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Migraine is a medical condition that involves severe, recurring headaches and other symptoms. Before the headache, there may be sensory changes that are known as an aura.
A migraine episode is different from a headache unrelated to migraine. An episode usually occurs in stages and can last for several days. It can affect a person’s daily life, including their ability to work or study.
How migraine affects people can also vary. There is a range of triggers, severity, symptoms, and frequency. Some people have more than one episode each week, while others have them only occasionally.
In 2018, researchers found that more than 15% of adults in the United States had experienced a migraine episode or a severe headache within the last 3 months.
Figures from 2015 found that migraine affects just over 19% of females and 9% of males. Episodes often occur from the ages of 18 to 44 years, but they can happen at any time, including during childhood.
Symptoms of migraine tend to occur in stages:
Before the headache: According to older research, around 20–60% of people experience symptoms that start hours, or possibly days, before the headache. These include physical and sensory symptoms, such as aura.
During the headache: Alongside a mild to severe throbbing or pulsing headache, symptoms may include nausea, vomiting, and nasal congestion.
Resolution: Tiredness and irritability may last another 2 days, and this period is sometimes called the “migraine hangover.”
Other common features are:
- head pain that worsens during physical activity or straining
- an inability to perform regular activities due to pain
- increased sensitivity to light and sound that lying quietly in a darkened room relieves
Other symptoms may include sweating, temperature changes, a stomachache, and diarrhea.
A migraine episode is different from a typical headache. The experience is different, and they can have different causes.
Keeping a diary of symptoms can help a person and their doctor identify a migraine episode. Keep the journal for at least 8 weeks, and record the following.
- the time that symptoms start
- possible triggers, such as stress or menstruation
- the nature of the headache
- any other symptoms
- how long symptoms last
- any noticeable indicators of migraine, such as aura
- any medications used and the effect that they had
Experts do not know what causes migraine episodes. They may stem from changes in the brain that affect the:
- way nerves communicate
- balance of chemicals
- blood vessels
Genetic features may also play a role, as having a family history of migraine is a common risk factor.
Migraine triggers vary but include:
- Hormonal changes, for example, around the time of menstruation.
- Emotional triggers, such as stress, depression, anxiety, and excitement.
- Dietary factors, including alcohol, caffeine, chocolate, cheese, citrus fruits, and foods containing the additive tyramine.
- Medications, such as sleeping pills, hormone replacement therapy (HRT), and some birth control pills.
- Environmental factors, including flickering screens, strong smells, secondhand smoke, loud noises, stuffy rooms, temperature changes, and bright lights.
Some other possible triggers include:
- a lack of sleep
- shoulder and neck tension
- poor posture
- physical overexertion
- low blood sugar
- jet lag
- irregular mealtimes
Anyone can develop migraine, but it is more common in people with any of the following:
- bipolar disorder
- irritable bowel syndrome
- an overactive bladder
- sleep disorders
- obsessive-compulsive disorder
There is no cure for migraine. However, medications can treat the symptoms when they arise, and people can take steps to reduce the frequency and severity of episodes.
Pain relief and other types of medication can often help. Taking medication as soon as symptoms start may keep them from becoming severe.
Some over-the-counter pain relief medications that may benefit people with migraine include:
Other options include:
- triptans, such as sumatriptan, to help reverse the brain changes that cause migraine
- antiemetics to manage any nausea and vomiting
- gepants, which block a protein involved in inflammation and pain called calcitonin gene-related peptide (CGRP)
- ditans, which interact with 5-HT1F receptors on the sensory nerves and blood vessels
It is important not to overuse medication, as doing so can cause a rebound headache. A healthcare provider can help a person determine how much of each medication is safe and effective.
Some home remedies that can help relieve the symptoms of migraine include:
- using flexible cold packs or masks
- staying in a quiet, darkened room
- sleeping, when necessary
The following supplements might help prevent migraine, although there is limited evidence that they work and not much is known about their side effects:
Before using any of these, speak to a doctor. Research has not proven that these remedies work.
Anyone who is looking for alternative therapy, such as acupuncture, should go to a qualified and experienced professional.
While it is not always possible to prevent migraine episodes, there are ways to reduce their frequency and severity.
Medication to prevent episodes
The following prescription drugs may help reduce the number of episodes that a person with severe migraine experiences:
- topiramate, an antiseizure drug
- propanolol, for treating high blood pressure
- antidepressant medications
It may take several weeks to see an improvement.
The best treatment in children or adolescents may be different from that in adults. A doctor can advise on the best option.
Identifying and avoiding triggers
A migraine episode is often a response to a trigger. To figure out the culprit, a person might try keeping a diary and recording what they did, ate, and drank before an episode.
It may be particularly helpful to avoid:
- low blood sugar
- physical overexertion
- certain foods, such as chocolate and any that contain tyramine
- certain medications, including HRT and some birth control pills
- bright lights and flickering screens
The following strategies can also help reduce the frequency of migraines:
- getting enough sleep
- reducing stress
- drinking plenty of water
- improving posture
- avoiding dietary triggers, such as caffeine, alcohol, and cheese
- getting regular physical exercise
If making these changes does not ease the severity and frequency of migraine episodes, a doctor may suggest medication or other options.
There are various types of migraine. A major distinguishing factor is whether they involve aura, or sensory changes.
Migraine with aura
Aura is a disturbance of the senses in the early stages of an episode. It can act as a warning that a migraine headache is approaching.
Aura can involve:
- having confusing thoughts or experiences
- seeing strange, sparkling, or flashing lights that are not there
- seeing zig-zagging lines of light
- having blind spots or blank patches in the vision
- feeling pins and needles in an arm or leg
- having difficulty speaking
- having weakness in the shoulders, neck, or limbs
- seeing things that are not there out of one eye, such as transparent strings of objects
- not being able to see part of something clearly
- having part of the field of vision disappear, then reappear
Aura may feel similar to the sensation that follows exposure to a very bright camera flash, but the visual changes can last for several minutes or up to an hour.
Migraine without aura
More commonly, a person experiences no sensory disturbances before an episode.
According to the Migraine Trust, 70–90% of episodes occur without aura.
Other types of migraine include:
- Chronic migraine: This involves having an episode on more than 15 days per month.
- Menstrual migraine: This occurs in a pattern that follows the menstrual cycle.
- Hemiplegic migraine: This type causes temporary weakness on one side of the body.
- Abdominal migraine: This involves migraine episodes linking with irregular function in the gut and abdomen, often with nausea or vomiting. It mainly affects children under 14 years of age.
- Vestibular migraine: Severe vertigo is a symptom of this form of migraine.
- Basilar migraine: This rare type is also known as migraine with brainstem aura, and it can affect neurological functions, such as speech.
Anyone who may be experiencing migraine should consult a doctor.
The International Headache Society recommend the “5, 4, 3, 2, 1” criteria to diagnose migraine without aura. This number series stands for:
- having five or more attacks, each with a duration of 4 hours to 3 days
- the headache having at least two of the following qualities:
– occurring on one side
– causing moderate-to-severe pain aggravated by activity
- having at least one additional symptom, such as:
– sensitivity to light
– sensitivity to sound
The doctor may recommend imaging or other tests to exclude other causes of symptoms, such as a tumor.
A person should see a doctor if they experience:
- what seems to be a first migraine episode
- worsening or unusual migraine symptoms
- severe symptoms
If any of the following occur, seek immediate medical help:
- an unusually severe headache
- visual disturbances
- a loss of sensation
- difficulty speaking
These could indicate another condition that may need urgent attention, such as a stroke.
Migraine is a medical condition that involves a headache, but it is not only a headache. It can have a significant impact on daily life, making it difficult to work or perform regular activities.
Identifying triggers can often help reduce the frequency or severity of episodes, though it is not always possible to prevent them.
Medication and other treatments can help manage migraine and its symptoms. Anyone who has concerns about migraine should see a doctor.