Migraine (Adha Sar Dard) in Pakistan: Triggers, Treatment and When It's Serious

Migraine is not a bad headache — it is a neurological condition, and it is one of the leading causes of years lived with disability worldwide according to the World Health Organization. It is also routinely dismissed, self-medicated and undertreated, which is why people spend years losing days to something that is often manageable.

At a glance

• Migraine typically affects one side of the head, throbs, and gets worse with movement
• Nausea, and sensitivity to light and sound, are what separate it from a tension headache
• Attacks last 4–72 hours untreated
• Treating early in the attack works far better than treating at the peak
• Painkiller overuse itself causes headaches — more than 10–15 days of painkillers a month is a trap
• A few headache patterns are emergencies. They are listed below — read them

Migraine aur aam sar dard mein farq

Migraine ki alamat:

• Dard aksar sar ke aadhe hissay mein (adha sar dard) — although it can be both sides
• Dhachka lagne jaisa dard (throbbing), jo chalne-phirne se barh jata hai
• Matli ya ulti (ji matlana)
• Roshni aur awaz se takleef (roshni chubhna) — andhere kamre mein lait jane ka dil chahna
• 4 se 72 ghante tak rehna
• Kabhi kabhi aura: dard se pehle 20–60 minute tak zigzag lakeerein, roshni ke dhabbay, ya hath/chehray mein sunn pan

A tension headache, by contrast, feels like a tight band around the head, is usually both-sided, is not made worse by walking, and does not usually come with vomiting or light sensitivity.

Red flags — when a headache is an emergency

Go to hospital immediately for any of these:

• Thunderclap headache — worst headache of your life, reaching maximum in under a minute
• Headache with fever and neck stiffness, or a rash (possible meningitis)
• Headache with weakness, numbness, drooping face, confusion or slurred speech — treat as stroke and use FAST
• Headache after a head injury
• A new headache pattern after age 50
• Headache that is worse lying down, worse in the morning, or worse on coughing and straining
• Headache with new visual loss, or a red painful eye
• Headache in pregnancy with swelling or high blood pressure (possible pre-eclampsia)
• New headache in someone with cancer or a weakened immune system

Triggers — and which ones matter here

Triggers are individual, and identifying yours is worth more than any general list. Common ones include: skipped meals, dehydration (a serious factor in Pakistani summers), poor or irregular sleep, stress — and notably the let-down after stress, which is why weekend migraines are a thing — bright sunlight and glare, loud noise, strong smells, hormonal changes around periods, MSG and aged/fermented foods, excess caffeine and caffeine withdrawal, and long screen time with poor posture.

Ramadan is a common and predictable trigger, combining caffeine withdrawal, disrupted sleep and dehydration. Tapering caffeine in the preceding week and hydrating deliberately between iftar and sehri helps many people considerably.

Keep a simple headache diary for 6–8 weeks: date, duration, severity, what you had eaten and slept, and what you took. Patterns that are invisible in memory become obvious on paper.

Treatment

During an attack

• Take medication early — at the first sign, not once it is severe
• Simple analgesics (paracetamol, NSAIDs) work for many attacks
• Triptans are migraine-specific and prescription-only; they are the step up when simple analgesics fail
• An anti-emetic helps both nausea and the absorption of the painkiller
• Dark, quiet room; cold compress; sleep if you can
• Hydrate

Prevention

If you get attacks on four or more days a month, or attacks that are severe and disabling, ask about preventive medication — beta blockers, some antidepressants, certain anti-epileptics, and newer CGRP-targeted drugs are all used. These are taken daily to reduce frequency, not to stop an attack in progress, and they take weeks to show effect.

Medication-overuse headache deserves its own warning. Taking painkillers on more than 10–15 days a month can itself produce a daily headache that no painkiller fixes, and the only treatment is withdrawal — supervised, because it gets worse before better. In Pakistan, where analgesics are bought freely across a counter, this is common and frequently missed. See our guide to self-medication.

When to see a doctor

See a general physician or neurologist if headaches are frequent or disabling, if over-the-counter painkillers are no longer working, if you are taking them most weeks, or if the pattern has changed. Any red flag above is an emergency, not an appointment.

Find care: browse general physicians and neurologists near you on DoctorOS — filter by city, distance and rating, and book without a phone call.

Uncorrected vision problems and jaw clenching are two commonly missed contributors — worth an eye check if you have never had one.

Frequently asked questions

Kya migraine hamesha ke liye theek ho jata hai?

Migraine aam taur par mukammal khatam nahi hota, lekin usay achhi tarah control kiya ja sakta hai. Bohat se logon mein trigger pehchan lene aur ehtiyati dawai se attacks kaafi kam ho jate hain. Umar ke sath, khas taur par auraton mein menopause ke baad, aksar kam ho jata hai.

Roz sar dard ki goli khana theek hai?

Nahi — aur yeh khud ek masla ban jata hai. Mahine mein 10–15 din se zyada dard ki goli khane se "medication overuse headache" ho jata hai, yani goli hi rozana dard ki wajah ban jati hai. Agar aap har hafte goliyan kha rahe hain to yeh doctor se milne ki nishani hai, dose barhane ki nahi.

Is migraine caused by weakness or "garmi"?

No. Migraine is a disorder of how the brain and its blood vessels and nerves respond to triggers — it is not caused by weakness, and tonics do not treat it. Heat and dehydration are genuine triggers, which is a different thing from a cause.

Sources

• World Health Organization — Headache disorders fact sheet
• NHS — Migraine: symptoms, causes and treatment
• International Classification of Headache Disorders (ICHD-3), migraine criteria

For practitioners: if you're a general physician or neurologist in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.

Cover image: Migraine by quinn.anya, licensed under CC BY-SA 2.0.