Migraine
A neurological condition causing severe, recurring headaches and other symptoms
Quick Facts
- Type: Neurological
- ICD-10: G43
- Prevalence: ~12% of population
- Gender: 3x more common in women
Overview
Migraine is a neurological disease characterized by recurrent, intense headaches that can cause significant disability. More than just a severe headache, migraine is a complex condition involving changes in brain chemistry, blood flow, and nerve signaling. Migraines affect approximately 12% of the population, including children, and are three times more common in women than men. They typically begin in adolescence or early adulthood but can occur at any age.
A migraine attack can last anywhere from 4 to 72 hours if untreated, and the pain is often so severe that it interferes with daily activities. The condition is believed to involve both genetic and environmental factors, with many sufferers having a family history of migraines. The economic impact is substantial, with migraines being one of the leading causes of lost work days and reduced productivity worldwide.
While migraines cannot be cured, they can be effectively managed through a combination of lifestyle modifications, trigger avoidance, and medications. Understanding your specific triggers and early warning signs is crucial for successful management. With proper treatment, most people with migraines can significantly reduce the frequency and severity of attacks, improving their quality of life. Recent advances in migraine-specific medications have provided new hope for those with difficult-to-treat migraines.
Symptoms
Migraine symptoms vary between individuals and can change over time. A migraine attack typically progresses through several stages, though not everyone experiences all stages.
Primary Symptoms
Visual and Sensory Symptoms
- Diminished vision or temporary vision loss
- Spots or clouds in vision (visual aura)
- Temporary blindness in one or both eyes
- Flashing lights, zigzag patterns, or shimmering spots
- Sensitivity to light (photophobia)
- Sensitivity to sound (phonophobia)
- Sensitivity to smells
Neurological Symptoms
- Facial symptoms including numbness or tingling
- Memory disturbances or confusion
- Difficulty speaking or finding words
- Weakness on one side of the body
- Pins and needles sensations in arms or legs
Migraine Phases
1. Prodrome (hours to days before)
- Mood changes (depression or euphoria)
- Food cravings
- Neck stiffness
- Increased thirst and urination
- Frequent yawning
2. Aura (5-60 minutes)
- Visual disturbances (most common)
- Sensory changes (numbness, tingling)
- Speech difficulties
- Motor weakness (rare)
3. Attack (4-72 hours)
- Severe, pulsating headache
- Nausea and vomiting
- Extreme sensitivity to stimuli
- Pain worsens with physical activity
4. Postdrome (24-48 hours)
- Exhaustion
- Confusion
- Mood changes
- Continued sensitivity
Types of Migraines
There are several types of migraines, each with distinct characteristics:
Common Types
Migraine Without Aura (Common Migraine)
- Most common type (70-90% of migraines)
- No warning signs before headache begins
- Moderate to severe pulsating headache
- Usually one-sided but can affect both sides
- Lasts 4-72 hours if untreated
Migraine With Aura (Classic Migraine)
- Affects 25-30% of migraine sufferers
- Visual or sensory disturbances before headache
- Aura symptoms develop gradually over 5-20 minutes
- Aura typically lasts less than 60 minutes
- Headache usually follows within 60 minutes
Less Common Types
Chronic Migraine
- Headaches on 15 or more days per month
- At least 8 days with migraine features
- For more than 3 months
- Often evolves from episodic migraine
Hemiplegic Migraine
- Rare form causing temporary paralysis
- Weakness on one side of body
- Can be familial or sporadic
- May mimic stroke symptoms
Vestibular Migraine
- Prominent dizziness or vertigo
- May occur with or without headache
- Balance problems
- Motion sensitivity
Retinal Migraine
- Temporary vision loss in one eye
- Repeated attacks in same eye
- Vision usually returns within an hour
- Requires immediate medical evaluation
Special Populations
Menstrual Migraine
- Occurs around menstruation
- Related to estrogen drop
- Often more severe and longer-lasting
- May be harder to treat
Childhood Migraine
- Can start as early as age 4
- May present differently than adult migraine
- Abdominal pain common
- Shorter duration typical
Causes and Triggers
The exact cause of migraines isn't fully understood, but they appear to involve genetic, neurological, and environmental factors.
Biological Mechanisms
- Cortical spreading depression: Wave of electrical activity in brain
- Trigeminal nerve activation: Major pain pathway involvement
- Neurotransmitter imbalances: Serotonin, dopamine, CGRP
- Blood vessel changes: Dilation and inflammation
- Genetic factors: Multiple genes involved
Common Triggers
Dietary Triggers
- Aged cheeses
- Alcohol, especially red wine
- Caffeine (excess or withdrawal)
- Chocolate
- Artificial sweeteners
- MSG and nitrites
- Skipping meals or fasting
Environmental Triggers
- Bright or flickering lights
- Strong smells (perfume, paint, gasoline)
- Loud noises
- Weather changes (barometric pressure)
- Altitude changes
- Extreme temperatures
Lifestyle Triggers
- Stress and anxiety
- Changes in sleep pattern
- Oversleeping or sleep deprivation
- Intense physical exertion
- Poor posture
- Dehydration
Hormonal Triggers
- Menstruation
- Ovulation
- Pregnancy
- Menopause
- Birth control pills
- Hormone replacement therapy
Medications
- Vasodilators
- Oral contraceptives
- Hormone replacement
- Overuse of pain medications
Risk Factors
Several factors increase the likelihood of developing migraines:
Non-Modifiable Risk Factors
- Family history: 70-80% have a first-degree relative with migraines
- Gender: Women 3x more likely due to hormonal influences
- Age: Peak prevalence between ages 25-55
- Genetics: Multiple genes contribute to susceptibility
Medical Conditions
- Depression and anxiety
- Epilepsy
- Sleep disorders
- High blood pressure
- Stroke risk
- Patent foramen ovale (heart condition)
Lifestyle Factors
- High stress levels
- Irregular sleep patterns
- Poor diet
- Sedentary lifestyle
- Smoking
- Excessive caffeine use
Environmental Factors
- Frequent weather changes
- High altitude living
- Exposure to bright lights
- Strong odors in environment
Diagnosis
Migraine diagnosis is primarily based on clinical history and symptoms, as there's no specific test for migraines.
Diagnostic Criteria
According to the International Headache Society, migraine without aura requires:
- At least 5 attacks fulfilling criteria
- Headache lasting 4-72 hours (untreated)
- At least 2 of: unilateral, pulsating, moderate/severe, aggravated by activity
- At least 1 of: nausea/vomiting or light/sound sensitivity
- Not attributed to another disorder
Medical History
Your doctor will ask about:
- Headache frequency, duration, and severity
- Location and quality of pain
- Associated symptoms
- Triggers and patterns
- Family history
- Previous treatments
- Impact on daily life
Headache Diary
Tracking helps identify patterns:
- Date and time of attacks
- Duration and severity
- Symptoms experienced
- Potential triggers
- Medications taken
- Menstrual cycle (for women)
Physical Examination
- Neurological exam
- Vision testing
- Reflexes and coordination
- Blood pressure check
When Imaging Is Needed
MRI or CT scan may be ordered if:
- Sudden, severe headache (thunderclap)
- Progressive worsening pattern
- Abnormal neurological exam
- Change in headache pattern
- New headache after age 50
- Headache with fever, stiff neck
- History of cancer or HIV
Treatment Options
Migraine treatment includes acute treatment to stop attacks and preventive treatment to reduce frequency and severity.
Acute Treatment
Mild to Moderate Attacks
- NSAIDs: Ibuprofen, naproxen, aspirin
- Acetaminophen: Alone or in combinations
- Caffeine combinations: Excedrin Migraine
Moderate to Severe Attacks
- Triptans: Sumatriptan, rizatriptan, eletriptan
- Ergotamines: For long-lasting migraines
- CGRP antagonists: Ubrogepant, rimegepant
- Lasmiditan: New serotonin receptor agonist
Severe Attacks/Emergency
- IV medications (DHE, valproate, magnesium)
- Steroids for status migrainosus
- Anti-nausea medications
- Nerve blocks
Preventive Treatment
Consider if ≥4 headache days/month or significant disability:
Oral Medications
- Beta-blockers: Propranolol, metoprolol
- Antidepressants: Amitriptyline, venlafaxine
- Anti-seizure: Topiramate, valproate
- Calcium channel blockers: Verapamil
Injectable Preventives
- CGRP monoclonal antibodies: Erenumab, fremanezumab, galcanezumab
- Botox: For chronic migraine (15+ days/month)
Non-Drug Treatments
- Biofeedback: Learn to control physical responses
- Cognitive behavioral therapy: Manage stress and triggers
- Acupuncture: May reduce frequency
- Relaxation techniques: Meditation, yoga, tai chi
- Physical therapy: For neck/shoulder tension
- Massage therapy: Reduce muscle tension
Lifestyle Management
- Regular sleep schedule (7-9 hours)
- Consistent meal times
- Regular moderate exercise
- Stress management
- Hydration (8+ glasses water daily)
- Limit caffeine and alcohol
Devices and Procedures
- Neuromodulation devices: Cefaly, gammaCore, Nerivio
- Transcranial magnetic stimulation: For prevention
- Occipital nerve stimulation: For chronic cases
- Sphenopalatine ganglion blocks: For acute treatment
Prevention
Preventing migraines involves identifying triggers, lifestyle modifications, and sometimes preventive medications.
Trigger Management
- Keep detailed headache diary
- Identify personal triggers
- Avoid known triggers when possible
- Plan for unavoidable triggers
- Gradual changes rather than sudden
Lifestyle Strategies
Sleep Hygiene
- Consistent sleep/wake times
- 7-9 hours nightly
- Dark, quiet bedroom
- Avoid screens before bed
- No caffeine after 2 PM
Diet and Nutrition
- Regular meal schedule
- Never skip meals
- Identify food triggers
- Stay hydrated
- Limit alcohol and caffeine
- Consider magnesium, B2, CoQ10 supplements
Exercise
- Regular moderate aerobic exercise
- Start slowly if sedentary
- Warm up and cool down
- Avoid sudden intense exercise
- Yoga or stretching for stress
Stress Management
- Regular relaxation practice
- Time management strategies
- Set realistic expectations
- Learn to say no
- Seek support when needed
- Consider counseling
Environmental Modifications
- Reduce bright/flickering lights
- Use sunglasses outdoors
- Minimize strong odors
- Control noise levels
- Maintain comfortable temperature
When to See a Doctor
Seek Emergency Care
Call 911 or go to ER for:
- Sudden, explosive headache (thunderclap)
- Headache with fever, stiff neck, confusion
- Headache after head injury
- Progressively worsening headache
- Headache with seizures
- Headache with weakness, numbness, difficulty speaking
- New headache pattern in people over 50
- Headache in people with cancer or HIV
Schedule an Appointment
- New or different headache pattern
- Headaches becoming more frequent or severe
- Headaches interfering with daily life
- Need for pain medication >2 days/week
- Previous treatments not working
- Side effects from medications
- Considering pregnancy (medication review)
See a Headache Specialist If
- Chronic daily headaches
- Failed multiple treatments
- Complex medication needs
- Medication overuse headache
- Need for procedures (Botox, nerve blocks)
- Unusual migraine types
Regular Follow-up
- Monitor treatment effectiveness
- Adjust medications as needed
- Address new symptoms
- Review preventive strategies
- Update headache diary findings
Frequently Asked Questions
Yes, migraines have a strong genetic component. If one parent has migraines, there's a 40% chance their child will too. If both parents have migraines, the risk increases to 75%. However, genetics isn't the only factor - environmental triggers and lifestyle also play important roles in whether someone develops migraines.
Yes, children can get migraines, sometimes as young as age 4. Childhood migraines may present differently than adult migraines - they're often shorter, may affect both sides of the head, and commonly include abdominal pain. Children may also experience migraine variants like cyclic vomiting syndrome or abdominal migraine.
Currently, there's no cure for migraines, but they can be effectively managed. Many people find significant relief through a combination of lifestyle modifications, trigger avoidance, and medications. Some people experience fewer migraines as they age, and women often see improvement after menopause. The goal is to reduce frequency, severity, and impact on daily life.
Yes, certain foods are common migraine triggers for some people, though triggers vary greatly between individuals. Common culprits include aged cheeses, processed meats, alcohol (especially red wine), chocolate, and foods containing MSG or artificial sweeteners. Keeping a food diary can help identify your personal triggers. However, it's often not the food alone but a combination of factors.
No, migraines are a complex neurological disease, not just severe headaches. They involve changes in brain chemistry, blood flow, and nerve signaling. Besides head pain, migraines can cause visual disturbances, nausea, sensitivity to light and sound, and even temporary paralysis. The impact extends beyond pain to affect overall functioning and quality of life.