What Migraine Is (Neurological, Not 'Just a Headache')
One of the most damaging myths in Indian households is that migraine is simply a strong headache that a determined person should be able to 'tolerate'. It is not. Migraine is a genuine neurological disorder in which the brain becomes transiently hyper-excitable and over-reactive to normal stimuli — light, sound, smell, movement. During an attack, a wave of altered electrical activity spreads across the surface of the brain, the trigeminal nerve system is activated, blood vessels around the brain dilate and inflame, and pain-signalling chemicals are released. This is measurable biology, not weakness of character.
That is why a migraine feels so different from a tension headache. It is typically one-sided, throbbing, moderate-to-severe, and made worse by ordinary activity like climbing stairs. It usually comes with nausea and a strong dislike of light (photophobia) and sound (phonophobia). People instinctively retreat to a dark, quiet room and lie still — this is the brain trying to reduce the stimulation it can no longer filter.
Understanding migraine as a neurological condition changes everything about how it is managed. It means the goal is not simply to swallow a painkiller and carry on, but to reduce the frequency and severity of attacks, treat each attack early and correctly, and identify the triggers that push a sensitive brain over the edge. Dr. Iqbal Singh treats migraine as a chronic condition that deserves a proper plan — the same way we treat diabetes or blood pressure.
The Four Phases of a Migraine Attack
Most migraines unfold through four phases, though not everyone experiences all of them. Learning your own pattern is powerful, because the earlier you treat, the better the result.
1. Prodrome (hours to a day before)
Subtle early warning signs that many people overlook: yawning, food cravings, mood changes, neck stiffness, unusual tiredness or a burst of energy, difficulty concentrating. Recognising your personal prodrome lets you rest, hydrate and avoid triggers before the pain begins.
2. Aura (in about a third of patients)
Temporary neurological symptoms lasting 5–60 minutes, most commonly visual — flashing lights, zig-zag lines, or a blind spot that expands. Some people get tingling spreading up an arm, or brief speech difficulty. Aura is reversible and, by itself, harmless — but its symptoms can mimic a stroke, so a first-ever aura should always be assessed.
3. Headache
The throbbing, usually one-sided pain, with nausea, light and sound sensitivity. It can last from 4 hours to 3 days if untreated. This is the phase most people recognise as 'the migraine'.
4. Postdrome (the 'migraine hangover')
After the pain settles, many feel washed out, foggy, tired or unusually low for a day. This is a real part of the attack, not laziness — the brain is recovering.
Common Triggers (Sleep, Food, Hormones, Stress, Light)
Triggers do not cause migraine — the underlying tendency is inherited — but they lower the threshold at which a sensitive brain fires. Identifying and managing yours is one of the most effective, drug-free steps you can take.
- Sleep — both too little and too much. Irregular sleep, shift work and weekend lie-ins are classic triggers. A steady sleep schedule matters more than most patients expect.
- Food and skipping meals — going hungry is a very common Indian trigger, as are aged cheeses, processed and preserved foods, MSG (ajinomoto), excess caffeine, and for some people, chocolate. Dehydration is a major and easily fixed trigger, especially in Punjab summers.
- Hormones — many women get migraines around their period; the fall in oestrogen is the trigger. This 'menstrual migraine' often responds to specific timed treatment.
- Stress — and the let-down after it — attacks often strike not at the peak of stress but on the first day of relaxation (the 'weekend migraine').
- Sensory triggers — bright or flickering light, glare, strong smells (perfume, paint, smoke), and loud noise.
We ask patients to keep a simple headache diary for a few weeks — noting attacks, sleep, meals, periods and possible triggers. This diary is often more revealing than any scan, and it makes the treatment plan genuinely personal.
Acute Treatment (Triptans, Anti-Emetics, NSAIDs)
Acute treatment aims to stop an individual attack quickly. The golden rule is to treat early and at an adequate dose — a small dose taken hours into a full-blown attack rarely works well.
For milder attacks, a NSAID (such as naproxen or ibuprofen) or paracetamol taken at the first sign can be enough, ideally combined with an anti-emetic (such as domperidone or metoclopramide). The anti-emetic does two jobs: it settles the nausea and it improves absorption of the painkiller, because the gut slows down during a migraine.
For moderate-to-severe attacks, triptans (sumatriptan, rizatriptan, naratriptan) are the specific migraine drugs. They act on the migraine mechanism itself rather than just dulling pain, and are highly effective when taken early. They are safe for most people but are avoided in those with significant heart disease, uncontrolled blood pressure or prior stroke — which is why they should be started under a doctor's guidance.
A crucial warning: taking acute painkillers or triptans too often — more than about 10–15 days a month — can cause medication-overuse (rebound) headache, where the treatment itself perpetuates a daily headache. This is one of the commonest reasons a migraine spirals out of control, and untangling it is a routine part of what we do at Gini.
Preventive Treatment (Propranolol, Topiramate, Amitriptyline & CGRP Inhibitors)
If you are having four or more disabling attacks a month, or if attacks are long, severe or not responding to acute treatment, it is time to consider preventive (prophylactic) medication. The aim is not to abolish every attack but to roughly halve their frequency and severity, so acute treatment works better and life returns to normal.
The established, affordable preventives — well suited to Indian patients — include:
- Propranolol — a beta-blocker, especially useful if you also have anxiety or mild hypertension.
- Topiramate — effective and helpful for those wanting to avoid weight gain, though it needs a slow, careful build-up.
- Amitriptyline — a low-dose option that also helps sleep and coexisting tension-type headache.
- Flunarizine and certain anti-epileptics are also used in selected patients.
These are taken daily for several months, not just during attacks, and are given time (6–8 weeks) to show benefit. Most patients can eventually taper off once control is stable.
Newer CGRP inhibitors
The biggest advance in migraine treatment in decades is the arrival of CGRP-targeted therapies. CGRP (calcitonin gene-related peptide) is a key molecule that drives migraine pain. The new CGRP monoclonal antibodies (given as a monthly or quarterly injection) and oral gepants block this pathway directly. They are transforming care for people who have failed older preventives, with few side effects. They are more expensive, but increasingly available in India, and Dr. Iqbal Singh can advise whether they are appropriate for you.
Migraine With Aura and Stroke Risk
Patients who have migraine with aura understandably worry when they read that it carries a slightly raised risk of stroke. The honest picture is reassuring but worth acting on. The relative increase in risk is real but the absolute risk for a young, otherwise healthy person remains low. What matters is that this risk multiplies when combined with other factors.
The two most important controllable factors are smoking and, in women, the combined oral contraceptive pill (containing oestrogen). A woman who has migraine with aura, smokes, and takes the oestrogen-containing pill carries a meaningfully higher stroke risk, and we usually advise against that combination — safer contraceptive options exist. Stopping smoking is the single most valuable step.
For everyone with aura, the sensible approach is to control the standard vascular risks — blood pressure, blood sugar, cholesterol, weight and activity. This is another area where Gini's model helps: neurology working alongside our physicians and endocrinology team means your migraine and your vascular health are managed together, not in isolation. Aura itself is not dangerous; the point is simply to keep the surrounding risks low.
When to See a Neurologist vs a GP — and Red-Flag Headache Symptoms
Many headaches are well handled by a good general practitioner. You should escalate to a neurologist if: your headaches are frequent or disabling; over-the-counter medicines are not working or you are relying on them most days; the pattern has clearly changed; you have aura for the first time; or you simply want an accurate diagnosis and a proper preventive plan rather than years of ad-hoc painkillers.
Some headache features are genuine red flags that need urgent assessment — and sometimes a scan — because they can signal something more serious than migraine:
- Thunderclap headache — the worst headache of your life, peaking within seconds to a minute (possible bleed on the brain).
- Headache with fever and a stiff neck (possible meningitis).
- A new or different headache after age 50.
- Headache that is steadily worsening over days to weeks, or is worse in the morning, on coughing, or on lying down.
- Headache with weakness, numbness, confusion, seizures, or persistent visual loss.
- New headache in someone with cancer or a weakened immune system.
If a headache has any of these features — particularly thunderclap onset — treat it as an emergency and call +91 82888 43800 or go straight to the nearest emergency department.
Why Gini Is the Right Place for Migraine Management in the Tricity
Migraine deserves more than a quick prescription. At Gini Advanced Care Hospital in Sector 69, Mohali, migraine is managed the way any serious chronic condition should be — with an accurate diagnosis, a search for correctable triggers, a tailored acute plan, and, where needed, a properly chosen preventive that is reviewed and adjusted over time.
Dr. Iqbal Singh, DM Neurology (DMC Ludhiana), sees a large number of headache patients from across Mohali, Chandigarh and Panchkula, many of whom have spent years cycling through painkillers without a clear diagnosis. A common and satisfying outcome is untangling medication-overuse headache and introducing a preventive that finally breaks the cycle. For refractory cases, newer options including CGRP therapies are available and discussed frankly, including cost.
The hospital is easy to reach — about 15 minutes from most of Chandigarh and 20 from Panchkula — with same-week appointments, on-site MRI when a scan is genuinely needed, and 24/7 emergency cover for red-flag headaches. To book, call 0172 4120100 or WhatsApp +91 82889 44490.