Brief Answer:
Relevant info provided.

Detailed Answer:
Hello, Sir.

I apologize for my delayed response due a hectic schedule.

I have carefully gone through your query.

A migraine is a chronic condition, but prolonged remissions are common.

The severity and frequency of migraine attacks tend to diminish with increasing age. After 15 years of suffering migraines, approximately 30% of men no longer have migraine attacks.

You seem to have a relapse after 15 years, this is a rare event.

Hence, It is very important to rule out other associations with Migraine or migraine mimickers like cerebrovascular.This should be the initial prime focus beyond all means considering your age and past medical history.

Neuroimaging is usually not necessary in patients with a history of recurrent migraine headaches and a normal neurologic examination.But one must consider MRI scan of brain for following reasons in your case-

1.New onset/relapse of a migraine after age 50 years

2.High association of migraine headaches with a cardiovascular or cerebrovascular disease (ie, stroke, myocardial infarction, high cholesterol levels) particularly in patients with pre-existing diabetes or hypertension.

3.Additionally blood work up for C-reactive protein, ESR and Lipid profile is indicated(since these are common predisposing factors for migraine attacks)

4.Blood pressure monitoring is very vital during episodes of Migraine to assess risk for vascular events


Secondly identification of Migraine precipitants is also very important in your case to avoid /prevent future attacks. I advise you to avoid the following if any.

1. Stress.
2. Excessive or insufficient sleep.
3. Smoking.
4. Exposure to bright or fluorescent lighting.
5. Strong odors (eg, perfumes, colognes, petroleum distillates).
6. Cold stimulus (eg, ice cream and water).

7. Fasting or skipping meals
8. Red wine.
9. Caffeine overuse or caffeine withdrawal
10. Chocolate
11. Citrus fruits, bananas, avocados, dried fruit, Peanuts, soy nuts, and soy sauce.
12. All canned and frozen foods.
13. Cheese, Meat, Pickled(sour and chilly) foods, and vinegar.

Even though the list is exhaustive, I advise you to adhere to it as a migraine can be largely prevented and controlled rather than cured. These measures offer excellent relief.

Pertaining to the treatment which you are currently receiving, you seem to receive both abortive (sumatriptan) and preventive(amitriptyline mainly and Vasograin) therapy with vasograin specially prescribed to control your nausea and photophobic symptoms. This is a good way of management.

Since you are a known case of BPH(benign prostate hypertrophy).use of two drugs with anticholinergic action(amitriptyline and vasograin can worsen symptoms of BPH causing acute urine retention.Hence, I advise you to kindly substitute these drugs with suitable alternative prophylactic drugs.

The best alternatives for prophylactic therapy in your case is either calcium channel blockers or ace inhibitors.Both belong to an antihypertensive group of drugs.If instituted in your case, they can serve a dual role of BP control and migraine prevention.

Sumatriptan is an excellent drug for Migraine. Before taking triptans, it is always advisable to have a complete cardiac evaluations as they may increase the risk of cardiac disorders.

Axe oil, hot/cold compress have no proven effect in suppressing migraine attacks.

But Butterbur has clinically proven efficacy against Migraine as complementary and alternative therapy(CAM).

A guideline from the XXXXXXX Academy of Neurology and the XXXXXXX Headache Society (AAN/AHS) recommends offering butterbur therapy to patients with migraine to reduce the frequency and severity of migraine attacks (level A recommendation).

Also, it is advised by the same academy that patients on butterbur require monitoring of liver enzymes.

Hence to conclude-

1.Evaluate further through Neuroimaging-MRI and blood work up for this new onset migraine.

2. A migraine can only be controlled, prevented or aborted, but cannot be cured.

Post your further queries if any.

Thank you.

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