitivity
Neck and shoulder pains
Euphoria or depressive feeling may occur.

Migraine Types

1.1. Migraine without Aura

Most common (70-80%) migraine type.
Headache is generally:
- Unilateral (but can also be bilateral)
- Throbbing / pulsating with pulse in character
- Lasts 4-72 hours
- Intensifies with physical activity
Nausea-vomiting, light and sound sensitivity are very common.
Starts suddenly and may not have warning symptoms.

1.2. Migraine with Aura

Seen in approximately 20-30% of migraine patients.
Aura: Neurological symptoms starting before headache, lasting 5-60 minutes:
- Visual: Light flashes, zigzag lines, gaps in visual field
- Sensory: Facial/arm numbness, tingling
- Language-speech: Word-finding difficulty, slowing
Aura generally spreads gradually → distinguished from stroke by not starting suddenly.
Typical migraine headache occurs after aura, but in some patients there may be no headache at all.

1.3. Chronic Migraine

Migraine complaints for more than 3 months:
- ≥15 days of headache per month
- ≥8 of the days with migraine features
Treatment is more difficult and creates high disability in daily life.
Medication Overuse Headache due to excessive painkiller use may accompany.

A1.1- A1.2. Menstrual Migraine

Related to estrogen drop.
Attack timing:
- Concentrates between -2 and +3 days of menstrual onset.
Typical feature:
- The attack being longer, more severe, and more resistant to treatment
There are two subtitles:
1. Pure menstrual migraine: Only seen during menstrual period. Can be with or without aura.
2. Menstrually-related migraine: Migraine attacks can also occur at other times outside menstruation.

A1.6.6. Vestibular Migraine

Dizziness, imbalance, and motion sensitivity are predominant.
Headache may not occur for a long time → Diagnosis is often delayed.
Can be triggered by visual stimuli (shopping mall, screen, fast movement).
Most commonly seen in women aged 30-50.

1.2.23. Hemiplegic Migraine

Hemiplegic migraine is one of the rarest subtypes of migraine and is quite rarely encountered in the population.
During migraine attacks:
- Temporary weakness on one half of the body (feeling of paralysis) is seen.
- Speech disorders may accompany.
Requires emergency evaluation as it can be confused with stroke.
Shows familial autosomal dominant inheritance (CACNA1A, ATP1A2, SCN1A mutations).
Therefore, the presence of individuals experiencing similar attacks in the family provides an important clue in diagnosis.

1.2.4. Retinal (Ocular) Migraine

Retinal migraine is a very rare type of migraine and is characterized by temporary visual disturbances occurring in only one eye. This condition generally involves
Temporary vision loss developing within minutes in one eye
Light flashes, black spots, shadows, or blurred vision
Progresses with typical migraine headache that develops afterward

These symptoms are always limited to one eye; this feature is important in distinguishing from other migraine aura types.

Retinal migraine is a diagnosis made after other serious eye and vascular diseases are excluded. Therefore:

Differential diagnoses that may require emergency evaluation must definitely be ruled out:

Retinal detachment
Retinal or optic nerve vascular occlusions
Glaucoma attack
Ischemic eye diseases

Therefore, follow-up by both ophthalmologist and neurologist together is of great importance.

1.2.2. Brainstem Aura Migraine (Formerly Basilar-Type Migraine)

Brainstem aura migraine is a very rare migraine subtype and aura symptoms originate from the brainstem. Therefore, before or during headache, the following neurological symptoms may occur:

Imbalance, severe vertigo
Speech disorder (dysarthria)
Double vision (diplopia)
Tinnitus, hearing disorder
Clouded consciousness, fainting sensation

Generally seen in young women.

Since these symptoms are very similar to cerebral circulation disorders, emergency medical evaluation is required during the first attack.
Neurological examination and MRI imaging if necessary are essential in differential diagnosis.

Why Can Migraine Appear So Different?

Migraine is a sensory processing disorder that affects very different areas of the brain. Therefore, different clinical pictures can emerge depending on the affected brain region.

Visual area → visual aura
Balance system → vestibular migraine
Motor areas → hemiplegic migraine
Retina → ocular migraine

Although the apparent picture is different, the basic pathophysiological mechanism is the same: trigeminovascular system activation + neuroinflammation + cortical spreading depression.

How is Migraine Diagnosed? What Tests Are Done?

Migraine diagnosis is essentially based on clinical evaluation. That is, the patient’s history, attack characteristics, and neurological examination findings are the most important determinants. There is no specific blood test or imaging method that confirms migraine.

When making a diagnosis, International Classification of Headache Disorders (ICHD-3) criteria are used. Basic criteria for migraine without aura:

ICHD-3 Migraine without Aura Diagnostic Criteria

All of the following features must be present:

Having experienced at least 5 attacks
B. Headache lasting 4-72 hours if untreated
C. Pain must have at least two of the following:

Unilateral
Throbbing/pulsating character
Moderate-severe
Worsening with physical activity

At least one of the following must accompany:

Nausea/vomiting
Light and/or sound sensitivity

Cannot be explained by other diseases

In migraine diagnosis, examination and patient history are the gold standard.

When Are Imaging and Tests Required?

MRI is not taken for every migraine patient. However, brain MRI imaging is definitely recommended in the following situations:

First-time occurring very severe headache
Sudden onset headache (thunderclap headache)
Accompaniment of persistent neurological findings
Headache starting after age 50
Presence of cancer, connective tissue disease, or immunodeficiency
Character-changing or worsening headaches

Importance of Family History in Migraine Diagnosis

Migraine is a disease that shows strong genetic predisposition. Approximately 70% of people with migraine also have a history of migraine in family members. Especially migraine on the maternal side significantly increases risk.

Therefore, in your initial evaluation:

Presence of migraine in parents and siblings
Migraine onset age
Presence of aura
Other diseases associated with migraine
are inquired about in detail.

Family history supports diagnosis and provides insight into disease progression.

Benefits of Keeping a Headache Diary

A headache diary is one of the most effective tools for migraine diagnosis and treatment follow-up.
The patient monitors their own symptoms, and the physician plans more accurate and personalized treatment.

Main information to be recorded in the diary:

Date and duration of headache
Severity and location of pain
Accompanying symptoms (nausea, light-sound sensitivity, etc.)
Medications taken and their effects
Situations that may be triggers (sleep, stress, foods, etc.)

With regular recording:
– Migraine type is determined more clearly
– Unnecessary tests are avoided
– Treatment response is objectively evaluated
– Triggers are recognized more easily

Migraine Treatment

Lifestyle Modifications in Migraine Management

Since migraine is a chronic disease, treatment is not limited to medications alone. Lifestyle modifications both reduce attack frequency and significantly decrease medication need. Therefore, international migraine guidelines definitely recommend lifestyle modifications before starting medication. Scientific studies have shown that when correctly applied, they provide up to 30% reduction in attacks.

Main Modifications to Be Applied

Regular sleep rhythm

Going to bed and waking up at the same time
Avoiding excessive sleep or sleeplessness
Paying attention to sleep hygiene

Not skipping meals

Drop in blood sugar triggers migraine
Regular and balanced eating habits

Limiting trigger foods

Excessive caffeine, alcohol, processed foods, some cheeses
A migraine diary should be kept for personal triggers

Regular physical activity

At least 3 times a week moderate-tempo exercise
Walking, swimming, cycling are ideal

Stress management

Breathing exercises, mindfulness, yoga
Cognitive behavioral therapy (evidence-based)

Reducing screen and light exposure

Especially rest intervals after prolonged screen exposure

The goal is to raise the migraine threshold in the brain and ensure the system works more balanced. Lifestyle changes, when successfully applied, reduce the necessity of medication therapy in many patients, and can even be sufficient alone in some patients.

How is Medication Treatment of Migraine Done?

Migraine treatment is based on two main treatment strategies:
– Acute (attack) treatment – Aims to stop the migraine that starts at that moment
– Preventive (prophylactic) treatment – Aims to reduce the frequency and severity of attacks

Acute (Attack) Treatment

Goal: Stop the starting attack as quickly as possible, prevent nausea-vomiting, make daily life sustainable.

The earlier medication is taken during a migraine attack, the higher its effectiveness. Ideally, it should be taken when pain is mild or during aura. Here, the restrictive step for migraine attack treatment is how many, what type, and how many days of medication the patient has to use in a month. Using medication more frequently than the recommended frequency within a monthly period not only harms the person’s general health but also causes the chronification of migraine and the addition of a new headache called chronic, daily “medication overuse headache” that makes treatment difficult. If you have such a suspicion, I recommend you read the “Medication Overuse Headache” section on the site.

Main Drug Groups Used

NSAIDs (Non-Steroidal Anti-inflammatory Drugs)

Ibuprofen, naproxen, diclofenac, acetylsalicylic acid
First step in mild-moderate migraine attacks
Can also be used as suppository in severe nausea-vomiting situations where oral medication cannot be taken

Triptans (Migraine-specific drugs)

Sumatriptan, rizatriptan, zolmitriptan, etc.
Most effective treatment option in moderate-severe migraine attacks
Provides significant relief within 2 hours
Patients with coronary artery disease and hypertension should stay away from this group of drugs.

Gepants (New generation anti-CGRP drugs)

Rimegepant, Ubrogepant, Zavegepant (nasal spray)
Especially preferred in patients who cannot use triptans or experience side effects
Do not work by constricting vessels. A safe choice in patients who cannot use triptans.
Do not cause medication overuse headache

Ditans

Lasmiditan
Acts through the central nervous system. Its most important side effect is “sedation,” i.e., drowsiness. It is recommended to sleep after taking the medication.
Since it does not act by constricting vessels, it is an alternative option in patients with cardiovascular disease and those at risk.

Antiemetics (For nausea)

Metoclopramide, domperidone, ondansetron
Both reduces nausea and increases painkiller effectiveness

Other Alternative Treatments for Migraine Attack (Applied in Hospital)

Nerve Blocks

Greater occipital nerve block (GON block)
Provides significant relief quickly in severe and prolonged attacks
Reduces emergency room visits

Intravenous treatments

Serum, antiemetic and NSAID combinations
In resistant attacks that apply to the hospital

Important Warning: Medication Overuse Headache (MOH)

More than 10-15 days per month of painkiller or triptan use
Can cause chronification of headache

Therefore, planning attack and preventive treatment together is very important.

2) Preventive (Prophylactic) Treatment

Preventive treatment of migraine aims to reduce the number and severity of attacks and the limitation the patient experiences in daily life. Not every migraine patient needs prophylaxis; however, it should definitely be considered in patients experiencing 4 or more migraine headache days per month, whose attacks are very severe or prolonged, who do not benefit sufficiently from acute medications, or who experience serious neurological symptoms with aura. These treatments prevent the chronification of migraine by reducing hypersensitivity in the brain and trigeminal system. Regular and long-term use is essential; seeing the effect generally takes 4-8 weeks.

Drugs used in preventive treatment include beta blockers (propranolol, metoprolol), antiepileptics (topiramate, valproate), and antidepressants (amitriptyline, venlafaxine). These drugs reduce brain excitability by acting on migraine mechanisms at different points. In recent years, CGRP monoclonal antibody therapies developed specifically for migraine—erenumab, fremanezumab, galcanezumab—provide great success especially in frequent and resistant migraines; they are applied monthly and have a very good side effect profile.

Another important option of preventive treatment is Onabotulinum toxin-A (Botox) application. It is FDA-approved especially for chronic migraine patients (≥15 headache days per month) and suppresses hyperactivity in widespread nerve endings when applied every 12 weeks. In addition, various peripheral nerve blocks, especially greater occipital nerve block, are supportive and safe options in reducing attack frequency. Additionally, gepants, i.e., new generation oral CGRP receptor antagonists, are modern and migraine-specific treatments that have taken their place in both acute and prophylactic treatment.

Each migraine patient is different; therefore, treatment should be personalized considering the person’s attack characteristics, accompanying diseases, and lifestyle. Which treatment will be most appropriate should be decided together in patient-physician cooperation.

Frequently Asked Questions About Migraine

1. How Are Migraine and Sinusitis Distinguished?

Migraine and sinusitis are often confused because both can have pain in the forehead, eye area, and facial region. However, there are important differences that enable distinction:

Sinusitis (acute sinusitis):

Starts after an upper respiratory tract infection
Nasal congestion, thick inflammatory nasal discharge
Fever generally accompanies the picture
Pain increases when leaning forward
Completely passes within days-weeks with appropriate treatment

Chronic sinusitis generally progresses with constant nasal problems (congestion, loss of smell); does not cause headache.

Migraine:

Comes in recurring attacks
Nausea, light-sound sensitivity is common
Headache is throbbing, increases with movement
Aura (visual or neurological symptoms) may accompany
Diagnosed according to ICHD-3 (International Classification of Headache Disorders) criteria

Nasal discharge and eye tearing may occur during a migraine attack; however, this is not sinusitis, but autonomic symptoms of migraine.

2. Does Migraine Completely Go Away? Is It Possible to Get Rid of Migraine?

Migraine is a genetically based, chronic neurological disease. Therefore, although it may not always be possible for it to completely disappear, attacks significantly decrease in 70-80% of patients with modern treatments. In some patients, an attack-free period may be seen for years.

With correct trigger management + appropriate medication therapy + lifestyle modifications, migraine can be controlled and quality of life can completely normalize.

3. How Long Does a Migraine Attack Last? When Should I Go to the Doctor?

If left untreated, attacks can last 4-72 hours.
Evaluation is definitely required in the following situations:

– If you have 4+ migraine days per month
– If pain is intensifying day by day
– If speech disorder, weakness, fever, altered consciousness accompanies the pain
– In new type headache starting after age 50

Early intervention both alleviates the attack and prevents chronification.

During menopause or premenopause period, the frequency of headaches may change; even if the frequency of headaches decreases, vestibular findings such as dizziness, lightheadedness, and balance disorder can affect the patient’s daily life; in such a situation, it is recommended that you consult with a neurology doctor.

4. Which Foods Trigger Migraine? Are Coffee and Chocolate Harmful?

When you research foods that trigger migraine on Google, a long list appears. Triggers show individual differences in migraine patients. Each patient has different triggers. Keeping a migraine diary is the best method for determining triggers according to the person.

Those that most frequently trigger migraine attacks:
– Fermented / yeast-containing foods
– Processed meat products containing nitrates
– Red wine, excessive alcohol
– Monosodium glutamate (MSG)
– Skipping meals and staying hungry for long periods

Coffee: Excessive caffeine consumption or sudden cessation of coffee can trigger a migraine attack. Drinking 1-2 cups of coffee per day does not trigger a migraine attack. In fact, caffeine can suppress the attack when consumed in the early stage of migraine headache. There is “caffeine” in many combination analgesics used for attack treatment.
Chocolate: In most patients, chocolate is not what triggers the migraine attack. Food craving occurs during the prodrome (prodromal) period of the migraine attack; patients think this is the cause of the attack because headache starts after eating chocolate during this period. However, chocolate consumption after food craving is a prodromal symptom of the starting attack.

5. What is “Migraine Injection”? Who Is It Suitable For?

The “migraine injection” that has created a major revolution in migraine treatment in recent years is a migraine-specific treatment that targets the CGRP molecule that plays a role in the vascular and nervous system.
It is applied as a monthly injection and provides great convenience to the patient.

Provides effective results in both migraine with and without aura,
Both episodic and chronic migraine patients.

Advantages of migraine injection:
Significantly reduces the number, duration, and severity of attacks
Its effect starts from the 1st month
Side effects are very low (usually mild injection site sensitivity)
There are no classic drug side effects such as drowsiness, weight gain, cognitive slowing
Easy treatment compliance → only once a month
Does not restrict daily life, compatible with social life

Who is it suitable for?
– If you have 4 or more migraine days per month
– If you do not see sufficient benefit from the medications you use
– If you cannot continue treatment due to drug side effects
– If you have chronic migraine (≥15 headache days per month, at least 8 of them migraine)

Migraine injection is one of the first treatments that directly affect the mechanism of migraine and dramatically increases quality of life in suitable patients.

Since it is not yet covered by reimbursement in Turkey, it may be costly, but it is a powerful treatment option for patients.

6. What Does Botox Treatment Do for Migraine? Who Is It Suitable For?

Botulinum toxin (Botox) is an FDA-approved method for chronic migraine treatment and has been used successfully for many years.

How does Botox work for migraine?

Botox regulates many pathological processes that play a role in migraine mechanisms:

Reduces the release of CGRP and other pain transmission chemicals
Decreases muscle tension and sensory sensitivity
Suppresses neurogenic inflammation by reducing pain sensitivity in the brainstem
Controls hyperactivity at nerve endings

Result:
– Decrease in number of attacks
– Decrease in attack severity
– Decrease in painkiller use
– Significant increase in quality of life.

Who Is It Suitable For?

Botox treatment is suitable for chronic migraine patients:

– 15 or more headache days per month
– At least 8 days of them with migraine character
– Continuing for at least 3 months

Also preferred in the following situations:
– Those who do not see sufficient benefit from drug therapies
– Those experiencing drug side effects
– Those who have developed a vicious cycle due to excessive painkiller use
– Those with severe neck shoulder muscle tension

How Is Treatment Applied?

Injection is made to 31 different points with thin needles
A total dose of 155-195 units is applied (PREEMPT and follow-the-pain protocol)
Its effect starts from week 2
Application is repeated every 3 months

Advantages of Botox

– Very low side effect rate
– Does not cause sleep problems, weight change, cognitive slowing
– Treatment response is fast and predictable

Research shows that up to 70% of chronic migraine patients experience significant improvement.

7. What is Rimegepant? Who Is It Suitable For?

Rimegepant is a new generation treatment that targets the substance called CGRP that plays a role in migraine pain. It is in orally dissolving tablet form and is one of the few migraine drugs used both during attacks and for preventive purposes.

Who is rimegepant suitable for as acute treatment?
It is a suitable option for people seeking a fast-acting solution when a migraine attack starts, who do not respond to triptans, or who cannot use triptans due to reasons such as cardiovascular disease. It helps reduce severe pain, nausea, and light-sound sensitivity.

Who is rimegepant suitable for as preventive treatment?
In patients experiencing 4 or more migraine attacks per month and wanting to reduce attack frequency, it provides preventive effect when used regularly every other day.

8. Can Nerve Blocks Be Used During Pregnancy?

Yes. During pregnancy when medication use is limited, in suitable patients, nerve blocks can be a safe option in migraine treatment. In this method, local anesthetic is injected near peripheral nerves that carry pain signals—most commonly to the Greater Occipital Nerve at the back of the head. Thus, pain transmission is suppressed and the migraine attack lightens.

Since the drugs used in nerve blocks pass very little into systemic circulation, the risk of reaching the fetus is low. Therefore, it can be an effective treatment option especially in frequent and severe attacks or when response to medications cannot be obtained. Nerve blocks can be used in pregnancy both in attack treatment or as preventive treatment to prevent attack frequency when necessary.

This application should definitely be evaluated by a neurology specialist experienced in headache disorders and performed when deemed necessary.

9. Does Migraine Occur in Children? Are Symptoms the Same?

Yes. Migraine can also be seen in children and adolescents. In Turkey, 1 in 10 children has migraine.

Symptoms may be slightly different in children:
– Headache may be bilateral
– Aggression, restlessness, abdominal pain may accompany
– Nausea-vomiting is more prominent
– Attack duration may be shorter

With early diagnosis and appropriate planning, it can be managed without affecting school and social life.