Quick checklist of signs of a migraine
You may notice the following symptoms one or two days before a migraine, called the prodrome phase, and it may be absent in some individuals:
- Constipation.
- Mood shifts from depression to elation.
- Food cravings.
- Neck stiffness.
- Increased urination.
- Fluid retention.
- Frequent yawning.
Migraine aura includes:
- Visual changes, such as seeing shapes, bright spots, or flashes of light.
- Temporary vision loss.
- A sensation of pins and needles in an arm or leg.
During a migraine attack, you might experience the following symptoms:
- Pain usually occurs on one side of your head, but it can happen on both sides.
- Throbbing or pulsing pain.
- Sensitivity to light, sound, and sometimes smell and touch.
- Nausea and vomiting.
What is a migraine?
A migraine is a type of headache marked by severe, throbbing, or pulsating pain, usually affecting one side of the head. It often comes with symptoms such as nausea, vomiting, and increased sensitivity to light and sound. Migraine attacks can last from hours to days, and the pain can be so intense that it disrupts daily activities.
Some people experience a warning sign called an aura before or during a migraine. An aura may include visual phenomena such as flashes of light or blind spots. It can also cause tingling sensations on one side of the face or in an arm or leg, and may result in speech difficulties.
Medicines can prevent certain migraines and reduce their severity. Using medication along with self-help strategies and lifestyle adjustments may provide additional relief.
What types of migraines exist?
The most common migraine types are:
- Migraine with aura, also known as classic migraine.
- Migraine without aura, also known as common migraine.
An aura is a phase of migraine that happens before head pain begins.
Other relatively uncommon types of migraines include:
- Migraines in Children: Migraines can affect kids too. While they are the same condition as in adults, children often experience different symptoms. Typically, children’s migraines involve both sides of the head, unlike adults who usually have one-sided migraines. Also, migraine episodes in kids tend to last shorter than in adults. However, childhood migraines can still be disabling, leading kids to miss school, sports, and other activities.
- Chronic migraine: involves frequent or long-lasting headaches and migraine episodes. Symptoms can vary daily or hourly, making it difficult to tell where one migraine or headache ends and the next begins.
- Hemiplegic migraine: is a form of migraine marked by standard migraine symptoms combined with muscle weakness on one side of the body. This weakness typically starts during the aura phase, either before or during the headache. Sensory, visual, or speech problems can also accompany it.
- Menstrual migraines: are a common form of migraine that happens around your period, caused by hormonal changes. These headaches are typically unilateral and may worsen with movement, light, smells, or noise. Symptoms often last for several hours but can sometimes persist for days.
- Silent migraines: also known as migraines without a headache, are characterized by aura symptoms and changes in sensory perception rather than the usual throbbing pain. Although they do not cause severe head pain, they can still interfere with daily activities. Treatment generally includes medications to prevent future episodes.
- Retinal migraine: or ocular migraine, involves episodes of visual disturbances in one eye along with migraine headaches. Typically, these visual symptoms fade after the attack ends, and vision returns to normal. In extremely rare instances, the visual problems can become permanent. If this happens, seek medical assistance immediately. The frequency of ocular migraines differs from person to person, but many people experience multiple episodes.
- Status migrainosus: is a migraine that lasts for more than 72 hours. It exhibits symptoms similar to typical migraines, like throbbing, unilateral head pain, light sensitivity, and nausea, but these symptoms may be more intense or severe.
What are the causes of migraines?
Although the causesof migraines are not fully understood but it is believed to be biologic or genetic in nature. And several specific triggers can precipate an attack.
Multiple factors may trigger a migraine, such as:
- Hormonal changes: such as fluctuations in estrogen levels, often cause headaches in many people. Migraines may worsen during menstruation. They usually fluctuate in frequency during pregnancy. Many patients report reduced frequency and intensity of migraines during pregnancy, while sone report an increase in frequency. Symptoms may intensify during perimenopause, qnd typically improve after menopause.
- Alcohol and caffeine: Alcohol, especially wine, and excessive caffeine intake, such as in coffee, can trigger migraines.
- Stress: Stress at work or home can lead to migraines.
- Sensory stimuli: such as bright or flashing lights and loud sounds can trigger migraines. Additionally, strong odors such as perfume, paint thinner, secondhand smoke, and other scents may trigger migraines in some individuals.
- Sleep pattern changes: such as missing sleep or sleeping excessively, can trigger migraines in some individuals.
- Physical exertion: such as intense activity or sex, may trigger migraines.
- Weather changes: such as shifts in barometric pressure, can trigger migraines.
- Medicines: like oral contraceptives and vasodilators, including nitroglycerin (Nitrostat, Nitro-Dur, and others), may exacerbate migraines.
- Foods: such as aged cheeses and salty, processed items can trigger migraines. Skipping meals may also lead to migraines. Certain foods are referred to as the 5 Cs of migraine, including cheese, chocolate, coffee, citrus fruits and cola.
- Food additives: consist of sweeteners like aspartame and preservatives such as monosodium glutamate, commonly known as MSG. These substances are present in numerous food products.
What are the risk factors associated with migraines?
Several risk factors increase your likelihood of experiencing migraines, including:
- Family history: Having a family member with migraines increases your risk of developing them.
- Age: Migraine onset can occur at any age, but most often begins in your teenage years. They typically peak in your 30s and then gradually decrease in frequency.
- Gender: Women are three times more likely than men to experience migraines.
- Hormonal changes: can trigger migraines, which might start just before or shortly after your first menstrual period. They also might fluctuate during pregnancy or menopause. Migraines typically get better after menopause.
How is a migraine diagnosed?
Migraines are usually diagnosed by a neurologist, a specialist trained to treat headaches. The diagnosis depends on your medical history, symptoms, and the results from a physical and neurological exam.
If your condition is complicated or suddenly becomes worse, tests to rule out other causes of your pain might include:
- An MRI scan: or magnetic resonance imaging scan, helps diagnose tumors, strokes, brain bleeding, infections, and various other conditions impacting the brain and nervous system.
- A CT scan: or computed tomography scan, aids in diagnosing tumors, infections, brain injuries, bleeding, and other conditions that can cause headaches.
What are the common treatments for migraines?
Migraine treatment focuses on relieving symptoms and preventing future attacks.
Medicines
Many medications have been developed to treat migraines, including:
- Pain-relief medicines: also known as acute or abortive treatments, are used during migraine attacks to reduce symptoms. These include Triptans, Ditans, Gepants, and Dihydroergotamine. Antiemetics may also be prescribed to manage nausea and vomiting associated with the condition.
- Preventive medicines: are taken regularly, often daily, to help reduce migraine symptoms. These medicines include anticonvulsants, beta-blockers, calcium channel blockers, monoclonal antibodies, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors.
Your treatment options vary based on the frequency and severity of your headaches. They are also influenced by whether you experience nausea, vomiting, if your headaches are disabling, and if you have other medical conditions.
Home remedies
You might be able to relieve symptoms by:
- Resting with your eyes shut in a dark, quiet room.
- Applying a cool compress or ice pack to your forehead.
- Drinking plenty of fluids
- Applying a warm compress or washcloth to your head or the back of your neck
- Gently massaging your neck, scalp, or temples.
- Meditating
What are effective ways to prevent a migraine?
While it’s impossible to prevent every migraine, you can use preventive medications as your doctor recommends to reduce the frequency and severity of your symptoms. Additionally, identifying your triggers and collaborating with your healthcare provider can help you avoid them.
Preventive medicine
Medicines can help prevent frequent migraines. Your doctor might suggest these drugs if you have long-lasting, severe headaches that occur often and do not respond well to treatment.
Preventive medicine can reduce the frequency, severity, and duration of migraines. Options include:
- Blood pressure-lowering medicines: including beta blockers like propranolol (Inderal LA, InnoPran XL) and metoprolol (Lopressor, Toprol-XL). Calcium channel blockers such as verapamil (Verelan) can help prevent migraines with aura.
- Antidepressants: particularly tricyclics like amitriptyline and nortriptyline, are frequently prescribed to prevent migraines. However, they often cause side effects such as dry mouth and drowsiness, and can interact with other medications. As a result, a different antidepressant with fewer side effects or interactions, like venlafaxine (Effexor XR), may be suggested as an alternative.
- Antiseizure medications: such as valproate and topiramate (such as Topamax, Qudexy XR, and others) may decrease the frequency of migraines. However, these drugs can lead to side effects, including dizziness, weight fluctuations, nausea, and more. They are generally not advised for individuals who are pregnant or planning pregnancy.
- Botox injections: which contain onabotulinumtoxinA, are given roughly every 12 weeks to help reduce frequency and intensity in some adults with chronic or severe migraines.
- Calcitonin gene-related peptide (CGRP): is targeted by a group of monoclonal antibody medications. These drugs help prevent migraines by blocking the chemical messenger CGRP. Examples include erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti). They are given through injections either monthly or once every three months. The most common side effect is usually a reaction at the injection site.
- Atogepant (Qulipta): is a gepant medication used to prevent migraines. It is administered daily as an oral tablet. Possible side effects include nausea, constipation, and fatigue.
- Rimegepant (Nurtec ODT): is a distinctive gepant medication that both prevents migraines and treats them after they start.
Consult your doctor to determine if these medicines are appropriate for your use. Some might not be safe during pregnancy. If you are pregnant or planning a pregnancy, avoid using these medicines until you have discussed them with your doctor.
Other preventive strategies
Nontraditional therapies might help in managing chronic migraine pain.
- Acupuncture: Clinical trials indicate it could be effective for headache relief. During the procedure, a practitioner inserts numerous thin, disposable needles into specific skin points at designated locations.
- Biofeedback appears: to be an effective way to ease migraine pain. This relaxation technique uses specialized devices to help you track and manage physical stress responses, such as muscle tension.
- Cognitive behavioral therapy: can help some people with migraines by showing how thoughts and behaviors influence pain perception.
- Meditation and yoga: can be beneficial. Meditation helps reduce stress, a common migraine trigger. Regular yoga practice may reduce the frequency and duration of migraines.
- Herbs, vitamins, and minerals: are often considered for migraine prevention. Some people report that herbs such as feverfew and butterbur may help reduce the frequency or severity of their migraines, but the results are inconsistent. Additionally, butterbur is not recommended due to safety concerns.
- Taking a high dose of riboflavin: or vitamin B-2, could decrease the number and intensity of migraines. Coenzyme Q10 supplements might also reduce migraine frequency, but further research is needed.
- Magnesium supplements: have been employed to manage migraines, though the outcomes have been inconsistent.
Check with your doctor to determine if these treatments are appropriate for you. If you are pregnant, consult your doctor before trying any of these options.
Check Your Migraine Symptoms
Living with migraines
Migraines differ from person to person. They are temporary, often recurring throughout life, and have no known cure. Your healthcare provider can help manage migraines to help them resolve more quickly and reduce their severity. It may take some time to find the most effective treatment. Inform your healthcare provider if your symptoms improve or worsen.
Frequently asked questions
What is a migraine like?
Migraine headache pain can feel like throbbing, pulsing, pounding, or dull sensations. The impact of a migraine varies, with pain levels from mild to severe. It can begin on one side of the head and move to the other, and you might also feel pain around your eyes, temples, face, sinuses, jaw, or neck.
How often do migraines happen?
Migraine frequency differs from person to person. Some individuals may experience just one per year, while others may face weekly attacks. Typically, most individuals experience two to four migraines each month, frequently in the morning. Although migraines can be unpredictable, specific triggers such as menstruation or stress can sometimes alert you to an impending attack.
What foods might cause migraines?
Your body may react negatively to certain chemicals and preservatives in foods. This sensitivity can increase the risk of migraines, especially when combined with other triggers. Common food triggers include (5Cs): aged cheese, coffee, citrus fruits, cola, chocolate, alcohol, additives such as nitrates and MSG, processed foods like hot dogs and pepperoni, and fermented or pickled items.
Are migraines inherited?
Yes, migraines often run in families, with up to 80% of people with the condition having a close biological relative who is also affected by the migraines.
How should I manage a migraine when it happens?
To relieve migraine symptoms, try resting in a dark, quiet, and cool room. Apply a cold or warm compress or washcloth to your forehead or neck. Gently massage your scalp and press in circles on your temples. Maintain calm through activities like meditation.
