Brief Answer:
Migraine prophylaxis/eliminate precipitating factors/Sleep hygiene.

Detailed Answer:
Hi XXXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist here to answer your query.

If you would have presented to me as an outpatient,with definite diagnosis of migraine with visual aura, chronic nausea and insomnia,as presently,I would have told you to be on the following management protocol-
1)Since migraine is known to be precipitated by specific trigger factors like stress,sunlight,loud sound,lack of sleep,smoking,alcohol and food items like tea ,coffee,cheese,chocolate-it becomes the responsibility of the individual to find out which particular trigger factor is causing his/her problems.These trigger factors can vary from individual to individual and can be any(many of them even beyond this list).So,please try to find the one and eliminate it from your life style.
2)Anti-migraine prophylactic drugs-once a week frequency means you should be on prophylactic therapy of migraine.Beta-blockers(propranolol),Tricyclic antidepressants(Amitriptyline),calcium channel blockers(flunarizine) and anticonvulsants(valproate,topiramate)are excellent prophylactic drugs.Please discuss with your physician to start the one which suits you the best or add on the current medication,if needed.
3)Abortive therapy-Triptans(sumatriptan,rizatriptan) and Ergots are excellent abortive drugs to terminate the episode of migraine.Non steroidal anti inflammatory drugs(Naproxen,Ibuprofen) can be used as add-on.Again,please discuss with your physician to start the one which suits you the best or add-on.
4)Nausea-Please start anti-nausea drug with less side effects like domperidone sustained release,for now as nausea appears to be your current trouble.Nausea may be a part of the chronicity of the migraine.So,be on regular prophylactic anti-migraine drugs which will help reduce nausea.
5)Insomnia-Insomnia can be a result of chronicity of migraine and on the other hand,it may be a trigger factor for your migraine,thus creating a vicious cycle.So,it has to managed well.Ensure proper 'sleep hygiene'.Drugs for insomnia like zolpidem,eszopiclone can be taken for a short course.

Tricyclic antidepressant(amitriptyline) is an excellent drug for migraine prophylaxis as well as an excellent antidepressant(as depression is usually associated with insomnia and chronic migraine).You can discuss with your physician to start this as this will be likely of great help.

Please start doing mental relaxation exercises/Yoga/Meditation to reduce stress levels,which may further help to combat your problems.

Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.

Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Not likely.

Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.

Your symptoms are not explainable by minerals or vitamins deficiency.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.

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Brief Answer:
Gastric acidity may be contributing to nausea.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Surely,gastric acidity cause nausea.Please take pantoprazole 40 mg once a day,empty stomach for 7 days.Nausea should improve.Also,try to figure out the food items or factors which cause acidity like smoking, tea or coffee and avoid them.

Your gastric acidity is probably causing sleep disturbances.If possible,try to sleep with your head end elevated so that there is no acid reflux while sleeping.Be regular on anti-migraine prophylaxis and if your sleep disturbances still persist,please refer to a psychiatrist as they are the specialists to treat insomnia.

Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.

Dr.Ajay Panwar,
MD,DM(Neurology)

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