Brief Answer:
need more information and differential diagnosis

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


I can understand your concern. Your brother is having seasonal hemicranial headache. Such kind of headache is most probably due to "Migraine". But I need more information about him to rule out other close differential diagnosis -

- Eye disease like refractive error, Glaucoma

- Ipsilateral sinusitis

- Cluster headache

- Pituitary tumor

Kindly provide me answers of below questions

- Is there any history of visual blurring, redness in eyes, watering in eyes?

- Is there any history of fear from light or photophobia?

- Does he suffer from repeated episodes of allergy, running nose, common cold, nasal blockade?

- What is the exact site of headache? Is there any radiation to eyes, neck?

- Is there any history of vomiting along with headache? Migraine usually presents with aura like symptoms just before headache. Aura like symptoms are sudden tingling, bad smell, bad taste. Is there any history of aura like symptoms?

- If MRI brain has been done, please send me the films.

Hope you will understand my point. I will be able to help you better after knowing these.
If you have any doubts, do let me know.
Thanks. Take care.

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Brief Answer:
Probably Migraine or eye disease

Detailed Answer:
Hi XXXXXXX welcome back.


Thank you for providing me the answers. Your brother is most probably suffering from either Migraine or local eye pathology.

To differentiate between these, he needs few investigations like

- Eye examination - It includes visual acuity, intraoccular pressure.

- MRI brain to rule out any mass or vascular lesion causing migraine.

After confirming the diagnosis, treatment can be started. For eye disease, he will need glasses, maintain hygiene, eye drops to prevent redness. That can be better given by ophthalmologist.
I will explain you how to treat migraine. Migraine attacks are treated by

- Preventive therapy - This therapy is given to reduce the attack frequency. It includes
= avoid mental stress
= avoid lack of sleep
= avoid some foods like cheese, paneer, coffee/tea, chocolates. These can induce migraine
= avoid cold season as it might be causing it. Ask him to be inside during winters. Use heater to beat it. Wear more clothes and keep his head covered.
Medication like
- Propranolol
- Gabapentine
- Pregabaline
- Amitriptyline or Nortriptyline
Any one of these can be started to reduce frequency. It will be decided by his treating doctor. You have to discuss it with him.

- Abortive therapy - It means treating the acute pain episode. It is treated by medication only. It includes
= Always start with NSAID's. Most patients respond to Naproxen.
= If no relief with NSAID's, then combination can be tried like Diclofenac+Paracetamol, Ibuprofen+Paracetamol etc.
= Second line drugs include Tramadol, Tramadol+Paracetamol.
= If still no relief, Sumatriptan, Ergotamine can be tried. Most patients respond to these.
= In extremely rare cases, opioids (pentazocine) can be needed if no relief.

You can start medication after getting proper prescription from doctor. But before it, please investigate him to rule out any other cause.
Hope it will help him. If any doubts, do let me know.
Thanks. Take care.

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