Migraine

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

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.

• 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.

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

Types #

Menstrual Migraine #

This is when the headache is linked to a woman’s period.

Silent mMigraine #

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.

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)

Treatment #

Pain relief #

• 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), sumatriptan (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.

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.