Recurrent headaches, which can be mild to severe, are the hallmark of the complicated neurological disorder known as migraines. It often involves pulsating or throbbing pain, usually on one side of the head, although it can affect on both the sides. They are frequently accompanied by additional symptoms like vomiting, nausea, and intolerance to light, sound, or scent. 

Although the precise etiology of migraines remains unclear, a confluence of neurological, environmental, and genetic variables is thought to be responsible. Some common triggers include hormonal changes, certain foods or drinks (such as alcohol, caffeine, or aged cheeses), stress, lack of sleep, sensory stimuli (like bright lights or strong odors), and changes in weather or altitude. 

There are several types of migraines, including: 

• Migraine without aura: This is the most prevalent kind, marked by medium to serious headaches without any warning signs in advance. 
• Migraine with aura: Aura, or distinct warning indications, are seen by certain individuals before to the commencement of migraine headaches. Aura can cause changes in senses, difficulty speaking, and visual disturbances like blind patches or flashing lights. 
• Chronic migraine: This refers to migraines that occur on 15 or more days per month, with at least 8 of those days involving migraine headaches. 
• Menstrual migraine: Migraines that occur in relation to a woman’s menstrual cycle, often around the time of menstruation.

• Global Prevalence: Migraine is a widespread condition, affecting people across the globe. According to the World Health Organization (WHO), it is one of the top 20 causes of disability worldwide. The prevalence of migraines varies among different countries and regions. 
• Gender Differences: Migraines are more common in women than in men. The peak prevalence often occurs during the reproductive years. Hormonal factors, particularly changes in estrogen levels, are thought to contribute to this gender difference. 
• Age Distribution: While migraines can occur at any age, they often first appear in childhood, adolescence, or early adulthood. The frequency and characteristics of migraines may change with age. 
• Family History and Genetics: There is a genetic component to migraines, and individuals with a family history of migraines are more likely to experience them. Specific genetic factors associated with migraines have been identified. 
• Socioeconomic Factors: Migraines can affect individuals of all socioeconomic backgrounds, but there may be associations with certain socioeconomic factors. Access to healthcare and treatment options may vary based on socioeconomic status. 
• Comorbidities: Migraines often coexist with other medical conditions. Common comorbidities include depression, anxiety, and other pain disorders. Understanding these associations can help in providing comprehensive care. 

Neurovascular Mechanism: 

• Vasodilation and Vasoconstriction: Early theories suggested that migraines were primarily caused by blood vessel changes, with initial vasodilation (expansion of blood vessels) followed by vasoconstriction (narrowing of blood vessels). However, current research indicates that the vasodilation is likely secondary to other processes. 

• Cortical Spreading Depression (CSD): CSD is caused by a wave of neuronal depolarization that propagates across the cerebral cortex. It is considered a key event in migraine with aura. CSD is thought to trigger changes in blood flow and release of inflammatory substances, contributing to the migraine headache. 

Neurochemical Imbalances: 

• Serotonin (5-HT) Dysfunction: Changes in serotonin levels are implicated in migraines. Serotonin has a role in mood and pain perception control. During a migraine attack, there is evidence of a transient decrease in serotonin levels, which may contribute to the headache phase. 
• Calcitonin Gene-Related Peptide (CGRP): CGRP is a neuropeptide that plays a role in vasodilation and inflammation. Elevated levels of CGRP have been observed during migraine attacks, and medications targeting CGRP or its receptors are being used as a new class of migraine-specific preventive treatments. 
• Glutamate and Neurotransmitters: Abnormalities in glutamate, a neurotransmitter involved in excitatory signaling, have been implicated in migraine pathophysiology. Changes in neurotransmitter release and receptor sensitivity may contribute to the initiation and maintenance of migraines. 

Genetic Factors: 

• Familial Predisposition: There is a strong genetic component to migraines, with a higher risk in individuals with a family history of migraines. Specific genetic variations may influence susceptibility to migraines and the response to triggers. 

Triggers and Environmental Factors: 

• Hormonal Changes: Fluctuations in hormones, particularly estrogen, are associated with migraine attacks. Many women experience migraines related to the menstrual cycle. 
• Stress, Sleep, and Environmental Factors: Emotional stress, lack of sleep, and exposure to certain environmental stimuli (such as bright lights, loud noises, or strong odors) can trigger migraines in susceptible individuals. 

Genetic Factors: 

• Family History: There is a strong genetic predisposition to migraines. Individuals with a family history of migraines are more likely to experience them, suggesting a hereditary component. 
• Specific Genetic Markers: Certain genetic variations have been associated with an increased susceptibility to migraines. These variations may influence the function of neurotransmitters, receptors, and ion channels involved in migraine pathophysiology. 

Neurovascular Changes: 

• Cortical Spreading Depression (CSD): A pulse of electricity that travels throughout the cerebral cortex causes alterations in blood flow and the production of inflammatory chemicals, which is the mechanism underlying this phenomena. CSD is believed to be involved in the aura phase of migraines. 
• Vasodilation and Vasoconstriction: While the role of blood vessel changes in migraines has evolved, alterations in blood flow, possibly influenced by neurovascular mechanisms, are still considered part of the migraine process. 

Neurochemical Imbalances: 

• Serotonin Dysfunction: One neurotransmitter that affects mood control and pain perception is serotonin. Changes in the serotonin levels have been implicated in migraine attacks, with a transient decrease observed during the headache phase. 
• Calcitonin Gene-Related Peptide (CGRP): Elevated levels of CGRP, a neuropeptide involved in vasodilation and inflammation, have been associated with migraines. Medications targeting the CGRP pathway are being used for migraine prevention. 

Hormonal Influences: 

• Estrogen Fluctuations: Hormonal changes, particularly fluctuations in estrogen levels, can trigger migraines in some individuals. Women often experience migraines related to their menstrual cycle, pregnancy, or menopause. 

Triggers and Environmental Factors: 

• Stress: It is a common trigger for migraines. Changes in stress levels can contribute to the onset of an attack. 
• Environmental Stimuli: Exposure to certain stimuli, such as bright lights, loud noises, strong odors, or specific foods and drinks (like alcohol, caffeine, and certain additives), can act as triggers for migraines. 

• Frequency and Severity of Attacks: Individuals experiencing more frequent and severe migraine attacks may have a different prognosis than those with less frequent or milder episodes. 
• Duration of Migraine History: The length of time an individual has been experiencing migraines can be a prognostic factor. Chronic migraine, defined as having migraines on 15 or more days per month, may have different implications for treatment and management compared to episodic migraine. 
• Aura Presence: Migraines with aura (visual or sensory disturbances that precede or accompany the headache) may have different prognostic implications compared to migraines without aura. 
• Response to Medications: How well an individual responds to acute and preventive medications can be a prognostic factor. Those who respond positively to treatment may have a more favorable prognosis in terms of symptom management. 
• Impact on Quality of Life: One predictor of future outcomes may be how much a person’s quality of life and everyday functioning are affected by migraines. Severe impairment and disability may require more comprehensive management strategies.

Clinical Presentation with Age Group: 

Children and Adolescents (Up to 18 years old): 

• Migraines in children often present as recurrent, throbbing headaches. 
• Nausea, vomiting, and abdominal pain may be prominent symptoms. 
• Attacks may be shorter in duration compared to adults. 

Young Adults (18 to 40 years old): 

• Migraines in this age group may be associated with hormonal changes, especially in women. 
• Visual disturbances (aura) may occur in some individuals. 
• Trigger factors, such as stress or irregular sleep patterns, may become more noticeable. 

Middle-aged Adults (40 to 60 years old): 

• Migraines may persist but can evolve in presentation. 
• Hormonal factors, stress, and lifestyle changes may continue to play a role. 
• Coexisting medical conditions like hypertension or cardiovascular issues may impact treatment decisions. 

Seniors (60 years and older): 

• Migraines may persist but can sometimes decrease in frequency. 
• Management may be complicated by other age-related health issues and medication interactions. 
• Associated Comorbidities or Activities: 

Psychiatric Comorbidities: 

• Anxiety and depression are commonly associated with migraines. 
• Effective management may require a holistic approach addressing both mental health and migraine symptoms. 

Cardiovascular Comorbidities: 

• They have been associated with an increased risk of certain cardiovascular conditions, such as stroke and coronary artery disease. 

Sleep Disorders: 

• Sleep disturbances, including sleep apnea, can influence the frequency and severity of migraines. 

Pregnancy-Related Factors: 

• For women, migraines may be affected by hormonal changes during pregnancy or menopause. 
• Management considerations during pregnancy involve balancing the need for relief with the safety of medications. 

Lifestyle Factors: 

• Certain activities or habits, such as irregular sleep patterns, skipping meals, or excessive caffeine intake, can trigger migraines. 
• Acuity of Presentation: 

Gradual Onset: 

• Migraine attacks often have a gradual onset, with symptoms intensifying over time. 

Aura Phase: 

• Some individuals experience an aura before the headache phase, involving visual disturbances, sensory changes, or other neurological symptoms. 

Severe Headache: 

• The headache phase is typically characterized by severe, throbbing pain, often on one side of the head. 

Nausea and Vomiting: 

• Nausea and vomiting are common symptoms during a migraine attack, contributing to the overall acuity of the presentation. 

• General Physical Examination: A comprehensive physical examination is performed to evaluate general health and spot any indications of systemic diseases that might be causing headaches. 
• Neurological Examination: A neurological examination is crucial to rule out other neurological conditions that may mimic migraine symptoms. It includes assessing cranial nerves, reflexes, coordination, muscle strength, and sensation. 
• Head and Neck Examination: Examination of the head and neck can help identify potential triggers or contributing factors. This may include assessing the temporomandibular joint (TMJ) for tenderness and examining the neck muscles for tension. 
• Blood Pressure Measurement: Monitoring blood pressure is important to rule out hypertensive emergencies or other cardiovascular issues that may cause headaches. 
• Eye Examination: An eye examination may be conducted to rule out eye-related issues that could contribute to headaches. This includes checking for visual disturbances and assessing eye movements. 
• Assessment of Trigger Points: Some individuals with migraines may have trigger points in the head, neck, or shoulder muscles. Palpation of these areas can help identify tender points and areas of muscle tension. 

Lifestyle Modifications: 

• Identify and avoid triggers: To find possible headache triggers, such as particular meals, sleep deprivation, stress, or hormonal changes, keep a headache journal. Once identified, make an effort to limit your exposure to these stressors. 
• Regular sleep: Maintain a consistent sleep schedule, ensuring you get adequate and regular sleep. 
• Hydration: To keep hydrated all day, drink a lot of water. 
• Stress management: Practice relaxation techniques, meditation, and stress-reducing activities to manage stress levels. 

Acute or Abortive Medications: 

• Over-the-counter (OTC) medications: Pain relievers such as naproxen sodium,ibuprofen, or aspirin may be effective for mild to moderate migraines. 
• Prescription medications: Triptans (sumatriptan, rizatriptan, etc.) are often prescribed for moderate to severe migraines. They work by narrowing blood vessels and blocking pain pathways in the brain. 

Preventive Medications: 

• Prescription medications: If migraines are frequent or severe, a healthcare provider may recommend preventive medications. These can include beta-blockers (propranolol), anticonvulsants (topiramate), tricyclic antidepressants (amitriptyline), or CGRP (calcitonin gene-related peptide) monoclonal antibodies. 
• Botulinum toxin (Botox): Injections of Botox may be considered for chronic migraines (15 or more headache days per month, with at least 8 being migraines). 

Non-Pharmacological Approaches: 

• Biofeedback and Relaxation Techniques: These can assist people in decreasing the frequency and intensity of migraines by teaching them how to regulate physiological processes like heart rate and muscular tension. 
• Cognitive Behavioral Therapy (CBT): CBT can be effective in managing stress and changing patterns of thinking that may contribute to migraines. 

Alternative Therapies: 

• Some people find relief through acupuncture, chiropractic care, or herbal supplements. However, the evidence supporting the effectiveness of these approaches varies. 

Internal Medicine

Neurology

Biofeedback: Biofeedback involves learning to control physiological functions such as heart rate,muscle tension, and skin temperature. This technique can help individuals gain better awareness and control over physical responses associated with migraines. 

Relaxation Techniques:  Deep breathing exercises, progressive muscle relaxation, and guided imagery are a few techniques that can reduce tension and induce calm, both of which can be linked to migraine symptoms. 

Cognitive Behavioral Therapy (CBT): It is a type of psychotherapy where the goal is to recognize and alter unfavorable thinking patterns and behavior patterns. It is effective in managing stress and improving coping mechanisms, potentially reducing migraine frequency. 

Lifestyle Modifications: 

•  Identify and avoid triggers: Keeping a headache diary to track potential triggers and avoiding them can be a crucial non-pharmacological strategy. 
• Regular sleep: Maintaining a consistent sleep schedule, ensuring adequate and quality sleep, can help prevent migraines triggered by changes in sleep patterns. 
• Hydration and nutrition: A balanced diet and adequate hydration might improve general health and perhaps lessen the frequency of migraine attacks. 

Acupuncture: It involves inserting of thin needles into the specific points on the body. Some people find relief from migraines through acupuncture, although the evidence is mixed, and individual responses may vary. 

Chiropractic Care: Some individuals may benefit from chiropractic adjustments, particularly if musculoskeletal issues contribute to their migraines. However, the effectiveness of chiropractic care for migraines is still a subject of debate, and it may not work for everyone. 

Physical Exercise: Frequent exercise helps lower stress and enhance general wellbeing. Walking, swimming, and yoga are a few exercises that may help reduce the incidence of migraines. 

Neurology

 Serotonin 5-HT1F agonists, also known as “ditans,” are a relatively new class of medications used in the treatment of migraines. They differ from the more established class of triptans, which primarily target the 5-HT1B/1D receptors. 

Lasmiditan: It is currently the only 5-HT1F agonist approved for the acute treatment of migrainesSerotonin 5-HT1F agonists, like lasmiditan, selectively activate serotonin receptors (5-HT1F receptors) in the trigeminal nerve pathway. This activation prevents the production of neuropeptides that are important in migraine-related pain signals.

Neurology

Serotonin (5-HT) receptor agonists, commonly known as triptans, play a crucial role in the acute treatment of migraines. These medications target specific serotonin receptors, primarily the 5-HT1B and 5-HT1D receptors, leading to vasoconstriction of dilated blood vessels and inhibition of the release of pro-inflammatory neuropeptides. Triptans are effective in relieving migraine symptoms and are widely used for acute migraine attacks. 

• Sumatriptan (Imitrex): One of the first triptans introduced and available in various forms, including tablets, nasal spray, and injections. 
• Rizatriptan (Maxalt): Available in orally disintegrating tablets and regular tablets, it is known for its relatively fast onset of action. 
• Zolmitriptan (Zomig): Available in oral tablets and nasal spray formulations. 
• Eletriptan (Relpax): Known for its longer half-life compared to some other triptans, it is available in oral tablet form. 
• Naratriptan (Amerge): Has a longer duration of action and is available in oral tablet form. 
• Almotriptan (Axert): Has a longer half-life and is available in oral tablet form. 

Neurology

Ergot derivatives, also known as ergot alkaloids, have historically been used in the treatment of migraines. These drugs work by interfering with serotonin along with other receptors, causing vasoconstriction and inhibiting certain neurotransmitters implicated in migraine pathogenesis. However, their use has declined in recent years due to the introduction of safer and more effective medications, such as triptans. Derivatives of ergot are often saved for situations when first-line therapies are either ineffective or poorly tolerated.  

• Ergotamine: Ergotamine is a classic ergot derivative used in the treatment of migraines. It is available in various formulations, including oral tablets, sublingual tablets, and rectal suppositories. 
• Dihydroergotamine (DHE): This is a semisynthetic ergot alkaloid that is more commonly used today than ergotamine. DHE is available in injectable forms (intravenous or intramuscular) and as a nasal spray.

Neurology

Analgesics, or pain relievers, are commonly used in the treatment of migraines, especially for milder attacks or when other specific migraine medications are not suitable.For moderate to severe migraines or when over-the-counter analgesics are not effective, specific migraine medications such as triptans or ergot derivatives may be more appropriate. These medications target the underlying mechanisms of migraines, including blood vessel dilation and neurogenic inflammation. 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): 

• Ibuprofen: Ibuprofen is an NSAID that can be effective in relieving mild to moderate migraines. It functions by inhibiting pain impulses and lowering inflammation. 
• Naproxen Sodium: Similar to ibuprofen, naproxen sodium is an NSAID that can help alleviate migraine symptoms. Because of its prolonged duration of action, fewer doses are necessary. 

Acetaminophen (Paracetamol): 

• Acetaminophen: While not an NSAID, acetaminophen is a common over-the-counter analgesic that may provide some relief for mild migraines. It functions by lessening the brain’s pain signals. 

Neurology

Pathology

Antipsychotic medications, although primarily used to treat psychiatric conditions such as schizophrenia and bipolar disorder, have shown some efficacy in the treatment of migraines, particularly in certain cases where other treatments have failed or are not well-tolerated. Although the precise method by which antipsychotics prevent migraines is not entirely known, it is thought to be related to their effects on neurotransmitters including norepinephrine, dopamine, and serotonin, which are also important in the pathophysiology of migraines. 

• Olanzapine (Zyprexa): Olanzapine, an atypical antipsychotic, has been studied for its effectiveness in migraine prevention. It has demonstrated potential in reducing migraine frequency and intensity, especially in those who suffer from chronic migraines. 
• Quetiapine (Seroquel): Quetiapine is another atypical antipsychotic that has been investigated for migraine prevention. While not as extensively studied as olanzapine, it has shown some benefit in reducing migraine frequency and severity in certain individuals. 
• Risperidone (Risperdal): Risperidone is a widely used atypical antipsychotic that has been studied for its potential role in migraine treatment. It may be considered in cases where other preventive medications have failed. 
• Aripiprazole (Abilify): Aripiprazole is another atypical antipsychotic that has been explored for migraine prevention. It has shown some efficacy in reducing migraine frequency and severity, although more research is needed to establish its role definitively. 

Neurology

Anticonvulsant medications are often used as preventive or prophylactic treatment for migraines in individuals who experience frequent or severe attacks. They are typically considered when other preventive medications or lifestyle modifications have not been successful or are not well-tolerated. 

• Topiramate (Topamax): Topiramate is one of the most commonly prescribed anticonvulsants for migraine prevention. It is believed to reduce neuronal excitability and modulate neurotransmitters. It has shown efficacy in reducing the frequency and severity of migraine attacks. 
• Valproic Acid (Depakote): Valproic acid is another anticonvulsant that has been used for migraine prevention. It is thought to have a stabilizing effect on neuronal membranes and modulate neurotransmitter release. However, it is generally considered a second-line option due to potential side effects, especially in women of childbearing potential. 
• Gabapentin (Neurontin): While more commonly used for neuropathic pain, gabapentin has also been studied for migraine prevention. Although its exact method of preventing migraines is unclear, it is thought to work via adjusting neurotransmitter release. 

• Pregabalin (Lyrica): Pregabalin, similar to gabapentin, is used for various neuropathic conditions. It has been investigated for its potential role in migraine prevention, although more research is needed to establish its efficacy definitively. 

Neurology

Calcium channel blockers (CCBs) are a class of medications that block the entry of calcium into cells, including cells in blood vessel walls. They are primarily known for their use in cardiovascular conditions, but some CCBs have shown effectiveness in the prevention of migraines. 

Verapamil: Verapamil is a commonly used calcium channel blocker for migraine prevention. It has shown efficacy in reducing the frequency and severity of migraine attacks. Verapamil is available in different formulations, including immediate-release and extended-release. 

Flunarizine: Although not available in all countries, flunarizine is a calcium channel blocker with antimigraine properties. It has been shown to be effective in reducing migraine frequency and severity. Flunarizine is used more widely in some regions, but its availability may vary. 

Cardiology, General

Neurology

Beta blockers lessen the frequency and intensity of migraine attacks. They are often considered when other preventive measures or medications are not suitable or have not been effective.Beta blockers work by blocking beta-adrenergic receptors, leading to several effects that are relevant to migraine prevention. They reduce vasodilation (expansion of blood vessels), which can contribute to the normalization of blood flow and reduce the risk of vasospasm, a potential trigger for migraines. Beta blockers also modulate neurotransmitters such as norepinephrine, serotonin, and dopamine, which are involved in migraine pathophysiology. 

• Propranolol (Inderal): Propranolol is one of the most commonly prescribed beta blockers for migraine prevention.It has been demonstrated to be useful in lowering migraine attack frequency and intensity. Since propranolol inhibits both the beta-1 and beta-2 receptors, it is a not selective beta blocker. 
• Metoprolol (Lopressor): Metoprolol is a beta-1 selective blocker and is another option for migraine prevention. It is generally well-tolerated and has shown efficacy in reducing migraine frequency. 
• Timolol (Blocadren): Timolol, a non-selective beta blocker, has been studied for migraine prevention and is available in oral and ophthalmic (eye drop) formulations. The eye drop form is also used to prevent certain types of headaches, including migraines. 
• Atenolol (Tenormin): Atenolol is another beta-1 selective blocker that has been investigated for migraine prevention. It is generally well-tolerated but may be less commonly prescribed than some other beta blockers for this indication. 

Internal Medicine

Neurology

Occipital Nerve Blocks: 

• A local anesthetic and occasionally a corticosteroid are injected around the occipital nerves, which are found in the back of the head, during an occipital nerve block. 
• Particularly for migraines affecting the occipital area, these injections can aid with pain relief and migraine frequency reduction. 

Botox Injections (OnabotulinumtoxinA): 

• Botox injections involve the administration of botulinum toxin type A into specific muscles in the head and neck. 
• Though mostly associated with cosmetic applications, adult patients with chronic migraines—defined as more than fifteen headache days per month—can now receive Botox injections as a preventative measure. 
• Some people may find that Botox injections lessen the frequency and intensity of their migraines, while their exact mechanism of action is unclear. 

SPG (Sphenopalatine Ganglion) Blocks: 

• SPG blocks involve the administration of local anesthetic to the sphenopalatine ganglion, a cluster of nerve cells located behind the nose. 
• These blocks can provide relief for acute migraine attacks and may also have a preventive effect when performed regularly. 

Greater Occipital Nerve Stimulation (ONS): 

• ONS involves the implantation of electrodes near the greater occipital nerves, which are thought to be involved in migraine pathophysiology. 
• These electrodes deliver mild electrical impulses to modulate nerve activity and reduce migraine symptoms. 

Percutaneous Radiofrequency Ablation: 

• Percutaneous radiofrequency ablation involves the use of heat generated by radiofrequency energy to disrupt nerve pathways involved in migraine transmission. 
• This procedure targets specific nerves believed to play a role in migraine generation and can provide long-lasting relief in some cases. 

Transcranial Magnetic Stimulation (TMS): 

• Magnetic pulses are used in this non-invasive technique to activate specific brain regions. 
• While primarily studied for its antidepressant effects, TMS has also shown promise in migraine treatment, particularly for acute migraine attacks. 

Internal Medicine

Neurology

Prodromal Phase: 

• The prodromal phase refers to the period before the onset of the headache when subtle symptoms may occur, serving as a warning sign of an impending migraine attack. 

• Symptoms during this phase can vary widely but may include mood changes, food cravings, increased thirst, fatigue, or changes in bowel habits. 
• Management during the prodromal phase may involve recognizing these early signs and taking preventive measures, such as ensuring adequate hydration, getting enough rest, avoiding triggers, and taking preventive medications if prescribed. 

Aura Phase (if present): 

• Not all individuals with migraines experience an aura, but for those who do, it typically occurs before or during the headache phase. 
• Auras are usually visual disturbances but can also involve sensory, motor, or speech disturbances. Visual auras may include flashing lights, zigzag lines, or blind spots. 
• Management during the aura phase may involve finding a quiet, dark environment to rest and minimizing exposure to triggers if possible. Some individuals may benefit from specific medications to alleviate aura symptoms if prescribed by their healthcare provider. 

Headache Phase: 

• The headache phase is characterized by the throbbing or pulsating headache typically associated with migraines. Other symptoms including light and sound sensitivity, nausea, vomiting, and trouble concentrating might accompany it. 
• Medications are frequently used as part of acute therapy for headaches in order to reduce pain and related symptoms. This may include over-the-counter analgesics, prescription migraine-specific medications (such as triptans), antiemetics for nausea, or combination medications. 
• Non-pharmacological approaches such as rest in a quiet, dark room, applying cold packs to the head or neck, and practicing relaxation techniques may also help alleviate symptoms during the headache phase. 

Postdromal Phase: 

• Also known as the migraine “hangover,” the postdromal phase occurs after the headache has resolved and is characterized by residual symptoms such as fatigue, mood changes, difficulty concentrating, and generalized malaise. 
• Management during the postdromal phase typically involves rest, hydration, and gentle activities to promote recovery. Ensuring adequate sleep, nutrition, and stress management may also help minimize the duration and severity of postdromal symptoms.