What are Migraines?
Migraines are caused by a neurological condition and they are generally characterized by intense, debilitating headaches. Symptoms include nausea, vomiting, difficulty speaking, numbness, tingling, and extreme sensitivity to light and sound. Migraines are often hereditary and they can affect people of all ages.
A diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other potential medical causes. The most common types of migraine headaches are those without aura (previously known as common migraines) and those with aura (previously known as classic migraines).
Migraines often begin in childhood, but they not occur until early adulthood. Women are more likely than men to suffer from migraines. Family history is one of the most common risk factors for experiencing migraines.
Migraine symptoms often appear 1-2 days before the headache itself. This window in time is known as the prodrome stage, and symptoms during this stage can include:
- food cravings
- fatigue or low energy
- frequent yawning
- neck stiffness
In migraines with aura, the aura occurs after the prodrome stage. During an aura, you may experience problems with vision, sensation, movement and speech. Some examples of these problems include:
- difficulty speaking clearly
- feeling a prickling or tingling sensation in your face, arms, or legs
- seeing shapes, light flashes, or bright spots
- temporarily losing your vision
The next phase migraine sufferers experience is known as the attack phase. This is when the actual migraine pain occurs and it’s considered the most acute or severe of the phases. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine headache can vary greatly from person to person, but symptoms may include:
- increased sensitivity to light and sound
- dizziness or feeling faint
- pain on one side of your head, either on the left side, right side, front, or back, or in your temples
- pulsing and throbbing head pain
After the attack phase, a migraine sufferer will often experience the postdrome phase. During this phase, the affected individual can experience drastic changes in mood and temperament. These effects range from feeling euphoric, excited and happy to feeling fatigued, exhausted and apathetic. A mild, dull headache may persist during this time. The length and intensity of these phases can impact migraine sufferers in varying degrees in different people.
Migraine sufferers frequently describe migraine pain as:
Migraines can also feel like a dull, steady ache. The pain may start out mild, but without treatment it will become moderate to severe in its effects. Most migraines last approximately 4 hours. If they’re not treated or you don’t respond well to treatment and medication, they can last up to 72 hours or more.
Over 50% of the people who suffer from migraines experience nausea as a symptom. The vast majority also experience vomiting and upset stomach. These symptoms may begin at the same time as the headache, but they frequently arrive one hour after the headache pain first becomes apparent.
Nausea and vomiting can be as troubling and painful as the migraine itself. If you only experience nausea, you may be able to take your usual migraine medications. Vomiting, however, can prevent you from being able to ingest medication and / or keep them in your body long enough to be absorbed. If you have to delay taking migraine medication, your migraine is very likely going to become worse.
Treating Migraine Nausea and Vomiting
If you experience nausea but you aren’t vomiting, your health practitioner may suggest medication to ease nausea called anti-nausea or antiemetic drugs. These medications can help prevent vomiting and relive the symptoms of nausea. Acupressure may also be helpful in the treatment of migraine nausea. A 2012 study determined that acupressure reduced the intensity of migraine-associated nausea after 30 minutes of treatment, so you may want to explore this further with your doctor.
Doctors diagnose migraines by observing your symptoms, performing a thorough review of your medical and family history, and completing a physical exam to rule out other potential causes. Imaging scans, such as a CT scan or MRI, can help rule out other potential causes of migraines, including tumors, abnormal brain structures and stroke.
Unfortunately, migraines cannot be cured, but a competent medical doctor can help you manage them effectively, so you experience them less often. Effective treatment can also help make the migraines you experience less severe. Your migraine treatment plan may include some or all of the following:
- Self-care migraine remedies
- Lifestyle changes including stress management and avoiding known migraine triggers.
- Over-the-counter pain or migraine medications such as NSAIDs or acetaminophen.
- Prescription migraine medications that you take daily to help prevent and reduce the frequency of migraines.
- Prescription migraine medications that you take at the first signs of a migraine to prevent it from becoming too severe.
- Prescription medications to help treat nausea and/or vomiting.
- Hormone therapy if migraines occur in relation to your menstrual cycle.
- Counselling and other mental health initiatives.
- Alternative medicine such as biofeedback, meditation, acupressure or acupuncture.
Migraine Headache Remedies
There’s also a few simple things you can do at home to help remedy the pain from your migraines:
- Lie down in a quiet, dark room.
- Massage your scalp or temples.
- Place a cold cloth over your forehead or behind your neck.
- Many people also try herbal home remedies to relieve migraines.
Medications can be used to prevent a migraine from happening or to treat it once it occurs. You may be able to find relief with over the counter medications. However, if over the counter medications are not effective, your primary care physician may prescribe other medications.
Medication Overuse Headaches
The frequent and recurring use of any migraine medication can cause what’s known as a medication overuse headache (often called a rebound headache). Persons with frequent migraine headaches are at higher risk of developing this complication. When determining how to deal with migraine headaches, speak with your doctor about the frequency of your medication intake and explore alternatives to pharmaceutical interventions.
There are surgical procedures that have shown great promise in the treatment of migraine headaches, but they haven’t yet been approved by the U.S. Food and Drug Administration (FDA). These emerging procedures include neurostimulation procedures and migraine trigger site decompression surgery (MTSDS).
During these procedures, a surgeon will insert electrodes under your skin and deliver electrical stimulation to specific nerves. Several forms of stimulators are currently being tested, including:
- occipital nerve stimulators
- deep brain stimulators
- vagal nerve stimulators
- sphenopalatine ganglion stimulators
Migraine Trigger Site Decompression Surgery (MTSDS)
MTSDS is surgical procedure which involves releasing nerves around the head and face that play a role as trigger sites for chronic migraines. Botox injections (Onabotulinumtoxin A) are used to identify the trigger point nerves involved during a migraine attack. Under sedation, the surgeon deactivates or decompresses the isolated nerves.
Please note, The American Headache Society does not endorse the treatment of migraine headaches with MTSDS. Rather, they recommend that anyone considering this procedure have an evaluation completed by a headache specialist to discuss the risks first. These surgeries are considered experimental until further studies can demonstrate that they work safely and consistently. However, MTSDS may play an important role for individuals that haven’t responded positively to other forms of treatment.
What causes Migraines?
To date, researchers have been unable to identify a definitive cause for migraines. However, they have discovered some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in levels of the brain chemical serotonin. Other factors that may trigger a migraine include:
- bright lights
- severe heat, or other extremes in weather
- changes in barometric pressure
- hormone changes in women, such as estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
- excess stress
- loud sounds
- intense physical activity
- skipping meals
- changes in sleep patterns
- use of certain medications, such as oral contraceptives or nitroglycerin
- unusual smells
- certain foods
- alcohol use
If you experience a migraine headache, your physician may ask you to maintain a headache journal. Writing down what you were doing, what foods you ate, and what medications you were taking before your migraine began can play an important role in identifying your individual migraine triggers.
Foods that Trigger Migraines
Certain foods or food ingredients may be more likely to trigger migraines than others. These may include:
- alcohol or caffeinated drinks
- food additives, such as nitrates (a preservative in cured meats), aspartame (an artificial sugar), or monosodium glutamate (MSG)
- tyramine, which occurs naturally in some foods
Types of Migraines
There are many types of migraines. The two most common types are migraine without aura and migraine with aura. Many people that suffer from migraines experience more than one type of migraine.
Migraine without aura
This type of migraine used to be called common migraine. Most people with migraine don’t experience an aura. According to the International Headache Society, individuals that have experienced migraine without aura have had at least five attacks that have these characteristics:
Headache attack usually lasting 4 to 72 hours if it’s not treated or if treatment doesn’t work.
Headache has at least two of these traits:
it occurs only on one side of the head (unilateral)
pain is pulsating or throbbing
pain level is moderate or severe
pain gets worse when you move, like when walking or climbing stairs
Headache has at least one of these traits:
it makes you sensitive to light (photophobia)
it makes you sensitive to sound (phonophobia)
you experience nausea with or without vomiting or diarrhea
Headache isn’t caused by another health problem or diagnosis.
Migraine with aura
This type of migraine used to be called classic migraine, complicated migraine or hemiplegic migraine. Migraine with aura occurs in over 25% of people who suffer from migraines.
According to the International Headache Society, you must have experienced at least two attacks that have these characteristics:
An aura that goes away, is completely reversible, and includes at least one of these symptoms:
visual problems (the most common aura symptom)
sensory problems of the body, face, or tongue, such as numbness, tingling, or dizziness
speech or language problems
problems moving or weakness, which may last up to 72 hours
brainstem symptoms, which includes:
difficulty talking or dysarthria (unclear speech)
vertigo (a spinning feeling)
tinnitus or ringing in the ears
hypacusis (problems hearing)
diplopia (double vision)
ataxia or an inability to control body movements
eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur they’re called retinal migraines)
An aura that has at least two of these traits:
at least one symptom spread gradually over five or more minutes
each symptom of the aura lasts between five minutes and one hour (if you have three symptoms, they may last up to three hours)
at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
aura occurs with the headache or one hour before the headache begins
Headache isn’t caused from another health problem and transient ischemic attack has been excluded as a cause.
An aura usually occurs before the headache pain begins, but it can continue once the headache appears. Alternatively, an aura may start at the same time as the headache does. Learn more about these two types of migraines:
Chronic migraines used to be called combination or mixed headache because it can manifest in features of both migraine and tension headaches. It’s also called severe migraine and it can be caused by medication overuse. People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura. Compared to people who have acute migraines, people with chronic migraines are more likely to have:
- severe headaches
- more disability at home and away from home
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), such as high blood pressure
- previous head or neck injuries
Acute migraine is a general term for migraines that aren’t diagnosed as chronic. Another name for this type is episodic migraine. People who have episodic migraines often experience headaches up to 14 days a month. Thus, people with episodic migraines have fewer headaches in a given month than people with chronic migraines.
Vestibular migraine is also known as migraine-associated vertigo. About 40% of individuals who experience migraines have some vestibular symptoms. These symptoms can affect your balance, cause dizziness, or both. People of any age, including children, may experience vestibular migraines.
Neurologists typically treat people who have difficulty managing their migraines, including vestibular migraines. Medications for this type of migraine are similar to those used for other types of migraine headaches. Vestibular migraines are also sensitive to foods that trigger migraines, so you may be able to prevent or ease vertigo and other related symptoms by making small changes or modifications to your diet.
Optical migraine is also known as eye migraine, ocular migraine, ophthalmic migraine, monocular migraine, and retinal migraine. This is a rare type of migraine with aura, but unlike other visual auras, it affects only one eye. The International Headache Society defines retinal migraines as attacks of fully reversible and temporary vision problems in only one eye. The symptoms may include:
- flashes of light, called scintillations
- a blind spot or partial loss of vision, called scotomata
- loss of vision in one eye
These vision problems usually occur within an hour of the appearance of a headache. Sometimes optical migraines are painless. Most people who have an optical migraine have experienced another type of migraine before.
Complex migraine isn’t a type of headache. Rather, complex or complicated migraine is a general way to describe migraines, though it’s not a very clinically accurate way to describe them. Some people use “complex migraine” to mean migraines with auras that have symptoms that are similar to symptoms of a stroke. These symptoms include:
- trouble speaking
- loss of vision
Menstrual-related migraines affect over 60% of women who experience one type of migraine or another. They can occur with or without an aura, and they can occur before, during or after menstruation and during ovulation.
Research has shown that menstrual migraines tend to be more intense, last longer, and have more significant nausea than migraines not associated with the menstrual cycle. In addition to standard treatments for migraines, women with menstrual-related migraines may also benefit from medications that affect serotonin levels as well as hormonal treatments.
Acephalgic migraine is also known as migraine without headache, aura without headache, silent migraine and visual migraine without headache. Acephalgic migraines occur when a person has an aura, but doesn’t experience a painful headache. This type of migraine is not common in people who start experiencing migraines after the age of 40. Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur with symptoms spreading over several minutes and they may shift from one symptom to another. After visual symptoms, people may experience numbness, speech problems, and then feel weak and unable to move a part of their body normally.
Also known as menstrual migraines and exogenous estrogen withdrawal headaches, hormonal migraines are linked with the female hormones, commonly estrogen. They include migraines during:
- your period
- the first few days after you start or stop taking medications that have estrogen in them, such as birth control pills or hormone therapy
If you’re being treated with hormone therapy and have an increase in headaches, you might consider speaking with your doctor about:
- adjusting your dosage
- changing the type of hormones
- stopping hormone therapy
Stress migraine isn’t a type of migraine recognized by the International Headache Society. However, stress can be a migraine trigger.These are also called tension-type headaches or ordinary headaches. If you think stress may be triggering your migraines, consider yoga as a form of relief.
Cluster migraine isn’t a migraine type defined by the International Headache Society. However, there are cluster headaches which cause extreme pain around and behind the eye, often with:
- tearing on one side
- nasal congestion
They can be brought on by alcohol or excessive smoking. You can experience both cluster headaches as well as migraines.
Vascular migraine isn’t a migraine type defined by The International Headache Society. Vascular headache is a term that some people use to describe a throbbing headache and pulsation caused by a migraine.
Migraines in Children
Children can experience many of the same types of migraines as adults. Children and teens, like adults, can also experience depression and anxiety disorders along with their migraines. Until they’re in their teenage years, children are more likely to experience symptoms on both sides of the head. It’s rare for children to have headache pain in the back of the head. Their migraines tend to last 2 to 72 hours. A few migraine variants are more common in children. These include abdominal migraine, benign paroxysmal vertigo and cyclic vomiting.
Children with abdominal migraines may have a stomach ache instead of a headache. The pain can be moderate or severe. Typically, the pain is felt in the middle of the stomach, in the area of the belly button. However, the pain may not be specific to this area. Children who experience abdominal migraines are likely to develop more typical migraine symptoms as adults.
Benign Paroxysmal Vertigo
Benign paroxysmal vertigo can occur in toddlers and young children. It often occurs when a child suddenly becomes unsteady and refuses to walk, or walks with their feet spread wide. They may or may not vomit. They may also experience a headache. Another frequently observed symptom is rapid eye movements (nystagmus). These attacks generally last from a few minutes to a few hours.
Cyclic vomiting frequently occurs in school-aged children. Forceful vomiting may occur 4-5 times an hour for at least one hour. Your child may also experience:
- stomach pain
- sensitivity to light or sound
In between bouts of vomiting, your child may act and feel completely normal. Attacks can occur a week or more apart, and the symptoms may develop a pattern of occurrence that becomes somewhat recognizable and predictable.
Migraines and Pregnancy
For many women, the severity of their migraines actually improve during pregnancy. However, they often become worse following delivery due to sudden and drastic hormonal shifts. Headaches during pregnancy require special attention to ensure that the root cause of the headache is properly understood. Research is ongoing, but a recent study determined that women with migraine during pregnancy experienced a higher rate of:
- preterm or early delivery
- a baby born with low birth weight
Certain migraine medications are not considered safe during pregnancy. If you experience migraines during pregnancy, please consult with your doctor to explore methods to treat your migraines that won’t harm your baby.
Migraines vs Tension Headaches
Migraine and tension headache, the most common type of headache, share some similar symptoms. However, migraines are also associated with many symptoms not shared by tension headaches. Migraines and tension headaches also respond differently to the same treatments. Both tension headaches and migraines can have:
- mild to moderate pain
- a steady ache
- pain on both sides of the head
Only migraines can have these symptoms:
- moderate to severe pain
- pounding or throbbing
- an inability to do your usual activities
- pain on one side of the head
- nausea with or without vomiting
- an aura
- sensitivity to light, sound, or both
The following actions can help prevent a migraine headache:
- Learn what triggers your migraines and avoid those things.
- Stay hydrated. Per day, Men should drink about 13 cups of fluids and women should drink 9 cups.
- Avoid skipping meals.
- Get quality sleep. A good night’s sleep is important for overall health.
- Quit smoking.
- Make it a priority to reduce stress in your life and learn to cope with it in helpful ways.
- Learn relaxation skills.
- Exercise regularly. Exercise may help you not only reduce stress but also lose weight. Experts believe obesity is linked to migraines. Be sure to start exercising slowly to warm up gradually. Starting too fast and intensely can trigger a migraine.
- Talk to your doctor
Sometimes the symptoms of a migraine headache can mimic those of a stroke. It’s important to seek immediate medical attention if you or a loved one has a headache that:
- causes slurred speech or drooping on one side of the face
- causes new leg or arm weakness
- comes on very suddenly and severely with no lead-in symptoms or warning
- occurs with a fever, neck stiffness, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
- has an aura where the symptoms last longer than an hour
- would be called the worst headache ever
- is accompanied by loss of consciousness
Make an appointment to see your doctor if your headaches start to affect your daily life. Let them know if you experience pain around your eyes or ears, or if you have multiple headaches a month that last for several hours or days. Migraine headaches can be severe, debilitating and terribly uncomfortable. There are many treatment options available, so be patient finding the one or combination that’s best for you. Keep track of your headaches and symptoms in order to identify migraine triggers. Knowing how to prevent migraines can often be the first step in managing them effectively.