Migraine Causes, Symptoms & Treatment
A migraine is a neurological condition that causes intense, throbbing head pain, usually on one side, along with sensitivity to light, sound, and movement. It’s not the same as a regular headache, and it’s one of the most common reasons people in Kathmandu walk into a neurosurgeon’s clinic, yet still one of the most misunderstood conditions we treat.
At Dr. Suresh Sapkota’s Brain Spine & Wellness Clinic, we see patients every week who’ve lived with migraines for years, tried painkillers on and off, and never got a real explanation of what’s actually happening in their brain. Dr. Sapkota, a Senior Consultant Neurosurgeon and Endoscopic Spine Surgeon at Kathmandu National Medical College, brings over a decade of clinical experience to every consultation, and that experience shapes how we approach migraine care here: not as a one-size-fits-all prescription, but as a diagnosis built around your specific triggers and history. This guide covers what causes migraines, how to recognize the symptoms early, and what migraine treatment in Nepal actually looks like today, from lifestyle changes to medication to when it’s time to see a specialist.
If your headaches are disrupting your work, sleep, or family life, you don’t have to just manage around them. Book a consultation with Dr. Suresh Sapkota to get a proper diagnosis and a treatment plan built for you.
What Is a Migraine ?
A migraine is a neurological condition, not just a headache. It happens when specific pathways and chemicals in your brain become overactive, causing changes in blood vessels and nerve signaling that produce intense, often one-sided pain.
Here’s the thing most people don’t realize: a migraine attack has stages. It can start hours before the actual headache with mood changes, food cravings, or neck stiffness, and it can leave you drained for a day afterward. That’s very different from a tension headache that comes and goes with stress.
Migraines are also far more common than most people assume. Globally, the World Health Organization lists migraine among the leading causes of disability, and in our clinical experience in Kathmandu, we’re seeing more young professionals and students presenting with frequent attacks, often tied to screen time, irregular sleep, and stress. Have you noticed your headaches getting more frequent over the past year? That pattern alone is worth discussing with a doctor.
Migraine vs. Regular Headache: How to Tell the Difference
Not every headache is a migraine, and treating them the same way rarely works. The distinction matters because the treatment approach is completely different.
A tension headache usually feels like a dull, constant pressure on both sides of the head. It’s uncomfortable, but you can generally still work through it. A migraine is a different experience altogether:
- Location: Often one-sided, sometimes switching sides between attacks
- Intensity: Moderate to severe, described as throbbing or pulsating
- Sensitivity: Light, sound, and sometimes smell become intolerable
- Movement: Physical activity makes it worse, not better
- Duration: Untreated attacks can last anywhere from 4 to 72 hours
- Accompanying symptoms: Nausea, vomiting, or visual disturbances
Types of Migraine
Migraines aren’t one single condition. In our practice, we typically categorize them into a few main types:
- Migraine without aura – The most common type, accounting for roughly 70 to 80% of cases we see. Pain builds gradually without warning visual or sensory signs.
- Migraine with aura – Involves temporary visual disturbances like flashing lights, zigzag lines, or blind spots, usually 20 to 60 minutes before the headache begins.
- Chronic migraine – Defined as headaches occurring on 15 or more days a month, with at least 8 of those meeting migraine criteria, for three months or longer.
- Vestibular migraine – Causes dizziness and balance problems, sometimes with little to no headache at all, which makes it one of the most missed diagnoses.
Chronic migraine, in particular, is where we see the biggest quality-of-life impact. Patients often describe feeling like they’re just surviving each week rather than living it.
Causes of Migraine
There’s no single cause of migraine. It’s usually a combination of genetic sensitivity and specific triggers that set off an attack in your brain.
Genetic and Hereditary FactorsIf a parent has migraines, you have a noticeably higher chance of developing them too. In our patient histories, it’s common to hear “my mother also gets these headaches.” Genetics don’t guarantee you’ll get migraines, but they lower your threshold, meaning it takes less to trigger an attack.
Hormonal ChangesThis is a big one for women. Estrogen fluctuations around menstruation, pregnancy, and menopause are strongly linked to migraine frequency. Many of our female patients notice a clear pattern tied to their cycle, with attacks clustering in the days just before or during their period.
Common Triggers: Stress, Sleep, and DietYour daily habits play a bigger role than most people expect. The most frequent triggers we hear about include:
- Sleep disruption – Both too little sleep and oversleeping can trigger attacks
- Stress and stress “let-down” – Some patients get migraines during high-pressure weeks, others get them right after the stress ends, over the weekend
- Dehydration – A surprisingly common and easily fixable trigger
- Skipped meals – Blood sugar drops can set off an attack within hours
- Caffeine changes – Both too much and sudden withdrawal can trigger pain
Living and working in Nepal comes with a few triggers that are worth paying attention to specifically:
- Altitude and weather shifts – Rapid changes in altitude, common if you travel between the Terai and hill regions, or sudden weather and pressure changes during monsoon season, can trigger attacks in sensitive individuals
- Air pollution in Kathmandu Valley – Poor air quality, especially during dry winter months, has been associated with increased headache frequency in several patients we’ve treated
- Dietary patterns – Fasting during festivals like Teej or Dashain, combined with irregular eating, is something we see spike migraine consultations around festival seasons
- Work and commute stress – Long hours in Kathmandu traffic, irregular work schedules, and high job stress in urban centers are recurring themes in patient histories
Imagine this: you’ve fasted for a festival, slept poorly because of family gatherings, and then sat in Kathmandu traffic for an hour under bright afternoon sun. That combination alone is enough to trigger a migraine in someone who’s genetically prone to them.
Symptoms of Migraine
Migraine symptoms follow a pattern, and recognizing that pattern early can genuinely change how much an attack affects you.
Early Warning Signs (Prodrome Stage)Hours or even a day before the headache starts, your body often gives you signals. These include unusual fatigue, irritability, neck stiffness, food cravings, or frequent yawning. Most patients only recognize these signs in hindsight, after we walk them through what to look for.
Aura SymptomsIf you experience an aura, you’ll typically notice visual changes first, such as shimmering spots, zigzag patterns, or temporary blind spots. Less commonly, people experience tingling in the hands or face, or brief difficulty finding words. These symptoms usually resolve within an hour, right before the headache phase begins.
Headache Phase SymptomsThis is the main event: throbbing pain, usually on one side, that worsens with movement. Nausea is common, and roughly a third of our patients report vomiting during severe attacks. Light and sound sensitivity are so pronounced that most people want to lie in a completely dark, quiet room.
Post-Migraine SymptomsAfter the pain fades, you’re not immediately back to normal. Many patients describe feeling foggy, drained, or emotionally flat for up to a day afterward. This “migraine hangover” is a real, recognized part of the condition, not something you’re imagining.
When to See a Doctor
You should book an appointment if you’re having migraines more than twice a month, if over-the-counter medication isn’t controlling the pain, or if the pattern of your headaches has changed recently. A change in pattern matters more than people realize. Are your migraines lasting longer than usual, or showing up more frequently than they did six months ago? That shift is exactly what we screen for during diagnosis.
Diagnosis of Migraine
Diagnosing migraine is mostly clinical, meaning it’s based on your history and symptom pattern rather than a single test.
Medical History and Physical ExaminationDuring your first visit, we’ll ask detailed questions: how often attacks happen, what they feel like, what seems to trigger them, and what runs in your family. A neurological exam checks reflexes, coordination, and vision to rule out other causes.
Tests Used to Rule Out Other ConditionsIn most straightforward cases, no imaging is needed. However, if your headaches start suddenly after age 50, come with fever or vision loss, or follow a head injury, we may order an MRI or CT scan to rule out other neurological conditions. This is a standard precaution, not a sign that something is necessarily wrong.
Where to Get Diagnosed in Nepal
Kathmandu has a growing number of neurology and neurosurgery clinics equipped to diagnose and manage migraines properly, including MRI facilities for cases that need imaging. At Dr. Suresh Sapkota’s Brain Spine & Wellness Clinic in Dhapasi-07, Tokha, diagnosis typically takes a single detailed consultation, with imaging arranged only when clinically necessary. Dr. Sapkota holds an MBBS from Kathmandu Medical College and an MS in Neurosurgery from King Edward Medical University, and is registered with the Nepal Medical Council (NMC 8223). What patients tell us they appreciate most is that he walks them through exactly what their scans show and what their options are, rather than rushing straight to a prescription pad.
When Migraine Becomes a Medical Emergency
Most migraines, while painful, aren’t dangerous. But a few warning signs mean you should seek care immediately rather than waiting it out.
Warning Signs You Shouldn’t IgnoreGo to a hospital or contact a neurosurgeon right away if you experience the worst headache of your life that comes on suddenly, a headache along with fever and stiff neck, confusion, slurred speech, weakness on one side of the body, or a headache following a head injury. These symptoms can point to conditions far more serious than migraine, and time matters.
Seeking Immediate Medical Help in NepalIf you’re in Kathmandu and experience any of the symptoms above, don’t wait for your next scheduled appointment. Head to an emergency department or contact a neurosurgeon in Kathmandu directly for urgent evaluation. It’s always better to be checked and reassured than to delay care for something serious.
Why Choose Brain Spine & Wellness Clinic?
Choosing who treats your migraines matters. Headache care ranges from a five-minute prescription refill to a real investigation of what’s driving your attacks, and that difference comes down to who’s sitting across from you.
A Neurosurgeon’s Depth of Training, Applied to Migraine CareDr. Suresh Sapkota is a Senior Consultant Neurosurgeon and Endoscopic Spine Surgeon at Kathmandu National Medical College, with an MBBS from Kathmandu Medical College and an MS in Neurosurgery from King Edward Medical University in Lahore. He’s registered with the Nepal Medical Council under NMC 8223, and has served as faculty with the Endoscopic Spine Society of India since 2023.
Here’s why that background matters for something like migraine, which isn’t a surgical condition for most patients: a neurosurgeon’s training covers the full range of what can go wrong inside the skull and spine, not just headache management in isolation. That means when you come in with recurring head pain, Dr. Sapkota isn’t just reaching for a standard migraine checklist. He’s evaluating your symptoms against the full picture of neurological conditions, so the rare cases that need more than migraine treatment don’t get missed.
Diagnosis Before PrescriptionA common mistake we see patients bring with them from previous consultations is being handed medication without ever being told why. Dr. Sapkota’s approach starts differently: a detailed history, a proper neurological exam, and a clear explanation of what’s actually driving your attacks before any treatment plan is discussed.
Patients consistently tell us this is what they were missing elsewhere. Being shown what a scan means, walked through each treatment option, and given time to ask questions, rather than being rushed out the door with a prescription, changes how confident you feel about your own care.
One Clinic for Brain, Spine, and Headache ConditionsMigraines don’t always exist in isolation. Some patients arrive with headaches that turn out to be connected to neck and spine issues, and some spine patients develop headaches as a secondary symptom. Because Brain Spine & Wellness Clinic covers brain, spine, and headache conditions under one roof, you’re not bounced between separate specialists to get a full picture of what’s going on.
Accessible, Local Care in TokhaThe clinic is based in Dhapasi-07, Tokha, Kathmandu, making specialist neurosurgical care accessible without needing to travel outside the valley. You can reach the clinic directly at +977-9709087879 or book a consultation online to get a proper evaluation, whether this is your first migraine consultation or you’ve been searching for answers for years.
Frequently Asked Questions
No, there is no permanent cure for migraine, but most patients can bring attacks down to a manageable level. With the right combination of trigger management, lifestyle changes, and medication, most patients see a significant drop in both frequency and severity within a few months.
Sudden altitude and weather changes are a recognized migraine trigger in people who are already prone to attacks. We see attack patterns shift with seasonal changes and travel between altitudes in Nepal, though altitude alone doesn't cause migraine in someone without an underlying predisposition.
Aged cheese, processed and cured meats, excessive caffeine, and alcohol, particularly red wine, are the most commonly reported migraine trigger foods. Triggers vary a lot between individuals though, which is why keeping a food and symptom diary is more useful than following a generic avoidance list.
Yes, chronic migraine is a leading cause of missed workdays and reduced concentration. Many patients underestimate how much it's affecting their performance until treatment brings noticeable relief.
An untreated migraine attack typically lasts anywhere from 4 to 72 hours, though most people get some relief sooner with medication. If an attack regularly lasts longer than 72 hours, that's a pattern worth discussing with a doctor, since it may point to a variant called status migrainosus.
