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A migraine is usually an intense pounding headache that can last for hours or even days. The pounding or pulsing pain usually begins in the forehead, the side of the head or around the eyes. The headache gradually gets worse. Just about any movement, activity, bright lights or loud noises seem to make it hurt more. Nausea and vomiting are common.

Migraines may happen only once or twice a year, or as often as daily. Women are more likely to have migraines than men.

Are there different kinds of migraine headaches?

Yes. The most common are classic migraine and common migraine.

Classic migraines start with a warning sign, called an aura. These types of migraines are also called "migraines with aura." The aura often involves changes in the way you see. You may see flashing lights, colours, a pattern of lines, or shadows. You may temporarily lose some of your vision, such as your side vision.

You may also feel a strange prickly or burning sensation, or have muscle weakness on one side of your body. You may have trouble communicating. You may also feel depressed, irritable and restless.

Auras last about 15 to 30 minutes. Auras may occur before or after your head pain, and sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic migraines may occur on one side of your head or on both sides.

Common migraines don't start with an aura. These types of migraines are also called "migraines without aura." Common migraines may start more slowly than classic migraines, last longer and interfere more with daily activities. The pain of common migraines may be on only one side of your head. Most people who have migraines have common migraines (they don't have an aura).

What does a migraine feel like?

The pain of a migraine headache can be intense. It can get in the way of your daily activities. Migraines aren't the same for all people. Possible symptoms of migraines are listed below. You may have a "premonition" several hours to a day before your headache starts. Premonitions are feelings you get that can signal a migraine is coming. These feelings can include intense energy, fatigue, food cravings, thirst, and mood changes.

Possible symptoms of migraines

This condition may be diagnosed based on the results of a blood test.

• Intense throbbing or dull aching pain on one side of your head or both sides
• Pain that worsens with physical activity
• Nausea or vomiting
• Changes in how you see, including blurred vision or blind spots
• Being bothered by light, noise or odours
• Feeling tired and/or confused
• Stopped-up nose
• Feeling cold or sweaty
• Stiff or tender neck
• Light-headedness
• Tender scalp

Causes & Risk Factors

What causes migraines?

Doctors don't know exactly what causes migraines. It appears that migraine headaches may be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems. Another aspect that is being studied is that migraine headaches go along with a spreading pattern of electrical activity in the brain.

What are some migraine risk factors and triggers?

Some things make you more likely to get migraine headaches (these are called "risk factors"). Other things may bring on a migraine (these are called "triggers").

Common migraine risk factors include the following:

• Family history: You are much more likely to have migraines if one or both of your parents had migraines.
• Gender: Women are more likely than men to have migraines.
• Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Common migraine triggers include the following:

• Food and drink: Certain food and drink (see list below) may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
• Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
• Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work, but your body can also be stressed if you exercise too much or don't get enough sleep.
• Senses: Loud sounds, bright lights (such as flashing lights or sunlight), or strong smells (such as paint fumes) may trigger migraines.
• Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
• Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.

 
Foods that may trigger migraines:

• Aged, canned, cured or processed meat, including bologna, game, ham, herring, hot dogs, pepperoni and sausage
• Aged cheese
• Alcoholic beverages, especially red wine
• Aspartame
• Avocados
• Beans, including pole, broad, lima, Italian, navy, pinto and garbanzo
• Brewer's yeast, including fresh yeast coffee cake, donuts and sourdough bread
• Caffeine (in excess)
• Canned soup or bouillon cubes
• Chocolate, cocoa and carob
• Cultured dairy products, such as buttermilk and sour cream
• Figs
• Lentils
• Meat tenderizer
• Monosodium glutamate (MSG)
• Nuts and peanut butter
• Onions, except small amounts for flavoring
• Papaya
• Passion fruit
• Pea pods
• Pickled, preserved or marinated foods, such as olives and pickles, and some snack foods
• Raisins
• Red plums
• Sauerkraut
• Seasoned salt
• Snow peas
• Soy sauce

Diagnosis & Tests

How is migraine diagnosed?

Your doctor can diagnose migraines by the symptoms you describe. If the diagnosis is not clear, your doctor will perform a physical exam. Your doctor might want to do blood tests or imaging tests, such as an MRI  or CAT scan of the brain, to be sure that there are no other causes for the headache. You may also be asked to keep a "headache diary" to help your doctor identify the things that might cause your migraines.

Treatment

How are migraines treated?

There are two types of medicines for migraine treatments. One type, called "abortive", focuses on stopping the headache from becoming severe and relieving the headache pain. This type of treatment should be started as soon as you think you're getting a migraine. The other type, called "prophylactic or preventive" includes medicines that are taken every day to reduce how often headaches occur.

Talk to your doctor about which of these two types of medicine is best for you. Some people use both types. Non-prescription and prescription medicines that are used often or in large doses may cause other problems.

What medicines help relieve migraine pain?

For mild to moderate migraines, over-the-counter medicines that may help relieve migraine pain include aspirin, acetaminophen, aspirin and caffeine combination, and ibuprofen.

People who have more severe migraines may need to try "abortive" prescription medicines. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful. Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan and frovatriptan.

If the pain won't go away, stronger pain medicine may be needed, such as a narcotic, or medicines that contain a barbiturate. These medicines can be habit-forming and should be used cautiously.

What else can I do?

To help manage your migraine pain, try the following:

• Lie down in a dark, quiet room.
• Put a cold compress or cloth over your forehead or behind your neck.
• Massage your scalp using pressure.
• Put pressure on your temples.

Prevention

Can medicine help prevent migraines?

Yes. Medicine to prevent migraines may be helpful if your headaches happen more than two times a month or if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not. Examples of medicines used to prevent migraines include certain antidepressants, anti-seizure medicines, cardiovascular drugs and Botox injections .

What else can I do to prevent migraines?

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

• Eat regularly and do not skip meals.
• Keep a regular sleep schedule.
• Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
• Keep a headache diary to help you learn what triggers your migraines and what treatments are most helpful.
  
  

References:

Buse D.C., Scher A.I., Dodick D.W., Reed M.L., Fanning K.M., Manack A.A., et. al.: Impact of migraine on the family: perspectives of people with migraine and their spouse/domestic partner in the cameo study. Mayo Clin Proc 2016; S0025-6196: pp. 126-129.

Mayans L., Walling A.: Acute migraine headache: treatment strategies. Am Fam Physician 2018; 97: pp. 243-251.

Peng K.P., Chen Y.T., Fuh J.L., Tang C.H., Wang S.J.: Migraine and incidence of ischemic stroke: a nationwide population-based study. Cephalalgia 2017; 37: pp. 327-335.

Silberstein S.D., Dodick D.W.: Migraine genetics: part ii. Headache 2013; 53: pp. 1218-1229.

Steiner T.J., Stovner L.J., Vos T., Jensen R., Katsarava Z.: Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain 2018; 19: pp. 17.

van Oosterhout W.P.J., Schoonman G.G., van Zwet E.W., Dekkers O.M., Terwindt G.M., MaassenVanDenBrink A., et. al.: Female sex hormones in men with migraine. Neurology 2018; 91: pp. e374-e381.

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