Migraine Treatment

Migraine is a chronic neurological condition — not just a bad headache. It involves abnormal brain chemistry, particularly changes in Serotonin and CGRP (Calcitonin Gene-Related Peptide), which cause abnormal blood vessel dilation and nerve hypersensitivity in the brain.

🧬 Migraines are caused by multiple factors working together:

• Genetics — Migraines run in families. If a parent has migraines, the likelihood of developing them increases significantly
• Brain chemistry abnormalities — Particularly involving Serotonin and CGRP, which drive inflammation and blood vessel dilation in the brain
• Triggers — Each person has different triggers: stress, sleep disruption, certain foods, hormonal changes, and more

Migraine symptoms are distinctly different from ordinary headaches.

🔴 Core migraine symptoms — Severe, throbbing pain usually on one side of the head (sometimes both) / pulsating pain that follows the heartbeat / lasts 4-72 hours without treatment / nausea and vomiting / sensitivity to light, sound, and smell / pain worsens with movement or activity

✨ Migraine with aura — 20-60 minutes before the headache, some people experience warning signs: flashing lights, zigzag lines in vision, numbness in hands or face, difficulty speaking. The aura usually resolves as the headache begins.

😫 Postdrome ("migraine hangover") — After the pain subsides, many people feel drained, foggy, and fatigued for 1-2 days.

Everyone has different triggers. Identifying yours is key to prevention.

😰 Stress and emotions — The number one trigger. Both acute stress and the "letdown" after stress (e.g. weekend after a busy work week) can provoke attacks.

😴 Sleep disruption — Too little sleep, too much sleep, or sudden schedule changes.

🍫 Food and drink — Cheese, chocolate, red wine, MSG, fermented foods, caffeine (both excess intake and sudden withdrawal).

🌤️ Environmental factors — Bright or flickering lights, loud noise, strong odours, extreme heat, or sudden weather changes.

🩸 Hormones — Women often experience migraines around menstruation, linked to falling oestrogen levels. Certain contraceptive pills may affect migraine patterns.

💊 Certain medications — Vasodilators and some hormonal treatments.

Sumigran is a Triptan-class migraine medication containing Sumatriptan — considered the gold standard for treating acute migraine attacks.

It works by binding to Serotonin receptors (5-HT1B/1D), which causes the abnormally dilated brain blood vessels to constrict back to normal, reduces nerve inflammation, and blocks pain signals to the brain.

Advantages of Sumigran — Targets migraine-specific mechanisms, not a general painkiller / starts working within 30 minutes / reduces headache, nausea, and light/sound sensitivity simultaneously / doesn't irritate the stomach like NSAIDs

Tofago is an Ergot-class migraine medication containing Ergotamine Tartrate — a long-established treatment for migraine.

It works by constricting the abnormally dilated blood vessels in the brain, reducing nerve compression and relieving pain.

Advantages of Tofago — Targeted action on migraine pain / long track record of use / affordable price point

Important caution — Must not be overused (no more than twice per week), as frequent use can cause Medication Overuse Headache.

Both are migraine-specific medications, but they have key differences.

Sumigran (Sumatriptan — Triptan) — Newer, faster-acting, fewer side effects / effectively reduces both pain and associated symptoms (nausea, light/sound sensitivity) / first-line treatment according to international guidelines

Tofago (Ergotamine — Ergot) — Traditional treatment, more affordable / some people respond better to Ergotamine than Triptans / more restrictions and contraindications

Bottom line: Sumigran is the recommended first choice. If Sumigran is ineffective or unsuitable, Tofago is an alternative. Consult a pharmacist for the best recommendation.

The most important principle for both medications: take it as early as possible when symptoms begin.

💊 Sumigran (Sumatriptan) — Take one tablet (50-100 mg) as soon as pain starts / if pain improves then returns, a second dose can be taken after at least 2 hours / maximum 200 mg per day

💊 Tofago (Ergotamine) — Take as directed by your pharmacist at the first sign of pain / do not use more than twice per week / do not use on consecutive days

⚡ Critical: The sooner you take it, the better it works. Waiting until pain is severe significantly reduces effectiveness. Always carry your migraine medication with you.

🚫 Sumigran (Sumatriptan) contraindications — History of coronary heart disease or stroke / uncontrolled high blood pressure / must not be combined with Ergotamine (not on the same day) / must not be used with MAOI antidepressants

🚫 Tofago (Ergotamine) contraindications — Same cardiovascular contraindications as Sumatriptan + must not be used during pregnancy / must not be overused (risk of Medication Overuse Headache) / must not be combined with Triptans

Sumatriptan side effects — Temporary chest tightness (common but not heart-related) / dizziness, drowsiness / tingling or numbness in extremities

Many people aren't sure whether they have migraines or ordinary headaches.

Migraine — Severe, one-sided throbbing pain / lasts 4-72 hours / nausea, vomiting / sensitivity to light, sound, smell / unable to function normally / may have aura before onset

Tension headache — Dull, squeezing pain on both sides / mild to moderate intensity / no nausea, no light sensitivity / can still function / responds well to paracetamol or standard painkillers

If you experience severe one-sided throbbing headaches with nausea and light sensitivity that prevent normal activity, it's very likely migraine. Consult a pharmacist for appropriate treatment.

Beyond acute treatment, prevention is equally important.

📝 Keep a trigger diary — Record what you did, ate, how you slept, and what environment you were in before each attack. This helps identify your personal triggers.

😴 Maintain consistent sleep — Go to bed and wake up at the same time every day, including weekends. Avoid excessive catch-up sleep.

🏃 Exercise regularly — Moderate-intensity exercise, 30 minutes, 5 days per week, is shown to reduce migraine frequency.

🧘 Manage stress — Breathing exercises, meditation, and yoga help address the number one trigger.

💧 Stay hydrated — Dehydration is an often-overlooked trigger.

🍽️ Eat regularly — Don't skip meals. Low blood sugar can trigger migraines.

Preventive medication — If you experience more than 4 migraines per month, a doctor may prescribe daily preventive medication (such as Propranolol, Topiramate, or Amitriptyline) to reduce frequency.