Migraine

Migraine is far more than just a bad headache. It’s a complex neurological condition that can leave you unable to carry out daily activities for hours or even days, causing intense throbbing pain, nausea, and extreme sensitivity to light and sound.

Table of contents

• What is migraine?
• Types of migraine
• How common are migraines?
• Phases of a migraine attack
• Symptoms
• What does a migraine feel like?
• How often do migraines happen?
• Causes and triggers
• Treatment options
• Lifestyle changes that help

What is migraine?

Migraine is a genetic neurological disease that causes much more than head pain^[1]. It is characterized by episodes of moderate to severe headaches that typically affect one side of your head and feel like throbbing or pulsing^[2]. These episodes are called migraine attacks and can last from four hours to three days^[4].

The symptoms of migraine are different from person to person, but often include headaches that keep coming back, along with nausea, vomiting, changes in mood, extreme tiredness, and sensitivity to light, noise, and smells^[3]. These symptoms can happen all at once during a migraine attack, or they can happen separately in between attacks.

Migraine is a significantly disabling condition. It has been termed the seventh disabler due to its considerable impact on the quality of life of patients, affecting their ability to work, socialize, and carry out everyday activities^[9]. Because migraine is genetic, it runs in families. If a parent has migraine, there’s about a 50 percent chance that a child may develop migraine as well^[1].

Current research shows that head pain happens when there is abnormal activity among nerve signals, chemical signals, and blood vessels in the brain^[3]. There is currently no cure for migraine, but treatments can help manage symptoms^[3].

Types of migraine

There are several types of migraines. The most common migraine categories are migraine with aura (classic migraine) and migraine without aura (common migraine)^[2]. An aura is a phase of the migraine before head pain begins, involving sensory, motor, and/or speech symptoms that act as a warning sign^[2].

Migraine without aura is the most prevalent type, accounting for 75% of cases^[5]. This type involves headaches lasting 4 to 72 hours that are typically on one side of the head, pulsating in quality, moderate to severe in intensity, and made worse by physical activity^[5].

Migraine with aura involves warning signs that usually include changes in vision, such as seeing dots, zigzags, or sparks. People may also experience changes in their ability to speak, or feelings of pins and needles in different body parts^[3]. These aura symptoms can last as long as 60 minutes or as little as five minutes^[2].

Other types of migraines include migraines in children (abdominal migraine), chronic migraine, hemiplegic migraine, menstrual migraine, migraine without headache (silent migraine), retinal migraine (ocular migraine), and status migrainosus^[2]. Chronic migraine is defined as having a headache on 15 or more days per month for at least three months, of which eight or more days meet the criteria for migraine^[9].

How common are migraines?

Migraines are very common. Studies show that an estimated 12% of people in the United States experience migraines^[2]. Approximately 44.5 million U.S. adults have experienced a migraine, according to data from 2009^[10].

Migraine attacks are three times more prevalent in women than in men, likely as a result of hormonal differences^[1]. The condition affects one in five women, one in 16 men, and even one in 11 children^[1].

Phases of a migraine attack

Migraine attacks happen in phases. There are four phases or stages: prodrome, aura, headache, and postdrome^[2]. It can take about eight to 72 hours to go through the four stages^[2]. Not everyone experiences all four phases during every migraine attack.

The prodrome phase is the first phase and begins up to 24 hours before you experience a headache^[2]. During this phase, you may notice early warning signs that a migraine is coming.

The aura phase involves a group of sensory, motor, and/or speech symptoms that act as a warning sign. This phase can last as long as 60 minutes or as little as five minutes^[2]. You might experience both the aura and the headache at the same time.

The headache phase is when the actual migraine headache occurs. A migraine headache lasts between four hours to 72 hours^[2]. The headache usually gets worse with physical activity, bright lights, loud noises, and strong odors^[2].

The postdrome stage usually lasts for a few hours up to 48 hours^[2]. Symptoms feel similar to an alcohol-induced hangover, which is why the postdrome phase is known as a migraine hangover.

Symptoms

Migraine symptoms vary based on the stage. Every migraine is different, and you won’t necessarily experience symptoms during all four stages of every migraine^[2].

During the prodrome phase, symptoms may include mood changes, difficulty concentrating, trouble sleeping, fatigue, nausea, increased hunger and thirst, and frequent urination^[2]. Some people also experience feelings of being very tired and yawning a lot, craving certain foods or feeling thirsty, and a stiff neck^[4].

Aura symptoms include muscle weakness, vision changes (such as seeing zigzag lines or flashing lights), ringing in your ears, sensitivity to touch, numbness and tingling, and difficulty speaking or concentrating^[2][4]. Aura symptoms should not last for longer than an hour^[4].

During the headache attack phase, head pain gradually gets more intense. It can affect one side of your head or both. This phase occurs with other symptoms like nausea and vomiting, and sensitivity to light, sound, and odors^[2].

Postdrome symptoms include fatigue, stiff neck, sensitivity to light and sound, difficulty concentrating, nausea, and dizziness^[2].

What does a migraine feel like?

A migraine tends to feel like a very bad headache with throbbing pain on one side of the head^[4]. Migraine headache pain may feel like throbbing, pulsing, pounding, or dull^[2].

A migraine can feel different for each person. The pain ranges from mild to severe. Head pain can start on one side and shift to the opposite side. You may also have pain around your eyes or temple, and sometimes, around your face, sinuses, jaw, or neck^[2].

The headache gets worse with physical activity, bright lights, loud noises, and strong odors^[2]. Migraines are disruptive and can interfere with your daily routine and affect your ability to meet personal and social obligations^[2].

How often do migraines happen?

The frequency of a migraine varies from person to person. You might have one migraine per year or one per week. On average, most people experience two to four migraines per month^[2].

Some people have infrequent attacks, but others may have frequent disabling attacks^[1]. Most people find their migraines slowly get better as they get older^[4]. It’s common to have migraines before or during your period, called menstrual migraines^[4].

A subset of patients progresses from having episodic migraine to chronic migraine, which affects 1% to 2% of the population^[9]. This is a gradual process that changes from low-frequency attacks to high-frequency attacks and eventually to chronic migraine^[9].

Causes and triggers

It’s not fully known what causes migraines^[4]. You’re more likely to get them if you have a close family member who gets them^[4]. Certainly genetic and environmental factors play a role in the development of migraine disease^[1].

Several factors can trigger a migraine attack or increase a person’s risk of having one. These factors vary from person to person and include sudden changes in weather or environment, too much or not enough sleep, strong smells or fumes, and stress that causes changes in mental health and wellbeing^[3].

Other triggers include too much physical stress on the body, loud or sudden noises, motion sickness, low blood sugar or skipped meals, tobacco, head trauma, drinking too much alcohol, some medicines, hormonal changes, and bright or flashing lights^[3].

Additional triggers that some people find can cause migraines include anxiety and depression, starting their period, stress and tiredness, not eating regularly or skipping meals, too much caffeine, and not getting enough exercise^[4].

However, it’s important to understand that if you get a migraine attack, it’s not your fault. You should not feel any guilt or shame for your symptoms^[1]. It can help to keep a migraine diary to work out what might trigger your migraines^[4].

Treatment options

Medicine is a proven way to both treat and prevent migraines^[12]. Treatment is available to help you manage migraines so they don’t take over your life^[2]. There are two main approaches to migraine treatment: medicines you take when you get a migraine attack to reduce your symptoms (acute medicines), and medicines you take to prevent migraine attacks (preventive medicines).

Migraine treatments include painkillers such as ibuprofen and paracetamol, medicines called triptans, medicines that stop you feeling sick or being sick, and other specialized medications^[4]. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines^[10].

You may have to try a combination of medicines before you find something that works^[4]. Several triptans are available with different characteristics and routes of administration. The choice of triptan should be individualized based on your migraine characteristics and on the route of administration, how the medicine works in your body, and cost^[10].

If your migraines are severe, you might be offered other treatments such as learning relaxation techniques and acupuncture^[4]. If these treatments do not manage your migraines or they’re getting worse, you may be referred to a specialist for further tests and treatment^[4].

For chronic migraine, Botox injections are a preventive treatment option^[11]. Newer types of medicines called gepants and CGRP monoclonal antibodies have been developed specifically for migraine. Gepants can be used both to treat and prevent migraine attacks^[11]. CGRP monoclonal antibodies are a type of preventive medicine for migraine^[11].

There are also several different types of devices for migraine available, which provide noninvasive options for treatment^[11]. Some supplements like riboflavin, magnesium, and co-enzyme Q10 may also help with preventing migraine attacks^[11].

It’s important to try not to take high doses of painkillers too often, as this could make it harder to treat your migraines^[4]. Taking medication early in an attack is an important treatment principle that can help ensure migraine treatment is effective^[10].

Lifestyle changes that help

Medicine is only part of the story. It’s also important to take good care of yourself and understand how to cope with migraine pain when it strikes^[12]. The same lifestyle choices that promote overall good health also can reduce the number of migraines you have and lessen the migraine pain. Combining medicine with behavioral measures and lifestyle changes can often be the most effective way to handle migraines^[12].

A healthcare provider may recommend making changes to your lifestyle to help manage your migraines, such as eating at regular times and drinking less caffeine^[4]. Because people with migraine have a sensitive nervous system, the best thing is to keep a very regular, stable lifestyle. Even though this won’t change the fact that someone has a sensitive nervous system, it may raise their threshold for migraine attacks^[16].

At the first sign of a migraine, take a break and step away from whatever you’re doing if possible. Turn off the lights, as light and sound can make migraine pain worse. Relax in a dark, quiet room and sleep if you can^[12].

Try temperature therapy by applying hot or cold compresses to your head or neck. Ice packs have a numbing effect which may dull the pain. Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect^[12].

In small amounts, caffeine alone can relieve migraine pain in the early stages and may enhance the pain-reducing effects of some medicines. However, be careful—drinking too much caffeine too often can lead to withdrawal headaches later on, and having caffeine too late in the day may interfere with sleep, which can affect migraines^[12].

Sleep is important. Migraines may keep you from falling asleep or wake you up at night. Getting consistent sleep can help reduce attack frequency and intensity^[14]. Regular physical activity also helps manage the symptoms and triggers of migraine. Exercise can reduce heart disease risks, improve brain health, maintain a healthy weight, and help with better sleep—all of which also improve migraine^[16].

Eating a healthy diet is important. It’s looking like a low-inflammation diet helps, which means a balance of healthy fats and lots of natural fruits, vegetables, and unprocessed food^[16]. Don’t skip meals, as skipped meals or not eating regularly can trigger migraines^[4].

Managing stress is also crucial. Stress is a common trigger for migraines^[4]. Behaviors like getting consistent sleep, eating a more balanced diet, and exercising regularly can help reduce attack frequency and intensity^[14].