A migraine isn’t just an average headache. Migraines are strong, pounding headaches typically on one side of the head.
Migraines usually include several other symptoms. They’re sometimes preceded by warning symptoms called aura. These symptoms may include flashes of light, visual “floaters,” or tingling sensations in your arms and legs.
Migraine episodes, which can last for hours or days, can greatly affect your life. According to the National Institute of Neurological Disorders and Stroke, migraines are experienced by 12 percent of the U.S. adult population. Many of these migraines are caused by the activation of nerve fibers in the blood vessels of the brain.
The classic migraine evolves through four separate stage. Each stage has different symptoms. These stages include:
- the prodrome (premonitory) stage
- the aura (visual symptoms or tingling)
- the headache (main attack) stage
- the postdrome (recovery) stage
Not all people who get migraines experience all of the stages.
The premonitory or prodrome stage can start anywhere from one hour to two days before your migraine begins. Symptoms that may indicate that a migraine is coming on include:
- mood changes, such as anxiety or depression
- craving for sugary foods
- tight or sore neck
- frequent yawning
The aura stage happens right before or during a migraine. Auras are usually visual disturbances, but can involve other sensations. Symptoms build up gradually and last for about 20 to 60 minutes. About 30 percent of people who experience migraine have migraine with aura.
Symptoms of an aura can include:
- seeing bright spots or flashes of light
- vision loss or seeing dark spots
- tingling sensations in an arm or leg described as “pins and needles”
- speech problems or inability to speak (aphasia)
- ringing in the ears (tinnitus)
The attack stage includes the headache and other symptoms. It can last for a few hours to a few days.
During an attack, you might experience the following symptoms:
- pulsating or throbbing pain on one or both sides of the head
- extreme sensitivity to light, sounds, or smells
- worsening pain during physical activity
- nausea and vomiting
- abdominal pain or heartburn
- loss of appetite
- blurred vision
If you have a migraine, you’ll often feel the need to lie down in the dark and quiet to escape from light, sounds, and movement. This is one of the main differences between migraines and other types of headaches. Fortunately, you may find that sleeping for an hour or two can help end an attack.
During the recovery (postdrome) stage, you may feel tired and drained. The migraine fades slowly. Some people report feelings of euphoria.
Tension headaches and migraines may cause very similar symptoms. Migraine symptoms tend to be more severe than tension headaches.
With a tension headache, your pain is usually mild to moderate throughout your head, and disappears within a few hours. Migraines tend to last longer and are often debilitating.
Tension headaches don’t typically cause any visual side effects like aura or physical side effects like nausea or vomiting. Tension headaches can make you feel sensitive to light or sound but usually not both.
Sinus headaches are often confused for migraines because they share many symptoms, including pressure in the sinuses and watery eyes. Sinus headaches are usually only moderately painful and can be treated with sinus treatments or other allergy medications.
Cluster headaches differ from migraines mainly in that they follow patterns of occurrence. They “cluster” together in short, episodic attacks during a period of weeks or months. Sometimes, an entire year can pass between two headache clusters. Migraines tend not to follow this kind of pattern.
Symptoms of migraines and cluster headaches are similar. In both cases, pain is severe. Cluster headaches can cause many distinct symptoms that migraines don't cause, including:
- red, bloodshot eyes
- swelling of the eyelids (edema)
- shrinking of the pupil (miosis)
- runny nose or congestion
- drooping of the eyelids (ptosis)
- agitation, annoyance, or restlessness during a headache
If you observe any of these symptoms during a severe headache, you’re likely experiencing a cluster headache, not a migraine. Your doctor can usually diagnose cluster headaches by examining the nerves in your eye or discovering an abnormality during MRI scans linked to cluster headaches. Talk to your doctor about getting checked for cluster headaches if you have these symptoms.
Medications for pain relief may be enough to treat your symptoms. Common pain relievers that can help migraine symptoms include:
- acetaminophen (Tylenol)
- Excedrin (aspirin, acetaminophen, and caffeine)
If your pain continues, talk to your doctor about other treatment options.
If you have at least six migraines per month or three migraines a month that severely interfere with your daily life, your doctor may recommend preventive medications that are effective against migraine symptoms, including:
- beta-blockers, such as propranolol or timolol, for high blood pressure or coronary diseases
- calcium channel blockers, such as verapamil, for high blood pressure
- tricyclic antidepressants, such as amitriptyline, for controlling serotonin and other chemicals in your brain
- antiseizure drugs, such as valproate (in moderate doses)
- pain relievers, such as naproxen
There can be side effects of these medications. Also, talk to your doctor about lifestyle changes that can help decrease migraines. Things like quitting smoking, getting plenty of sleep, avoiding triggers from certain foods, and staying hydrated can be useful.
Some alternative medicines are often used to aid in relieving migraine symptoms, including:
- cognitive behavioral therapy, a type of therapy that instructs you on how your behavior and thinking can change the way you perceive your migraine pain
- herbs, such as feverfew
- riboflavin (B-2)
- magnesium supplements (if you have low levels of magnesium in your body)
Your doctor may recommend that you try these alternative options if medicinal treatments aren’t working for you or if you want to take greater control of preventive care for your migraines.
Around 10 percent of children and teens experience migraines. Symptoms are generally similar to migraines in adults.
Teens are also more likely to have chronic migraine (CM), which causes migraines for several hours a day for over 15 days of the month across three or more months. CM may cause your child to miss school or social activities.
Migraines can be passed on genetically. If you or your child’s other biological parent has a history of migraines, your child has a 50 percent chance of having them. If both you and the other parent have a migraine history, your child has a 75 percent chance. Plus, many things can trigger your child’s migraines, including:
- medications, including birth control and asthma treatment
- routine changes
Find out what’s causing your child’s migraine, then talk to your doctor about the best way to treat and prevent migraines. In addition to medications, your doctor may recommend relaxation techniques and preventive therapy so that your child can better understand and manage their migraines.
Migraine pain can be severe, and often unbearable. Depression is more likely to occur in those who experience migraines than those who do not. Medications and other treatments are available to reduce the frequency and severity of your migraines.
If you regularly get migraines, make an appointment with your doctor to discuss your symptoms and a treatment plan.
You asked, we answered
- Are there any medications that can make migraines worse?
While pain medications like acetaminophen (Tylenol), ibuprofen (Advil), and naproxen (Aleve) are useful for treating headaches, taking these medications frequently or in higher than recommended doses can actually make migraines worse. Birth control and depression medicines can also aggravate headaches. Keeping a headache diary can be useful to both your and your doctor. When you have a headache, write down your symptoms, how long they last, what you ate and drank that day, along with any medications you are taking. This can help your doctor uncover the cause of your headaches and develop a treatment plan.- Judith Marcin, MD