Reviewing Migraine as Vascular Disease


Migraine is a common disease that is considered to be a benign disorder. It is a complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms. Migraine is most common in women and has a strong genetic component.

The incidence of migraine with aura peaks in boys at around age 5 years and in girls at around age 12-13 years. Before puberty, the prevalence and incidence of migraine are higher in boys than in girls. After age 12 years, the prevalence increases in males and females, reaching a peak at age 30-40 years. The female-to-male ratio increases from 2.5:1 at puberty to 3.5:1 at age 40 years. Attacks usually decrease in severity and frequency after age 40 years, except for women in per menopause.

Worldwide, migraines affect nearly 15% or approximately one billion people. It is more common in women at 19% than men at 11%.In the United States, about 6% of men and 18% of women get a migraine in a given year, with a lifetime risk of about 18% and 43% respectively.


The causes of migraines are unknown. However, they are believed to be related to a mix of environmental and genetic factors. They run in families in about two-thirds of cases and rarely occur due to a single gene defect. While migraines were once believed to be more common in those of high intelligence, this does not appear to be true. A number of psychological conditions are associated including: depression, anxiety, and bipolar disorder as are many biological events or triggers.


The path physiology is still unknown. Patients might have endothelial dysfunction, which is associated with an increased risk of stroke and cardiac events. Other potential mechanisms include coagulation abnormalities and platelet hyper aggregability.

The cranial blood vessel is considered an integral player in the path physiology of migraine. Migraines can begin when blood vessels in the brain contract and expand inappropriately. This may start in the occipital lobe, in the back of the brain as arteries spasm. The reduced flow of blood from the occipital lobe triggers the aura that some individuals who have migraines experience because the visual cortex is in the occipital area. For migraine with aura, only two attacks are required to justify the diagnosis. Migraine is accompanied by significant derangements in vascular function that may represent important targets for investigation and treatment. The typical migraine headache is unilateral and pulsating, lasting from 4 to 72 hours; this theory was based on the following 3 observations:

  • Extra cranial vessels become distended and pulsatile during a migraine attack
  • Stimulation of intracranial vessels in an awake person induces headache
  • Vasoconstrictors improve the headache, whereas vasodilators provoke an attack

Symptoms of migraine

Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

  • Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines
  • Pulsing and throbbing head pain
  • Increasing pain during physical activity
  • Inability to perform regular activities due to pain
  • Nausea
  • Vomiting
  • Increased sensitivity to light and sound

Many people experience migraines with auras just before or during the head pain, but most do not. Auras are perceptual disturbances such as confusing thoughts or experiences and the perception of strange lights, sparkling or flashing lights, lines in the visual field, blind spots, pins and needles in an arm or leg, or unpleasant smells.

Migraine sufferers also may have premonitions called prodrome that can occur several hours or a day or so before the headache. These premonitions may consist of feelings of elation or intense energy, cravings for sweets, thirst, drowsiness, irritability, or depression.


Physicians will look at family medical history and check the patient for the symptoms described above in order to diagnose migraine. The International Headache Society recommends the "5, 4, 3, 2, 1 criteria" to diagnose migraines without aura. This stands for:

  • 5 or more attacks
  • 4 hours to 3 days in duration
  • At least 2 of unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
  • At least 1 additional symptom such as nausea, vomiting, sensitivity to light, sensitivity to sound.

For migraine with aura, only two attacks are required to justify the diagnosis. The mnemonic pounding (Pulsating, duration of 4–72 hours, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.

The presence of disability, nausea or sensitivity, can diagnose migraine with:

  • sensitivity of 81%
  • specificity of 75%


1. Electroencephalography (EEG),
2. Computed tomography (CT),
3. Magnetic resonance imaging (MRI),
4. Spinal tap

Modern view of treatment-

Migraine prevention begins with avoiding things that trigger the condition. The main goals of prophylactic therapies are to reduce the frequency, painfulness, and duration of migraine headaches and to increase the effectiveness of abortive therapies. There are several categories of preventive migraine medicine, ranging from diet changes and exercise to prescription drugs. Some of these include:

  • Prescription beta blocker, anticonvulsants, and antidepressant
  • Botulinum toxin A
  • Herbs and vitamins such as butterbur, cannabis, coenzyme Q10, feverfew, magnesium citrate, riboflavin, B12, melatonin
  • Surgery that severs corrugators supercilious muscle and zygomaticotemporal nerve in the brain
  • Spinal cord stimulator implantation
  • Hyperbaric oxygen therapy
  • Vision correction
  • Exercise, sleep, sexual activity
  • Visualization and self-hypnosis
  • Chiropractic care or acupuncture.
  • Special diets such as gluten free

It is possible for people to get medication overuse headache (MOH), or rebound headache, when taking too many medications in an attempt to prevent migraine.

Dosh Dushti in Ardahvbhedak (Migraine)

1. Sushruta : Tridosh
2. Charak : Vata or Vatakapha
3. Vagbha : only vata

Sushruta said tridosh Dushti seems to be more related to pathology of migraine with RaktaDushti.

Strotas Dushti:

1. PranavahaStrotas.
2. RaktavahaStrotas.
3. RasavahaStrotas

According to modern science there is Disequilibrium in vasoconsrriction& vasodilation of vein in migraine.

These complications have similarities with AURA symptoms which found in migraine patient.


More by :  Dr. Gangaprasad Waghmare

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