Medically reviewed by Dr Itender Pal Singh
Migraine is a complex neurological condition known primarily for the intense, throbbing headaches it causes. According to the National Institute of Neurological Disorders and Stroke (NINDS), migraines impact nearly one in eight Americans. While migraines are most commonly associated with head pain, they often bring additional symptoms like nausea, fatigue, and heightened sensitivity to light and sound.
Types of Migraines
Migraines fall under the category of primary headaches, meaning they are not the result of another underlying health issue. The International Headache Society (IHS) identifies three main types of migraines:
1. Migraine Without Aura
This is the most common type of migraine, occurring without any warning signs. Individuals with this type experience at least five headache episodes, each lasting between four to 72 hours. The pain often arrives suddenly, with no preceding symptoms.
2. Migraine With Aura
This type of migraine is characterized by specific neurological symptoms that appear shortly before the headache begins. These symptoms can affect vision, causing issues like seeing spots or zig-zag lines; they may also impact speech, motor skills, and even cause temporary vision loss. These symptoms typically emerge within an hour of the headache.
3. Chronic Migraine
Chronic migraines are defined by frequent headaches, occurring 15 or more days per month for over three months. Up to 5% of the U.S. population experiences chronic migraines, which can be severely debilitating.
Phases of a Migraine Attack
Migraines are more than just headaches; they can disrupt your entire day with a range of symptoms. The progression of a migraine can be broken down into four distinct phases:
1. Prodrome
This is the pre-headache phase, which can begin hours or even days before the migraine itself. Symptoms during this phase include fatigue, difficulty concentrating, neck stiffness, light sensitivity, and irritability. Some individuals also experience frequent yawning, nausea, or an increased need to urinate.
2. Aura
For those who experience migraines with aura, this phase involves a range of neurological symptoms, most commonly visual disturbances like flashes of light or blind spots. Other possible symptoms include tingling sensations, slurred speech, and muscle weakness.
3. Headache
This is the most intense phase, where the throbbing pain typically sets in. The pain is often localized to one side of the head and may be accompanied by nausea, vomiting, dizziness, and heightened sensitivity to light, sound, or odors.
4. Postdrome
After the headache subsides, individuals may enter the postdrome phase, which can last for hours or even days. Common symptoms include fatigue, sleepiness, decreased energy, and irritability. Some may also experience lingering light sensitivity or pain when moving their head.
What Causes Migraines? Exploring the Triggers
While genetic factors play a significant role in the development of migraines, they are not the sole cause. Certain lifestyle habits and environmental changes, known as triggers, can significantly increase the likelihood of an attack. Common triggers include:
- Stress and Anxiety: Emotional stress is a well-known trigger for migraines.
- Hormonal Changes: Fluctuations in hormones, especially in women, can lead to migraines.
- Sleep Irregularities: Both too much and too little sleep can trigger migraines.
- Dietary Factors: Skipping meals, consuming caffeine or alcohol, and eating certain foods like chocolate or cheese can provoke migraines.
- Environmental Changes: Weather changes, exposure to smoke, strong odors, and bright lights can also be triggers.
- Overuse of Medication: Taking headache medicines too frequently can paradoxically cause more headaches.
Diagnosing Migraines
Migraines are often undiagnosed or misdiagnosed, which can delay effective treatment. If you experience symptoms of migraines, it’s crucial to consult with a healthcare provider who may refer you to a neurologist or headache specialist for a thorough evaluation. Diagnosis typically involves a detailed medical history, a discussion of symptoms, and possibly a physical or neurological exam to assess reflexes, motor skills, and vision.
In some cases, further tests like an MRI may be needed to rule out other conditions such as aneurysms or tumors.
Managing and Preventing Migraines
Managing migraines often requires a multi-faceted approach, including both acute and preventive treatments.
1. Acute Medication
These are medications taken at the onset of a migraine to relieve symptoms. Options include:
- Over-the-Counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen are first-line treatments for mild to moderate migraines.
- Triptans: Prescription medications like sumatriptan and zolmitriptan are often used for moderate to severe migraines.
- Gepants: These newer medications target the calcitonin gene-related peptide (CGRP) protein, which is linked to inflammation in the brain.
- Reyvow (lasmiditan): The first FDA-approved medication in the ditan class, which can stop a migraine without constricting blood vessels.
- Ergot Alkaloids: Used for migraines that do not respond to other treatments, these drugs can be administered via nasal spray, injection, or intravenous infusion.
2. Preventive Medication
For those who experience frequent or debilitating migraines, preventive medications can be an effective strategy. These include:
- Antihypertensives: Blood pressure medications like beta-blockers and calcium channel blockers.
- Antiseizure Medications: Drugs like Topamax (topiramate) are often prescribed.
- Antidepressants: Amitriptyline and venlafaxine are common choices.
- Botox Injections: OnabotulinumtoxinA injections can be effective for chronic migraines.
- Anti-CGRP Monoclonal Antibodies: This newer class of drugs includes options like Aimovig (erenumab) and Ajovy (fremanezumab), which are administered by injection or infusion.
Non-Pharmaceutical Treatments
In addition to medications, some people find relief through non-pharmaceutical treatments, such as neuromodulation devices. These devices use magnets or electrical currents to alter brain activity and have been approved by the FDA for migraine prevention and treatment. While promising, more research is needed to fully understand their effectiveness.
Preventing Migraines Strategies
Prevention is key when it comes to managing migraines. Here are some strategies that can help reduce the frequency and severity of attacks:
- Maintain a Headache Diary: Keeping a detailed record of your migraines, including potential triggers and the circumstances surrounding each attack, can help identify patterns and avoid future episodes.
- Manage Stress: Stress is a major trigger for migraines. Techniques such as biofeedback, meditation, and progressive muscle relaxation can help manage stress levels.
- Consistent Sleep Patterns: Maintaining regular sleep habits can reduce the risk of migraines.
Migraines are a debilitating condition that affects millions of people worldwide. Understanding the types, triggers, and treatment options available is essential for managing this condition effectively. With the right combination of medications, lifestyle adjustments, and preventive strategies, many people with migraines can lead a more comfortable and productive life. If you suspect you have migraines, it is important to consult a healthcare provider to explore the best treatment options for your specific needs.
SOURCE–
Harrison manual of internal medicine.
American Migraine Foundation. The timeline of a migraine attack.
American Migraine Foundation. Migraine with aura: Types, symptoms & treatments.
National Library of Medicine. Migraine prevention in adults
