Migraines

What are migraines?

Migraines are a type of headache characterized by intense, often debilitating pain. The pain is typically throbbing or pulsing, usually on one side of the head, and can last for hours or days. Migraines often come with sensitivity to light, noise, or smells, and may include nausea and vomiting. In some cases, people experience visual disturbances called aura before the headache, such as flashes of light, blind spots, or tingling in the face or limbs.

The exact cause is not fully understood, but migraines are believed to involve changes in the brain and surrounding blood vessels. Common triggers include hormonal fluctuations, stress, certain foods and drinks, bright lights, loud noises, and disrupted sleep. Migraines are more common in women and often run in families, suggesting a genetic component. Treatment may include medications, lifestyle changes, and alternative therapies.

What are the types of migraines?

  • Migraine with aura: Preceded by neurologic symptoms such as vision changes, numbness, or difficulty speaking.
  • Migraine without aura: Headache occurs without warning signs and is the most common form.
  • Abdominal migraine: Primarily affects children, causing abdominal pain and nausea.
  • Hemiplegic migraine: Causes temporary weakness on one side of the body.
  • Chronic migraine: Occurs 15 or more days per month for more than three months.
  • Menstrual migraine: Linked to menstrual cycle hormone changes.
  • Retinal migraine: Involves temporary visual loss or disturbances in one eye.
  • Status migrainosus: A debilitating migraine lasting more than 72 hours.
  • Migraine aura without headache: Neurologic symptoms occur without subsequent headache.

What are the risk factors for migraines?

Migraines arise from abnormal brain activity affecting nerves, chemicals, and blood vessels. Key contributing factors include:

  • Genetics: Family history often increases migraine risk.
  • Neurological factors: Changes in the brainstem and trigeminal nerve pathways, along with serotonin imbalances.
  • Vascular changes: Fluctuations in blood vessel behavior may play a role.
  • Environmental triggers: Stress, weather changes, bright lights, loud noises, and strong odors.
  • Dietary triggers: Aged cheeses, red wine, caffeine, chocolate, and foods with MSG.
  • Hormonal changes: Fluctuations in estrogen during menstruation, pregnancy, or menopause.
  • Physical activity: Intense exertion or sexual activity.
  • Medications: Oral contraceptives and certain vasodilators.
  • Sleep disruptions: Both insufficient and excessive sleep.

What are the symptoms of migraines?

Migraines can involve up to four phases—prodrome, aura, headache, and postdrome—but not everyone experiences them all. Common symptoms include:

  • Severe headache: Pulsing or throbbing pain, often one-sided but can vary.
  • Aura: Visual disturbances like flashing lights or zigzag lines, sensory changes, or speech difficulties.
  • Sensitivity to light and sound: Photophobia and phonophobia are common.
  • Nausea and vomiting: Often accompany the headache phase.
  • Dizziness or vertigo: A spinning sensation in some cases.
  • Cognitive symptoms: Difficulty concentrating or mental fog.
  • Fatigue: Extreme tiredness before, during, or after an attack.
  • Mood changes: Euphoria or depression preceding or following the headache.
  • Neck pain and stiffness: Can occur before or during a migraine.

How are migraines diagnosed?

Diagnosis relies on clinical evaluation and ruling out other causes:

  • Medical history: Detailed account of symptoms, frequency, duration, and family history.
  • Headache diary: Tracking triggers, timing, and response to treatments.
  • Neurological exam: Assessment of reflexes, muscle strength, coordination, and sensory function.
  • Blood tests: To exclude infections, thyroid problems, and other conditions.
  • Imaging studies (MRI or CT): Used when red-flag symptoms suggest structural issues.
  • Lumbar puncture: Rarely used to check for infections or bleeding.
  • International Headache Society criteria: Standard guidelines for migraine diagnosis.

How are migraines treated?

Treatment combines acute relief, prevention, and lifestyle modifications:

Acute treatments

  • Pain relievers: Over-the-counter NSAIDs and acetaminophen for mild attacks.
  • Triptans: Target serotonin receptors to relieve pain and associated symptoms.
  • Ergots: Older agents useful for prolonged attacks.
  • Anti-nausea drugs: Medications like metoclopramide to control vomiting.
  • Ditans and gepants: Newer agents targeting migraine pathways with fewer cardiovascular risks.

Preventive treatments

  • Daily medications: Beta blockers, calcium channel blockers, antidepressants, anti-seizure drugs, and CGRP inhibitors.
  • Botox injections: Used every 12 weeks for chronic migraine.

Lifestyle adjustments

  • Avoid triggers: Identify and minimize exposure to known triggers.
  • Regular exercise: Helps lower migraine frequency and severity.
  • Sleep hygiene: Maintain consistent sleep patterns.
  • Stress management: Techniques such as yoga, meditation, and biofeedback.

Alternative therapies

  • Acupuncture: May reduce attack frequency.
  • Supplements: Magnesium, riboflavin (B2), coenzyme Q10; herbal options like feverfew.
  • Essential oils: Peppermint and lavender for symptomatic relief.
  • Behavioral therapy: Cognitive-behavioral therapy to improve coping strategies.

Sources

  • What is Migraine? American Migraine Foundation. Accessed Apr. 17, 2024.
  • Migraine Headache. National Library of Medicine. Accessed Apr. 17, 2024.
  • Migraine. National Institute of Neurological Disorders and Stroke. Accessed Apr. 17, 2024.
  • Types of Migraine. The Migraine Trust. Accessed Apr. 17, 2024.