More than just the cause of “really bad headaches,” migraine is a neurological condition that can cause multiple symptoms. While intense, debilitating headaches frequently characterize it, additional symptoms may include:
nausea
vomiting
difficulty speaking
numbness or tingling
sensitivity to light and sound
The condition often runs in families and can affect all ages. People assigned female at birth are more likely than people assigned male at birth to be diagnosed with migraine.
The diagnosis of migraine is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headaches (or attacks) are episodic versus chronic, and then those without aura and those with aura.
What does migraine feel like?
People describe migraine pain as:
pulsating
perforating
pounding
debilitating
It can also feel like a severe, dull, steady ache. The pain may start out as mild. But without treatment, it can become moderate to severe. Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides or shift. Most migraine attacks last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraine with aura, pain may overlap with an aura or may never occur at all.
Migraine symptoms
Migraine symptoms may begin 1 to 2 days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
food cravings
depression
fatigue or low energy
frequent yawning
hyperactivity
irritability
neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, you may have problems with your vision, sensation, movement, and speech. Examples of these problems include:
difficulty speaking clearly
feeling a prickling or tingling sensation in your face, arms, or legs
seeing shapes, light flashes, or bright spots
temporarily losing your vision
The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of migraine can vary from person to person.
Some symptoms may include:
increased sensitivity to light and sound
nausea
dizziness or feeling faint
pain on one side of your head, either on the left side, right side, front, or back, or in your temples
pulsing and throbbing head pain
vomiting
After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy to feeling very fatigued and apathetic. A mild, dull headache may persist. The length and intensity of these phases can occur to different degrees in different people. Sometimes, a phase gets skipped, and a migraine attack may occur without causing a headache.
What causes migraine attacks?
Researchers haven’t identified a definitive cause for migraine. But they still believe the condition is due to “abnormal” brain activity that affects nerve signaling, and chemicals and blood vessels in the brain.
There are also many migraine triggers that are continually reported, including:
bright lights
severe heat, or other extremes in weather
dehydration
changes in barometric pressure
hormone changes in people assigned female at birth, like estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
excess stress
loud sounds
intense physical activity
skipping meals
changes in sleep patterns
use of certain medications, like oral contraceptives or nitroglycerin
unusual smells
certain foods
smoking
alcohol use
traveling
If you experience a migraine attack, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you took before your migraine attack began can help identify your triggers.
Migraine triggers
While migraine attack triggers can be very personal, certain foods or food ingredients may be more likely to trigger an attack than others. These may include:
alcohol or caffeinated drinks
food additives, like nitrates (a preservative in cured meats), aspartame (an artificial sugar), or monosodium glutamate (MSG)
tyramine, which occurs naturally in some foods
Tyramine also increases when foods are fermented or aged. These include foods like some aged cheeses, sauerkraut, and soy sauce. But ongoing research is looking more closely at the role of tyramine in migraines, as it may not be as big of a trigger as previously thought.
Other migraine attack triggers can be varied and seem random:
hormone triggers in people assigned female at birth
stress
anxiety
excitement
poor sleep quality
strenuous exercise (if you don’t do it often)
bright lights
changes in climate
hormone replacement therapy drugs
Keeping a journal of when your migraine attacks occur can help you identify your personal triggers.
Migraine treatment
Migraine can’t be cured, but your doctor can help you manage migraine attacks by giving you the tools to treat symptoms when they occur, which may lead to fewer attacks in general. Treatment can also help make migraine less severe.
More than just the cause of “really bad headaches,” migraine is a neurological condition that can cause multiple symptoms. While intense, debilitating headaches frequently characterize it, additional symptoms may include:
nausea
vomiting
difficulty speaking
numbness or tingling
sensitivity to light and sound
The diagnosis of migraine is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headaches (or attacks) are episodic versus chronic, and then those without aura and those with aura.
Your treatment plan depends on:
your age
how often you have migraines attacks
the type of migraine you have
how severe they are — based on how long they last, how much pain you have, and how often they keep you from going to school or work
whether they include nausea or vomiting, as well as other symptoms
other health conditions you may have and other medications you may take
Your treatment plan may include a combination of:
lifestyle adjustments, including stress management and avoiding migraine triggers
OTC pain or migraine medications, like Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol)
prescription migraine medications that you take every day to help prevent migraine headaches and reduce how often you have headaches
prescription migraine medications that you take as soon as an attack starts to keep it from becoming severe and to ease symptoms
prescription medications to help with nausea or vomiting
hormone therapy if migraines seem to occur in relation to your menstrual cycle
counseling
alternative care, which may include meditation, acupressure, or acupuncture
Medication
Medications can be used to either prevent a migraine attack from happening or treat it once it occurs. You may be able to get relief with OTC medication. But if OTC medications aren’t effective, your doctor may decide to prescribe other medications.
The severity of your migraine and any other health conditions you have will determine which treatment is right for you.
Acute medications — taken as soon as you suspect a migraine attack is coming — include:
NSAIDs: These medications, like ibuprofen or aspirin, are typically used in mild-to-moderate attacks that don’t include nausea or vomiting.
Triptans: These medications, like sumatriptan, eletriptan, and rizatriptan, are typically the first line of defense for individuals who have nerve pain as a symptom of their migraine attacks.
Antiemetics: These medications, like metoclopramide, chlorpromazine, and prochlorperazine, are typically used with NSAIDs to help decrease nausea.
Ergot alkaloids: These medications, like Migranal and Ergomar, aren’t prescribed that often and are usually reserved for individuals who don’t respond to triptans or analgesics.
Preventative medications — prescribed to people whose migraine attacks can be debilitating or happen more than four times a month — are taken once a day, or every 3 months via injection. These medications include:
Antihypertensives: These drugs are prescribed for high blood pressure and can also help with migraine attacks. Beta-blockers and angiotensin receptor blockers (candesartan) are some examples of antihypertensive drugs used for migraine prevention.
Anticonvulsants: Certain anti-seizure medications may also be able to prevent migraine attacks.
Antidepressants: Some antidepressants, like amitriptyline and venlafaxine, may also be able to prevent migraine attacks.
Botox: Botox injections are administered to the head and neck muscles every 3 months.
Calcitonin gene-related peptide treatments: These treatments are administered either via injection or through an IV and work to prevent a migraine attack from developing.
Types of migraine:
Migraine with aura
An aura typically occurs in 25 percent of people who have migraine. If you have a migraine with aura, you most likely have at least two attacks that have these characteristics:
an aura that goes away, is completely reversible, and includes at least one of these symptoms:
visual problems (the most common aura symptom)
sensory problems of the body, face, or tongue, like numbness, tingling, or dizziness
speech or language problems
problems moving or weakness, which may last up to 72 hours
brainstem symptoms, which includes:
difficulty talking or dysarthria (unclear speech)
vertigo (a spinning feeling)
tinnitus or ringing in the ears
diplopia (double vision)
ataxia or an inability to control body movements
eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur, they’re called retinal migraines)
Migraine without aura (common migraine): This type of migraine headache strikes without the warning an aura may give you. The symptoms are the same, but that phase doesn’t happen.
Chronic migraine
Chronic migraine used to be called a “combination” or “mixed” because it can have features of migraine and a tension headache. It’s also sometimes called a severe migraine headache and can be caused by medication overuse.
People who have chronic migraine have a severe tension headache or migraine attack more than 15 days a month for 3 or more months. More than eight of those attacks are migraine with or without aura.
Migraine nausea
Many people experience nausea as a symptom of migraine. Many also vomit. These symptoms may start at the same time the attack does. Usually, though, they start about 1 hour after the headache pain begins.
Migraine without head pain: “Silent migraine” or “acephalgic migraine,” as this type is also known as, includes the aura symptom but not the headache that typically follows.
Hemiplegic migraine: You'll have temporary paralysis (hemiplegia) or neurological or sensory changes on one side of your body. The onset of the headache may be associated with temporary numbness, extreme weakness on one side of your body, a tingling sensation, a loss of sensation and dizziness or vision changes. Sometimes it includes head pain and sometimes it doesn’t.
Retinal migraine (ocular migraine): You may notice temporary, partial or complete loss of vision in one of your eyes, along with a dull ache behind the eye that may spread to the rest of your head. That vision loss may last a minute, or as long as months. You should always report a retinal migraine to a healthcare provider because it could be a sign of a more serious issue.
Status migrainosus. This is a rare and severe type of migraine that can last longer than 72 hours. The headache pain and nausea can be extremely bad. Certain medications, or medication withdrawal, can cause you to have this type of migraine.
Sources:
https://www.healthline.com/health/migraine
https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
Prepared by Viktorija Stučytė based on online sources
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