Understanding Migraines

Migraines are far more than just bad headaches. They are a complex neurological condition that can cause debilitating symptoms and significantly impact daily life. If you experience migraines, understanding your condition can help you identify triggers, find effective treatments, and regain control of your health and well-being.

What Are Migraines?

A migraine is a type of primary headache disorder characterized by recurrent episodes of moderate to severe throbbing pain, usually on one side of the head. Migraines often come with additional symptoms such as nausea, vomiting, and extreme sensitivity to light and sound. Episodes can last anywhere from 4 to 72 hours if untreated.

Migraines affect approximately 1 billion people worldwide, making them the third most prevalent illness globally. They are most common between ages 25 and 55 and affect women three times more often than men, largely due to hormonal factors. Many people with migraines have a family history of the condition.

Types of migraines include:

• Migraine without aura - The most common type, accounting for about 70-90% of migraines
• Migraine with aura - Preceded by sensory warning symptoms, typically visual disturbances
• Chronic migraine - Headaches occurring 15 or more days per month for at least 3 months
• Vestibular migraine - Characterized by dizziness and balance problems
• Hemiplegic migraine - Causes temporary weakness on one side of the body
• Menstrual migraine - Occurs in relation to the menstrual cycle
• Migraine with brainstem aura - Aura symptoms originating from the brainstem

Causes and Risk Factors

The exact cause of migraines isn’t fully understood, but they’re believed to result from abnormal brain activity affecting nerve signals, chemicals, and blood vessels in the brain.

Risk factors include:

• Family history of migraines
• Gender (women are more affected)
• Age (peak occurrence in 30s and 40s)
• Hormonal changes
• History of other headache disorders

Common migraine triggers:

• Stress and anxiety
• Hormonal changes (menstruation, pregnancy, menopause)
• Sleep changes (too much or too little)
• Skipping meals or fasting
• Dehydration
• Certain foods (aged cheese, processed meats, chocolate, artificial sweeteners)
• Alcohol, especially red wine
• Caffeine (too much or withdrawal)
• Weather changes or barometric pressure shifts
• Strong smells or bright lights
• Physical exertion
• Certain medications

Common Symptoms

Migraines often progress through distinct phases, though not everyone experiences all stages.

Prodrome (1-2 days before):

• Mood changes (depression, irritability, euphoria)
• Food cravings
• Neck stiffness
• Increased thirst and urination
• Frequent yawning
• Constipation

Aura (5-60 minutes before or during):

• Visual disturbances (flashing lights, zigzag lines, blind spots)
• Tingling or numbness in face or extremities
• Speech difficulties
• Weakness on one side of the body
• Hearing sounds or music

Headache phase (4-72 hours):

• Throbbing or pulsating pain, usually on one side
• Sensitivity to light, sound, and sometimes smell or touch
• Nausea and vomiting
• Blurred vision
• Lightheadedness or fainting
• Pain worsened by physical activity

Postdrome (up to 24 hours after):

• Fatigue and exhaustion
• Confusion
• Mood changes
• Dizziness
• Continued sensitivity to light and sound
• Weakness

Diagnosis

There’s no specific test for migraines. Diagnosis is based on your medical history, symptoms, and ruling out other conditions.

Diagnostic process:

• Medical history review - Detailed discussion of your headaches, their characteristics, frequency, and impact
• Headache diary - Record of headache patterns, triggers, and symptoms
• Physical and neurological examination - Checking reflexes, coordination, sensation, and vision
• Imaging tests - MRI or CT scan to rule out other causes (tumors, stroke, structural abnormalities)
• Blood tests - To rule out underlying conditions

Criteria for migraine diagnosis typically include:

• At least 5 attacks lasting 4-72 hours
• Pain with at least two characteristics: one-sided, pulsating, moderate to severe intensity, worsened by activity
• At least one accompanying symptom: nausea/vomiting or light and sound sensitivity

Treatment Options

Migraine treatment focuses on relieving symptoms during attacks and preventing future episodes.

Acute treatments (taken during an attack):

• Over-the-counter pain relievers - Aspirin, ibuprofen, acetaminophen (most effective when taken early)
• Triptans - Prescription medications that block pain pathways (sumatriptan, rizatriptan)
• Gepants - Newer medications blocking CGRP (ubrogepant, rimegepant)
• Ditans - Another newer class (lasmiditan)
• Ergotamines - For longer-lasting migraines
• Anti-nausea medications - To address nausea and vomiting
• Combination medications - Such as Excedrin Migraine

Preventive treatments (taken regularly):

• Beta-blockers - Propranolol, metoprolol
• Antidepressants - Amitriptyline, venlafaxine
• Anti-seizure medications - Topiramate, valproate
• CGRP monoclonal antibodies - Erenumab, fremanezumab, galcanezumab (monthly injections)
• Botox injections - For chronic migraines
• Blood pressure medications - Certain calcium channel blockers

Device-based treatments:

• Transcranial magnetic stimulation
• Vagus nerve stimulation
• External trigeminal nerve stimulation

What You Can Do

Self-management strategies can help reduce migraine frequency and severity.

1. Identify your triggers - Keep a detailed headache diary tracking potential triggers, including foods, sleep, stress, weather, and hormonal changes. Look for patterns.

2. Maintain regular sleep habits - Go to bed and wake up at consistent times, even on weekends. Aim for 7-8 hours of quality sleep.

3. Stay hydrated - Dehydration is a common trigger. Drink water throughout the day and limit alcohol and caffeine.

4. Eat regular, balanced meals - Don’t skip meals. Maintain stable blood sugar by eating regular, nutritious meals. Identify and avoid food triggers.

5. Manage stress - Practice stress-reduction techniques like meditation, yoga, deep breathing, or progressive muscle relaxation. Regular exercise also helps.

6. Create a migraine toolkit - Keep supplies ready: medications, cold pack, eye mask, earplugs, and a quiet dark space to retreat to during an attack.

7. Exercise regularly - Moderate, consistent aerobic exercise can reduce migraine frequency. Start gradually to avoid triggering exercise-induced migraines.

8. Limit medication overuse - Taking acute medications more than 2-3 days per week can lead to medication overuse headaches, worsening the cycle.

9. Consider supplements - Some supplements may help prevent migraines: magnesium, riboflavin (vitamin B2), Coenzyme Q10, and feverfew. Discuss with your doctor.

10. Track your headaches - Use a diary or app to monitor frequency, severity, triggers, and treatment effectiveness. This information helps your doctor optimize your treatment.

When to See a Doctor

Consult a healthcare provider if:

• Your headaches are becoming more frequent or severe
• Over-the-counter medications aren’t providing relief
• Migraines are affecting your work, relationships, or daily activities
• You’re using acute medications more than twice a week
• Your headache pattern changes
• You’ve never been diagnosed but suspect migraines

Seek emergency care if you experience:

• A sudden, severe headache unlike any before (“thunderclap headache”)
• Headache with fever, stiff neck, confusion, seizures, double vision, weakness, numbness, or difficulty speaking
• Headache after a head injury
• Chronic headache that worsens with coughing, exertion, or sudden movement
• New headache if you’re over 50

Key Takeaways

• Migraines are a neurological condition involving more than just head pain, with symptoms that can include nausea, sensitivity to light and sound, and visual disturbances
• Identifying and avoiding personal triggers is essential for reducing migraine frequency
• Treatment includes both acute medications for attacks and preventive treatments for frequent migraines
• Lifestyle modifications such as regular sleep, stress management, and consistent meals play a significant role in migraine management