Migraines, though less common than typical headaches, are painful episodes of moderate to severe head pain. Most patients with migraines experience these episodes once or twice a month, and they typically last between 4 to 72 hours. Often, migraine attacks are severe enough to interfere with daily activities and normal everyday functioning. Migraines are experienced by about 12 percent of the US population, and almost 1 in 4 US households include a person suffering from migraines. They are three times more common in women than in men, can occur in children, and are most frequent in patients between the ages of 25 and 55. People whose close family members also suffer from migraines have an increased chance of suffering from migraines.
Treatment with medications and/or lifestyle changes can often help reduce the severity, as well as the frequency, of migraine attacks. Consider speaking with a medical provider if you are looking for help managing the symptoms associated with migraines.
What is a Migraine?
It is important to keep in mind that not all headaches are migraines, and there are different types of very severe headaches. For example, a cluster headache is a less common, very intense, recurring, and isolated (occurring in a “cluster”) headache that can be worse than a migraine. Migraines are also different than typical headaches, or tension headaches.
Migraines typically present suddenly, with intense pain, and unilaterally. These one-sided headaches are experienced as a throbbing or pounding sensation in the head, and symptoms can be worsened by physical activity. Patients can also experience a sensitivity to light or sound, nausea, and vomiting during or immediately prior to experiencing a migraine. Though migraines are typically experienced as pain on one side of the head, about 1/3 of migraine episodes affect both sides of the head.
The severity of migraines is often debilitating and can interfere with work, school, or everyday social activities and responsibilities. Symptoms of a migraine attack vary from patient to patient, and can even differ between different attacks in the same patient.
Half of all migraine sufferers had their first migraine attack before the age of 12. Migraines can begin at any age, though they are more common during active adulthood (ages 25 to 55.) Although post-pubertal women are more likely to experience migraines, young boys are more likely than pre-pubertal young girls to get a migraine attack.
Migraines are also referred to as Migraine disorders, Migraine headaches, Migraine attacks, or Sick headaches.
What Causes Migraines?
The exact cause of migraines is not fully understood. Current scientific thought points to both genetic and environmental influences causing migraines. Some believe that migraines occur when blood vessels in the brain become constricted or inflamed. Migraines may also be caused by imbalances in neurotransmitters, or chemicals in the brain, such as serotonin. Lower than normal levels of serotonin trigger the body’s trigeminal system to release neuropeptides, which cause head pain by traveling to the brain’s meninges, or outer covering.
Other theories have focused on the inherited component as the cause of migraines, and believe that migraines are neurological abnormalities due to genetic mutations. Researchers at the National Institute of Neurological Disorders and Stroke have found a mutation in a gene that codes for a potassium ion channel, the TRESK gene. These potassium ion channel mutations can yield overactive nerve cells that have much lower thresholds for responding to pain levels, thus producing the sudden and intense pain associated with migraine headaches. Statistics have shown the strong genetic component to migraine attacks. Patients with one parent who suffers from migraines have a 40% chance of also suffering from migraines, while patients with both parents who suffer from migraines have up to a 90% chance of having migraine attacks.
Although the exact cause of migraines is not fully comprehended, there are certain known triggers that lead to migraine attacks. Such migraine triggers include:
- Hormonal changes (particularly changes in estrogen in women before or during menstruation, pregnancy, or menopause)
- Lack of sleep
- Too much sleep, oversleeping
- Intense physical exertion (including sexual activity)
- Lack of food
- Weather or environmental changes, such as changes in barometric pressure
- Exposure to light (usually bright light or sun glare)
- Loud sounds
- Strong smells (perfume, secondhand smoke, paint)
- Aged cheeses
- Salty foods
- Dairy products
- Red wine
- Processed foods
- Food additives such as aspartame or monosodium glutamate
- Oral contraceptives
- Hormone replacement therapy
Signs and Symptoms of a Migraine
Patients often notice they are experiencing a migraine due to the sudden, intense, and throbbing pain in a localized part of the head.
There are four stages of a migraine attack – prodrome, aura, headache, and postdrome – although some patients may not experience all four stages each time a migraine attack occurs.
The prodrome stage typically occurs 24 to 48 hours prior to the onset of a migraine. Symptoms may include:
- Food cravings
- Stiffness of the neck
- Persistent and uncontrollable yawning
The second stage, the aura stage, includes neurological symptoms that typically last between 20-60 minutes and occur prior to migraine symptoms. Symptoms of auras are not long-lasting, and occur in about 15-20% of migraine attacks. Not all patients who have migraines experience auras. Auras may be alarming to some patients, as the symptoms often mimic what seems to be a stroke. Symptoms of auras may include:
- Loss of vision (temporary)
- Blind spot
- Distorted or blurry vision
- Visual phenomena – flashing lights, flashing dots, strange shapes, wavy lines, jagged lines, blind spots
- Sensation of tingling and “pins and needles” in the extremities (arms or legs) or face
- Speech or language difficulties
- Limb weakness
- Numbness or weakness in one side of the body
The migraine headache is the third stage. This stage includes symptoms that are typically associated with migraine attacks. The International Headache Society has set guidelines for diagnosing migraines based on the pain it causes and the number of attacks. Contingent on this classification, migraines are diagnosed after at least 5 attacks of mild to intense head pain, with each episode lasting between 4-72 hours if no medical intervention or treatment is sought. Additional migraine symptoms include the following, and not all symptoms are seen with every patient, or at each migraine attack:
- Throbbing, intense, pounding/pulsating pain (typically on one side of the head, can be seen on both sides of the head)
- Eye pain
- Sensitivity to light (photophobia)
- Sensitivity to sounds (phonophobia)
- Sensitivity to smells (osmophobia)
- Sensitivity to touch
- Blurry vision
- Sensations of being warm or cold
- Feelings of lightheadedness
- Fever (this is rare)
The postdrome stage is the fourth and final stage of a migraine attack. While most patients feel some level of exhaustion, some patients have noted feelings of euphoria in this post-headache stage.
Prevention of Migraines
When dealing with migraine attacks, two routes for medical care include prevention of the onset of symptoms, and treatment of existing symptoms.
Migraine prevention varies among patients who suffer from these attacks. Techniques and options for prevention include:
- Lifestyle changes
- Changes in diet (avoiding certain foods may help those whose migraines are triggered by particular foods)
- Increasing water intake and hydration
- Dietary supplements
- Herbal medicinal products
- Cognitive behavioral therapy or other psychological techniques
- Biofeedback mechanisms
- Massage therapy
- Yoga, meditation, or other relaxation techniques – these can help prevent triggers as well as manage pain associated with migraines
Obese patients suffering from recurring migraines may find relief after managing their weight through a weight loss program.
Some patients find it helpful to document their migraine attacks, so they may identify certain triggers that lead to these headaches, and make proactive lifestyle changes to avoid the probability of future attacks.
Preventive medications can be helpful in patients who experience long-lasting and/or frequent headaches. These are taken every day, to minimize the frequency, severity, and duration of migraine headaches and attacks. Sometimes, preventive medications are taken before certain expected triggers, such as prior to the onset of menses each month in women. Examples of preventive medications include:
- Blood pressure medications – such as propranolol (Inderal), nadolol (corgard), verapamil (Clan, Covera, Isoptin, Verelan), flunarizine
- Anti-seizure medications – such as divalproex sodium (Depakote), topiramate (Topamax), gabapentin (Neurontin, Gralise)
- Antidepressant medications – such as amitriptyline, venlafaxine
- Supplements – such as magnesium, butterbur, riboflavin, vitamin B12, coenzyme Q10
Some patients who experience almost daily migraines are sometimes given Botox (Botulinum toxin A) injections, in an attempt to lessen the severity and frequency of the migraine attacks.
It is important to keep in mind that certain patients are more susceptible, or genetically predisposed to, suffering from migraine attacks. Techniques for prevention can help manage migraine symptoms, but are not guaranteed to completely eliminate the possibility of attacks.
Treatment of a Migraine
Treatment of migraines can often be difficult, as the specific causes are not fully understood. Treatment of migraines involves management of symptoms, as there is no cure for migraine attacks. Treating the symptoms associated with migraine headaches often involves medications, both over-the-counter and prescription. The specific course of treatment depends on how often and how long each migraine episode lasts.
Many people find that lying down in a quiet, dark room helps relieve the headaches associated with migraine attacks. Other helpful techniques include placing a cool towel over the eyes, or using a cooling pad over the affected side of the head.
Certain over-the-counter medications can help relieve migraine symptoms, such as:
- Acetaminophen (Tylenol)
- Ibuprofen (Advil, Motrin)
- Combination of acetaminophen, aspirin, and caffeine (Excedrin Migraine)
Common prescription medications for pain relieve due to migraines include:
- Sumatriptan (Imitrex, Alsuma, Sumavel DosePro)
- Rizatriptan (Maxalt)
- Eletriptan (Relpax)
- Zolmitriptan (Zomig)
- Naratriptan (Amerge)
- Almotriptan (Axert)
- Frovatriptan (Frova)
- Combination of sumatriptan and naproxen sodium (Treximet)
When Should I Call a Doctor?
Many patients with migraines do not seek medical care, and migraines are often undiagnosed and untreated.
Pregnant women who commonly suffer from migraines are encouraged to seek medical advice early in or before their pregnancy, to develop a safe treatment and prevention plan during their pregnancy.
Consider speaking with a medical provider if you are experiencing side effects from any medications you take to manage migraine headache pain.
Although sensitivity to light is a common symptom of migraine headaches, it is rare to experience eye pain. If you are experiencing pain in your eye, either alone or in combination with blurry vision or temporary blindness, you should speak with a medical provider as soon as possible.
If you are experiencing any new or unusual symptoms associated with a migraine headache, speak with a medical provider.
Rarely, migraine-like symptoms are indications of much more serious conditions, such as an aneurysm or tumor. Although uncommon, these conditions may become severe and life-threatening. New, sudden, and extremely painful headaches (“the worst headache of your life,”) headaches that wake you up in the night, headaches that occur after an injury or accident, or headaches that lead to unusual changes in behavior warrant medical evaluation. Circumstances and migraine-related symptoms that are emergency warning signs include:
- Unstoppable and uncontrollable vomiting – this may lead to dehydration or signal a stroke
- Unstoppable and uncontrollable diarrhea – this may lead to dehydration or signal a stroke
- Migraines lasting longer than 72 hours – this may increase your risk of a stroke
- The worst headache or migraine of your life – this may be a sign of an aneurysm
- A fever with a stiff neck – this may be a sign of meningitis
- Difficulty speaking, difficulty walking, with severe vomiting and nausea – this may be a sign of a hemorrhagic stroke
If you experience any of these signs, head to the closest Emergency Room. If possible, have somebody else drive you.
If you are worried about symptoms related to migraine headaches, or would like medical advice regarding the possibility of migraine attacks, consider setting up an appointment and discussing your questions and concerns with a medical provider.