What Is a Migraine?
Migraines are intense, sometimes debilitating headaches. The most common types of migraine are those with aura (classical migraines) and those without aura (common migraines).
Migraines can begin in childhood or may not occur until early adulthood. According to the Mayo Clinic, women are three times more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.
What Are the Symptoms and Phases of a Migraine?
Migraine symptoms may begin one to two days before the headache itself. This is known as the migraine’s prodrome stage. Symptoms include:
- food cravings
- fatigue or low energy
- frequent yawning
- neck stiffness
Some — but not all — people may also experience an aura after the prodrome stage. An aura causes visual, motor, and/or speech disturbances, such as:
- difficulty speaking clearly
- feeling a prickling or tingling sensation in the arms and legs
- flashes of light
- seeing shapes, light flashes or bright spots
- transient vision loss
The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine occurs. Attack phase symptoms can last anywhere from four hours to three days. Symptoms of a migraine can vary from person to person. Some symptoms may include:
- feeling dizzy or faint
- increased sensitivity to light and sound
- pain on one side of the head
- pulsing and/or throbbing pain
After the attack phase, a person will experience the postdrome phase. During this last phase, a person will often experience changes in mood and feelings, which can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic.
What Causes a Migraine?
Researchers haven’t identified a definitive cause for migraines. However, they have found some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in serotonin levels.
Factors that may trigger a migraine include:
- bright lights
- severe heat, or other extremes in weather
- changes in barometric pressure
- hormonal changes, such as estrogen fluctuations during menstruation, pregnancy, or menopause for women
- drinking alcohol or caffeinated drinks
- foods such as aged cheese, salty, or processed foods
- consuming food additives, such as aspartame (an artificial sugar) or monosodium glutamate (MSG)
- eating foods that have the additive tyramine, which is found in soy products, fava beans, hard sausages, smoked fish, aged cheeses, and Chianti wine
- excess stress
- loud sounds
- physical activity
- skipping meals
- loss of sleep
- taking certain medicines, such as oral contraceptives or nitroglycerin
- unusual smells
If you experience a migraine, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you were taking before your migraine began can help identify your triggers.
What Are the Risks Associated with Migraines?
Migraine headaches can cause risks and complications, both from the headaches themselves and from the medications you take to help with your symptoms.
Sometimes migraine headaches can be long-lasting, occurring anywhere from 3 to 15 days or more in a month. Because the headache affects your ability to think clearly, you may have difficulty at school or at work.
Taking nonsteroidal anti-inflammatory drugs (NSAIDS) in high doses or for a long period of time can lead to stomach pain or bleeding ulcers. Taking medicines for more than 10 days a month for longer than three months can lead to more headaches. This can cause medication-overuse headaches.
If you take prescription medications for your migraines, you’re at risk for experiencing a condition known as serotonin syndrome. Many prescription medicines boost the amount of serotonin in the brain to reduce migraines. Examples include:
- duloxetine (Cymbalta)
- fluoxetine (Sarafem, Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- sumatriptan (Imitrex)
- venlafaxine (Effexor XR)
- zolmitriptan (Zomig)
Too much serotonin can lead to hallucinations, nausea, vomiting, agitation, diarrhea, and a rapid heart rate. In some instances, this condition can be life-threatening. As always, make sure to take your medications as prescribed.
When Should I See a Doctor About My Migraines?
Sometimes the symptoms of a migraine headache can mimic those of a stroke. It’s important to seek immediate medical attention if you or a loved one has any of the following symptoms:
- headache that causes slurred speech or drooping on one side of the face
- headache that comes on very suddenly and severely with no lead-in symptoms
- headache that occurs with a fever, neck stiffness, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
- headache with an aura where the symptoms last longer than an hour
Make an appointment to see your doctor if your headaches start to affect your daily life. Tell your doctor if you experience pain around your eyes or ears, or if you have several headaches a month that last for several hours or days.
How Are Migraines Diagnosed?
Doctors diagnose migraines by listening to your symptoms and performing a physical exam to rule out other potential causes. Imaging scans, such as a CT or MRI scan, can rule out other causes, including tumors or strokes.
How Are Migraines Treated?
Medications can be used to either prevent the migraine from occurring or treating it once it occurs. Your doctor will decide what medication to prescribe based on the severity of your headaches and any of your other health conditions. Over-the-counter medicines may provide relief as well.
Other steps you can take at home to relieve migraine pain include:
- lying down in a quiet, dark room
- massaging your scalp or temples
- placing a cold cloth over your forehead or behind your neck
Many people also engage in preventive techniques, such as avoiding their known headache triggers.
Migraine headaches can be severe, debilitating, and uncomfortable. Treatments are available, and identifying migraine triggers can help prevent the headache from happening in the first place.