Migraine Management Practices in India: A Comprehensive Review of Current Approaches, Challenges, and Future Directions

Author(s): Sarthak Joshi, Bhavya Goyal, Dr. Sameeksha Joshi, Dr. Tanishq Joshi, Dr. Manjul Joshi, Suvan Goyal, Dr. Arun Koul

Migraine constitutes a substantial public health challenge in India, marked by high prevalence, significant disability, and considerable socio-economic impact. Despite the availability of diverse treatment modalities, migraine remains widely underdiagnosed and undertreated. This systematic review comprehensively examines India's migraine treatment landscape, detailing conventional pharmacological agents-including Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Triptans, Tricyclic Antidepressants (TCAs), beta-blockers, and newer Calcitonin Gene-related Peptide (CGRP) inhibitors, alongside traditional Ayurvedic and Unani medicines and complementary therapies like Yoga and meditation. Emerging non-invasive neuromodulation techniques are also discussed as promising alternatives. Analysis of current prescription trends reveals the prevalent use of NSAIDs and Fixed Dose Combinations (FDCs) for acute management, and TCAs, propranolol, and flunarizine for prevention, with concerns regarding polypharmacy. Furthermore, critical gaps are identified in healthcare professional knowledge, drug information accessibility, and patient access, exacerbated by sociocultural factors and prevailing stigma. The article underscores the imperative for integrated, culturally sensitive, and policy-driven interventions to enhance patient outcomes and mitigate the national burden of this debilitating neurological disorder. It highlights the significant opportunity for combining evidence-based traditional therapies with conventional treatments to foster a more personalized and holistic treatment paradigm in India.