What are migraines?
Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.
What causes migraines?
Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine, including
- Hormonal changes in women
- Bright or flashing lights
- Loud noises
- Strong smells
- Too much or not enough sleep
- Sudden changes in weather or environment
- Overexertion (too much physical activity)
- Caffeine or caffeine withdrawal
- Skipped meals
- Medication overuse (taking medicine for migraines too often)
- Certain foods and food additives such as
- Aged cheeses
- Mono sodium glutamate (MSG)
- Some fruits and nuts
- Fermented or pickled goods
- Cured or processed meats
Who is at risk for migraines?
About 12 percent of Americans get migraines. They can affect anyone, but you are more likely to have them if you
- Are a woman. Women are three times more likely than men to get migraines.
- Have a family history of migraines. Most people with migraines have family members who have migraines.
What are the symptoms of migraines?
There are four different phases of migraines. You may not always go through every phase each time you have a migraine.
- Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
- Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
- Headache. A migraine usually starts gradually and then becomes
more severe. It typically causes throbbing or pulsing pain, which is often on
one side of your head. But sometimes you can have a migraine without a
headache. Other migraine symptoms may include
- Increased sensitivity to light, noise, and odors
- Nausea and vomiting
- Worsened pain when you move, cough, or sneeze
- Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.
Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.
How are migraines diagnosed?
- Take your medical history
- Ask about your symptoms
- Do a physical and neurological exam
An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms of migraines. So you may also have blood tests, an MRI or CT scan, or other tests.
How are migraines treated?
There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.
There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.
There are also other things you can do to feel better:
- Resting with your eyes closed in a quiet, darkened room
- Placing a cool cloth or ice pack on your forehead
- Drinking fluids
There are some lifestyle changes you can make to prevent migraines:
- Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
- Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
- Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
- If you have obesity, losing weight may also be helpful
If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.
Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.
Migraine is the most common cause of recurrent moderate to severe headache; 1-yr prevalence is 18% for women and 6% for men in the US. Migraine most commonly begins during puberty or young adulthood, waxing and waning in frequency and severity over the ensuing years; it often diminishes after age 50. Studies show familial aggregation of migraine.
Evidence based on evaluation of veterans of the Iraq and Afghanistan conflicts suggests that migraine may frequently develop after mild traumatic brain injury.
Migraine is thought to be a neurovascular pain syndrome with altered central neuronal processing (activation of brain stem nuclei, cortical hyperexcitability, and spreading cortical depression) and involvement of the trigeminovascular system (triggering neuropeptide release, which causes painful inflammation in cranial vessels and the dura mater).
Many potential migraine triggers have been identified; they include the following:
- Drinking red wine
- Skipping meals
- Excessive afferent stimuli (eg, flashing lights, strong odors)
- Weather changes
- Sleep deprivation
- Hormonal factors, particularly menstruation
- Certain foods
Food triggers vary from person to person.
Fluctuating estrogen levels are a potent migraine trigger. Many women have onset of migraine at menarche, severe attacks during menstruation (menstrual migraine), and worsening during menopause. For most women, migraines remit during pregnancy (but sometimes they worsen during the 1st or 2nd trimester); they worsen after childbirth, when estrogen levels decrease rapidly.
Oral contraceptives and other hormone therapy occasionally trigger or worsen migraine and have been associated with stroke in women who have migraine with aura.
Familial hemiplegic migraine, a rare subtype of migraine, is associated with genetic defects on chromosomes 1, 2, and 19. The role of genes in the more common forms of migraine is under study.
- Symptoms and sign: Often, a prodrome (a sensation that a migraine is beginning) heralds attacks. The prodrome may include mood changes, loss of appetite, nausea, or a combination. An aura precedes attacks in about 25% of patients. Auras are temporary neurologic disturbances that can affect sensation, balance, muscle coordination, speech, or vision; they last minutes to an hour. The aura may persist after headache onset. Most commonly, auras involve visual symptoms (fortification spectra—eg, binocular flashes, arcs of scintillating lights, bright zigzags, scotomata). Paresthesias and numbness (typically starting in one hand and marching to the ipsilateral arm and face), speech disturbances, and transient brain stem dysfunction (causing, for example, ataxia, confusion, or even obtundation) are less common than visual auras. Some patients have an aura with little or no headache.Headache varies from moderate to severe, and attacks last from 4 h to several days, typically resolving with sleep. The pain is often unilateral but may be bilateral, most often in a frontotemporal distribution, and is typically described as pulsating or throbbing.
Migraine is more than a headache. Associated symptoms such as nausea (and occasionally vomiting), photophobia, sonophobia, and osmophobia are prominent. Patients report difficulty concentrating during attacks. Routine physical activity usually aggravates migraine headache; this effect, plus the photophobia and sonophobia, encourages most patients to lie in a dark, quiet room during attacks. Severe attacks can be incapacitating, disrupting family and work life.
Attacks vary significantly in frequency and severity. Many patients have several types of headache, including milder attacks without nausea or photophobia; they may resemble tension-type headache but are a forme fruste of migraine.
Patients with episodic migraine can develop chronic migraine. These patients have headaches ≥ 15 days/mo. This headache disorder used to be called combination or mixed headache because it had features of migraine and tension-type headache. These headaches often develop in patients who overuse drugs for acute treatment of headaches.
Other, rare forms of migraine can cause other symptoms:
- Basilar artery migraine causes combinations of vertigo, ataxia, visual field loss, sensory disturbances, focal weakness, and altered level of consciousness.
- Hemiplegic migraine, which may be sporadic or familial, causes unilateral weakness.
A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.
Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant.
Migraine attacks may be triggered by any of the following:
- Caffeine withdrawal
- Changes in hormone levels during a woman’s menstrual cycle or with the use of birth control pills
- Changes in sleep patterns, such as not getting enough sleep
- Drinking alcohol
- Exercise or other physical stress
- Loud noises or bright lights
- Missed meals
- Odors or perfumes
- Smoking or exposure to smoke
- Stress and anxiety
Migraines can also be triggered by certain foods. Most common are:
- Dairy foods, especially certain cheeses
- Foods with monosodium glutamate (MSG)
- Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
- Fruits (avocado, banana, citrus fruit)
- Meats containing nitrates (bacon, hot dogs, salami, cured meats)
- Peanuts and other nuts and seeds
- Processed, fermented, pickled, or marinated foods
True migraine headaches are not a result of a brain tumor or other serious medical problem. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition.