What Is Migraine?

 Medically Reviewed by Melinda Ratini, DO, MS on July 18, 2020

ARTICLES ONMIGRAINE OVERVIEW

 Migraine Basics
 Phases
 Symptoms
 Types
 Triggers
 Complications

What Is a Migraine?
A migraine is a strong headache that often comes with nausea,
vomiting, and sensitivity to light. It can last hours or days.

Migraine Symptoms
Migraines are different in everyone. In many people, they
happen in stages. These stages may include:
Prodrome
Hours or days before a headache, about 60% of people who
have migraines notice symptoms like:

 Being sensitive to light, sound, or smell

 Fatigue
 Food cravings or lack of appetite
 Mood changes
 Severe thirst
 Bloating
 Constipation or diarrhea

Aura
These symptoms stem from your nervous system and often
involve your vision. They usually start gradually, over a 5- to 20-
minute period, and last less than an hour. You may:

 See black dots, wavy lines, flashes of light, or things that

aren’t there (hallucinations)
 Have tunnel vision
 Not be able to see at all
 Have tingling or numbness on one side of your body
 Not be able to speak clearly
 Have a heavy feeling in your arms and legs
 Have ringing in your ears
 Notice changes in smell, taste, or touch

Attack
A migraine headache often begins as a dull ache and grows into
throbbing pain. It usually gets worse during physical activity. The
pain can move from one side of your head to the other, can be in
the front of your head, or can feel like it's affecting your entire
head.
About 80% of people have nausea along with a headache, and
about half vomit. You may also be pale and clammy or feel faint.
Most migraine headaches last about 4 hours, but severe ones
can go for more than 3 days. It’s common to get two to four
headaches per month. Some people may get migraine headaches
every few days, while others get them once or twice a year.
Postdrome
This stage can last up to a day after a headache. Symptoms
include:

 Feeling tired, wiped out, or cranky

 Feeling unusually refreshed or happy
 Muscle pain or weakness
 Food cravings or lack of appetite
 Migraine Causes
Migraine headaches are a symptom of a condition known as
migraine. Doctors don’t know the exact cause of migraine
headaches, although they seem to be related to changes in your
brain and to your genes. Your parents can even pass
down migraine triggers like fatigue, bright lights, or weather
changes.

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For many years, scientists thought migraines happened because

of changes in blood flow in the brain. Most now think this can
contribute to the pain, but is not what starts it.
Current thinking is that a migraine likely starts when overactive
nerve cells send out signals that trigger your trigeminal nerve,
which gives sensation to your head and face. This cues your
body to release chemicals like serotonin and calcitonin gene-
related peptide (CGRP). CGRP makes blood vessels in the lining
of your brain swell. Then, neurotransmitters
cause inflammation and pain.

Migraine Risk Factors

The American Migraine Foundation estimates that more than 38
million Americans get migraines. Some things may make you
more likely to get them:

 Sex. Women have migraines three times more often than

men.
 Age. Most people start having migraine headaches between
ages 10 and 40. But many women find that their migraines
get better or go away after age 50.
  Family history. Four out of five people with migraines
have other family members who get them. If one parent
has a history of these types of headaches, their child has a
50% chance of getting them. If both parents have them,
the risk jumps to 75%.
 Other medical conditions. Depression, anxiety, bipolar
disorder, sleep disorders, and epilepsy can raise your odds.

Migraine Triggers
Some common migraine triggers include:

 Hormone changes. Many women notice that they have

headaches around their period, while they’re pregnant, or
when they’re ovulating. Symptoms may also be tied to
menopause, birth control that uses hormones, or hormone
replacement therapy.
 Stress. When you’re stressed, your brain releases
chemicals that can cause blood vessel changes that might
lead to a migraine.
 Foods. Some foods and drinks, such as
aged cheese, alcohol, and food additives like nitrates (in
pepperoni, hot dogs, and lunchmeats) and monosodium
glutamate (MSG), may be responsible in some people.
 Skipping meals
 Caffeine. Getting too much or not getting as much as
you’re used to can cause headaches. Caffeine itself can be a
treatment for acute migraine attacks.
 Changes in weather. Storm fronts, changes in barometric
pressure, strong winds, or changes in altitude can all trigger
a migraine.
 Senses. Loud noises, bright lights, and strong smells can
set off a migraine.
 Medications. Vasodilators, which widen your blood vessels,
can trigger them.
 Physical activity. This includes exercise and sex.
 Tobacco
  Changes to your sleep. You might get headaches when
you sleep too much or not enough.

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Migraine Types
There are several kinds of migraines. The most common
are migraine with aura (also known as a classic migraine)
and migraine without aura (or common migraine).
Other types include:

 Menstrual migraine. This is when the headache is linked

to a woman’s period.
 Silent migraine. This kind is also known as an acephalgic
migraine. You have aura symptoms without a headache.
 Vestibular migraine. You have balance problems, vertigo,
nausea, and vomiting, with or without a headache. This kind
usually happens in people who have a history of motion
sickness.
 Abdominal migraine. Experts don’t know a lot about this
type. It causes stomach pain, nausea, and vomiting. It
often happens in children and may change into classic
migraine headaches over time.
 Hemiplegic migraine. You have a short period
of paralysis (hemiplegia) or weakness on one side of your
body. You might also feel numbness, dizziness, or vision
changes. These symptoms can also be signs of a stroke, so
get medical help right away.
 Ophthalmic migraine. This is also known as an ocular or
retinal migraine. It causes short-lived, partial, or total loss
of vision in one eye, along with a dull ache behind the eye,
 which may spread to the rest of your head. Get medical
help right away if you have any vision changes.
 Migraine with brainstem aura. Dizziness, confusion, or
loss of balance can happen before the headache. The pain
may affect the back of your head. These symptoms usually
start suddenly and can come along with trouble speaking,
ringing in your ears, and vomiting. This type of migraine is
strongly linked to hormone changes and mainly affects
young adult women. Again, get these symptoms checked
out by a doctor right away.
 Status migrainosus. This severe type of migraine can last
more than 72 hours. The pain and nausea are so intense
that you may need to go to the hospital. Sometimes,
medicines or medication withdrawal can cause them.
 Ophthalmoplegic migraine. This causes pain around
your eye, including paralysis of the muscles around it. This
is a medical emergency because the symptoms can also be
caused by pressure on the nerves behind the eye or by
an aneurysm. Other symptoms include a droopy
eyelid, double vision, or other vision changes.

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Migraine Frequency
Doctors divide migraine into three levels of frequency.
Episodic migraine means you get migraine now and then. High-
frequency episodic migraine means you get eight to 14 headache
days per month. This condition also makes you more likely than
others to develop chronic migraine.
Chronic migraine means you have headache on more than 15
days of the month and eight of those days have migraine
features such as:

 Moderate to intense head pain

 Pain is on side of head (one or both)
 Pain throbs or pulsates
 Pain gets worse when you move
 You have nausea or vomiting
 You’re sensitive to light and sound

About 12% of Americans get migraine from time to time, but

only about a third of those have chronic migraine.
Chronic and even high-frequency episodic migraine can be
disabling conditions. And the higher the pain intensity of each
headache, the more disabling it can be. That’s why it’s especially
important to work closely with your doctor on a treatment plan.

Are Migraines Curable?

There's no cure for migraines yet. But medications can help
prevent or stop them, or keep your symptoms from getting
worse.
You can also avoid things that trigger your migraines. Lifestyle
changes like easing stress and having good sleep habits can
help, too.

Are Migraines Fatal?

Most migraines don't cause lasting harm.
Rarely, you can have a complication called migrainous infarction.
That's when you have a stroke while you're having a migraine.
But there's no evidence migraine can trigger a stroke.
It's extremely rare, but a hemiplegic migraine can sometimes
lead to a coma or other serious complications.
 A very intense headache that starts suddenly can be a sign of
another, more serious condition, like a stroke or aneurysm. Get
medical help right away if this happens.

When to Call Your Doctor

See your doctor any time a headache doesn’t go away or comes
back.
See a health care provider right away or go to the emergency
room if you have a headache with a stiff neck, fever, vomiting,
numbness or weakness in the limbs, or trouble speaking.

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Migraine Diagnosis
Your doctor will ask about your health history and your
symptoms. It may help if you have a diary of your symptoms
and any triggers you’ve noticed. Write down:

 What symptoms you have, including where it hurts

 How often you have them
 How long they last
 Any other family members who have migraines
 All the medicines and supplements you take, even over-the-
counter ones
 Other medicines you remember taking in the past

Your doctor may order tests to rule out other things that could
cause your symptoms, including:

 Blood tests
 Imaging tests like MRI or CT scans
  Electroencephalogram (EEG)

Migraine Treatment and Home Remedies

There's no cure for migraine headaches. But many drugs can
treat or even prevent them. Common migraine treatments
include:

 Pain relief. Over-the-counter (OTC) drugs often work well.

The main ingredients are acetaminophen, aspirin, caffeine,
and ibuprofen. Never give aspirin to anyone under the age
of 19 because of the risk of Reye’s syndrome. Be careful
when you take OTC pain meds, because they might also
add to a headache. If you use them too much, you can
get rebound headaches or become dependent on them. If
you take any OTC pain relievers more than 2 days a week,
talk to your doctor about prescription drugs that may work
better. They may suggest prescription medicines that may
work well to end your migraine pain, including triptans, as
well as the newer ditans and gepants. Your doctor can tell
you if these are right for you.
 Nausea medicine. Your doctor can prescribe medication if
you get nausea with your migraine.
 Triptans. These drugs balance the chemicals in your brain.
You might get a pill to swallow, tablets you dissolve on
your tongue, a nasal spray, or a shot. Examples
include almotriptan (Axert), eletriptan (Relpax), sumatripta
n (Imitrex), rizatriptan (Maxalt), and zolmitriptan (Zomig).
 Ergotamine (Cafergot, Ergomar, Migergot). This also
works on the chemicals in your brain.
 Lasmiditan (Reyvow). This drug eases pain, nausea, and
sensitivity to light or sound.
 CGRP receptor antagonists. Your doctor might give
you rimegepant (Nurtec), or ubrogepant (Ubrelvy) if other
treatments don’t help.
 Preventive medicines. If other treatments don’t work,
your headaches are severe, or you have four or more
 migraine days a month, your doctor may suggest these.
You take them regularly to make your headaches less
severe or frequent. They include seizure medicines, blood
pressure medicines (like beta-blockers and calcium channel
blockers), some antidepressants, and shots of botulinum
toxin type A (Botox). CGRP antagonists such as atogepant
(Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), frem
anezumab (Ajovy), and galcanezumab (Emgality) can
also prevent migraines.
 Single-pulse transcranial magnetic stimulation
(sTMS). You place this device on the back of your head at
the start of a migraine with aura. It sends a pulse of
magnetic energy to part of your brain, which may stop or
reduce pain.
 Neuromodulation devices. Other devices can affect the
vagus nerve and the trigeminal nerve to give relief from or
prevent migraines.

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Home remedies
You may ease migraine symptoms by:

 Resting with your eyes closed in a dark, quiet room

 Putting a cool compress or ice pack on your forehead
 Drinking plenty of liquids

Complementary and alternative treatments

Some people get relief with therapies they use in addition to or
instead of traditional medical treatment. These are called
complementary or alternative treatments. For migraine, they
include:
  Biofeedback. This helps you take note of stressful
situations that could trigger symptoms. If the headache
begins slowly, biofeedback can stop the attack before it
becomes full-blown.
 Cognitive behavioral therapy (CBT). A specialist can
teach you how actions and thoughts affect how you sense
pain.
 Supplements. Research has found that some
vitamins, minerals, and herbs can prevent or treat
migraines. These include riboflavin, coenzyme Q10,
and melatonin. Butterbur may head off migraines, but it can
also affect your liver enzymes.
 Body work. Physical treatments like chiropractic, massage,
acupressure, acupuncture, and craniosacral therapy might
ease headache symptoms.

Talk to your doctor before trying any complementary or

alternative treatments.

Migraine Prevention
Try these steps to prevent symptoms:

 Identify and avoid triggers. Keep track of your symptom

patterns in a diary so you can figure out what’s causing
them.
 Manage stress. Relaxation techniques like meditation, yoga,
and mindful breathing can help.
 Eat on a regular schedule.
 Drink lots of fluids.
 Get plenty of rest.
 Get regular moderate exercise.
 Ask your doctor about preventive medicines if you get
migraines around your period or if lifestyle changes don’t
help.
Some new devices can also prevent migraines. Cefaly is a
headband-like gadget that sends electrical pulses through
the skin of your forehead. It affects your trigeminal nerve, which
is linked with migraine headaches. You use Cefaly once a day for
20 minutes. When it's on, you'll feel a tingling or massaging
sensation. Another stimulator, gammaCore, sends out a mild
electrical signal to the fibers of the vagus nerve in your neck to
relieve pain and help prevent migraines.