What You Need To Know About Migraines

Some research shows that about 1 in 7 Americans¹ get migraines every year. While anyone can get them, women are more likely than men to develop migraine headaches. 

In a 2015 study¹, researchers found that migraines occurred in 19% of women participants over a 3-month period while affecting only 9% of the men.

A migraine occurs in four stages: prodrome, aura, headache, and postdrome stages. 

Prodrome

Prodrome is a medical term used to refer to the very early stages of a condition before its full onset, also known as the premonitory stage. This could last a couple of hours or, in some cases, days before progressing to the next stage. 

You might experience mood swings, difficulty concentrating, become sensitive to bright lights and loud sounds, and you may find yourself becoming more irritable and quickly tired.

Aura

Not everyone with migraines will have this stage because it only occurs in people who get migraines with aura. An aura is a warning sign for many people that they are about to get a migraine headache. 

While some people report having a typical aura before the headache sets in, others might find it occurs at the same time as the headache. 

Not everyone experiences an aura in the same way. Some people report feeling as though they are seeing the world through a kaleidoscope. Others suddenly see blurry spots in their vision or what appears to be a bright light. 

Aura symptoms are not always visual. They can also include sensory disturbances like a tingle in your hands and face. You might also experience numbness in certain parts of your body, dizziness, or difficulty speaking. 

Symptoms of an aura typically last a few minutes up to about an hour. 

Headache

A migraine is much more severe than a regular headache. At this stage, a person with migraines will have severe head pain that could last for days. 

Some people liken the sensation to feeling as if there's a constant hammering on one side of their head. Others may describe it as a continuous throbbing or pulsating pain. The pain will start on one side of the head before spreading to the other in many cases. 

Postdrome

This occurs after the headache has passed. Your headache and other accompanying symptoms will have resolved by the time you get to this stage. However, you might still feel tired due to the toll a migraine can take on your body. 

Additional symptoms

Beyond the aura and head pain described, a migraine might also be accompanied by other symptoms during its prodrome or headache stage. These could last anywhere from a few hours to three or four days and include:

• Chills

• Fatigue

• Nausea, vomiting

• Sensitivity to bright lights and loud noise

• Dizziness

• Stomach ache

• Difficulty concentrating

• Sweating excessively

• Diarrhea

• Loss of appetite

• Frequent urination 

Who can get a migraine?

You are more likely to develop migraines if you have a family history of the condition or any of the risk factors already discussed. 

Children

Children can experience migraines, although the condition often appears different for them. A child with a migraine might experience pain for a shorter time, and they frequently have stomach aches and nausea with their headaches. 

Pregnant women

A high percentage of women get migraines when they are pregnant. Some research puts the number at up to 10%¹. Almost half of these individuals report that their migraines begin to disappear in their last trimester, but they may have a return or worsening of their migraines after delivery in some cases. 

However, some women who have experienced menstrual migraines are likely to find reprieve during pregnancy. 

When to see a doctor

Chronic migraine headaches can be very painful, but they are rarely a life-threatening condition. If you have any form of long-term, persistent, and severe headache, you should speak to your doctor about it as soon as possible so you can receive appropriate treatment. 

When you experience headaches for the first time or a completely different type of headache than you've had previously, it could be a migraine. However, there is a possibility that such headaches indicate an underlying medical condition such as a brain tumor. So a prompt evaluation by your healthcare professional is highly recommended. 

To ease your pain before seeing your doctor, you could take a mild over-the-counter pain reliever such as acetaminophen or ibuprofen. No matter the severity of the pain, it's essential to take no more than what is recommended. 

If you experience a sudden worsening of your symptoms, you should call 911 or emergency health services near you. Symptoms such as sudden paralysis, seizure, stiff neck, or slurred speech indicate the need for immediate medical attention and warrant contacting emergency medical services. 

If you've already been diagnosed with migraines and have persistent or worsening symptoms while being treated, you should report this to your doctor without delay.

It's not entirely understood what exactly causes a migraine. It appears that several areas of the brain are involved, adding to the complexity of the process. Researchers are exploring different hypotheses as explanations for this condition.

Low serotonin levels have been identified as a possible contributor. Inflammation in certain parts of the nervous system seems to be an underlying factor in how migraines happen and can be exacerbated by many things, including stress, diet, and chronic medical conditions.

Researchers believe that blood vessels and nerves in the brain can also interact with inflammatory messengers in different ways that lead to pain and other migraine symptoms.

Some research¹ indicates that in the early stage of a migraine, your hypothalamus (the area of the brain that controls your hormone system) might play a major role in either enabling or intensifying your pain during an attack.

Another theory suggests that migraine triggers such as stress could activate pathways in your brain, resulting in pain.

While there's ongoing research into the exact cause of migraines, scientists have observed that a combination of several risk factors and triggers can play a role.

Risk factors

Certain risk factors make it more likely for you to develop a migraine. Some of the most common include:

• Smoking: smoking cigarettes appears to be an aggravating factor in the development of migraines

• Sex: migraines are three to four times more likely² to occur in women than men, with greater severity

• Genetics: a family history of migraines is a very significant risk factor for migraine disorders

• Medical conditions: some medical conditions can increase your risk of developing migraines, such as coronary artery disease, high blood pressure, stroke, and seizure disorder, as well as psychiatric conditions such as bipolar disorder, depression, anxiety, and obsessive-compulsive disorder

Triggers

Whether or not you have a family history of migraines, specific factors could trigger them to occur, either occasionally or frequently.

Some of these triggers include:

• Medications: different drugs have been linked to the development of migraines as a side effect

• Hormone changes: research shows that women are more likely to develop migraines, and this is thought to be due to hormonal changes as a result of menstruation or menopause

• Stress and anxiety: a clear link³ exists between stress and migraines

• Diet: dietary factors, including excessive alcohol and caffeine consumption and dehydration, have been found to play a strong role and contribute to the development of migraines in some people

• Environmental changes: moving to a vastly different climate can trigger migraines

• Work environment: exposure to deafening noises and bright lights or cigarette smoke in a workplace could also be responsible for bringing on migraines

If you've been experiencing migraines and can't figure out what's triggering them, it may help to keep a migraine journal. You should note the events that precede and follow your migraine attacks in your migraine journal. You should also register your symptoms, their severity, and how long they last.

With time, a pattern will most likely appear, and you should be able to identify any physical, environmental, or emotional factors responsible for triggering your episodes.

Diagnosis

Migraines can be tricky to diagnose because your doctor will need to determine that their cause is indeed a migraine syndrome and not another type of headache or neurological condition. 

To determine a diagnosis, your doctor will look into your medical and family history. They'll ask you a series of questions that may help to identify the cause and severity of your headaches before deciding on the next steps for treatment.

Your doctor will also perform a thorough physical exam. They might order a brain imaging test like an MRI or CT scan to rule out any other causes for your headaches, such as a tumor or other brain abnormality.

The International Classification of Headache Disorders⁴ provides criteria for diagnosing migraines that can help ensure you get the proper diagnosis. Such criteria include:

• episode lasting between 4 and 72 hours

• at least five migraine episodes

• the headache must have at least two of the following: be on one side of your head, have moderate or severe intensity, become worse with physical activity (walking or going upstairs), and feel the pulsating

• presence of nausea and/or vomiting or sensitivity to noise and light during the headache

There's no particular test that can be used to diagnose migraines. If your doctor needs more information to make an accurate diagnosis, they might ask you to start keeping a journal of your symptoms.

Some questions to answer and document usually includes:

• What happens when your pain starts and where is it located?

• How long does the pain last?

• How severe is the pain?

• What other symptoms do you experience, if any?

• What activity are you typically doing when the pain starts?

• What medications were you on, if any, when the headaches began?

In most cases, treatment for migraines focuses on easing your pain and improving your functionality. If you are prone to very regular migraines, your doctor will consider recommending preventive treatment options. 

With successful management, a person can go for months and even years without experiencing a migraine, but there is no absolute cure for this condition. 

Medication

If you experience mild to moderate migraines, over-the-counter pain medicines can help relieve the symptoms. But it's essential to take them as recommended and in alignment with your physician's instructions. Overusing painkillers could make your migraines worse over the long term, also known as rebound or medication overuse headaches. 

While some over-the-counter drugs like acetaminophen and ibuprofen can be effective for mild migraines, more severe cases typically need to be treated with prescription medicines directed at migraine symptoms. 

• Triptans: Triptans are a type of medication made specifically to treat migraines. They help relieve pain and nausea and reduce sensitivity to light. While using triptans, you might experience common side effects such as flushing, tingling, or warm sensations. Axert (almotriptan), Amerge (naratriptan), and Imitrex (sumatriptan) are commonly prescribed.

• Gepants: Gepants are a newer class of migraine medication, typically prescribed to people who react severely to triptans or find them ineffective for their migraines. Ubrogepant (Ubrelvy) and remegepant (Nurtec) are usually prescribed for migraines.

• Botulinum toxin: This is known more commonly as Botox. Although formulated as a treatment for wrinkles, Botox has been approved by the U.S Food and Drug Administration for the treatment of migraines. A 2019 review¹ of the evidence found that Botox was effective in reducing the duration and severity of headaches in patients with chronic migraines. 

Some people with migraines experience other symptoms that can disrupt their daily functioning. When these symptoms are severe, medications can be prescribed to help treat them.

• For nausea: Prescription anti-nausea medication can be helpful if you have severe nausea and vomiting with your migraines. Anti-nausea drugs like domperidone (Motilium) and metoclopramide (Reglan) are typically prescribed. Research also shows that treating the migraine itself can help relieve symptoms of nausea and vomiting. 

It's important to remember to be patient with the treatment process. Anyone who has experienced a migraine finds themselves looking for instant relief, especially when in severe pain. But determining the most effective treatment regimen and implementing it can take time. Sometimes, it can be weeks before you notice a significant improvement in your symptoms. 

Biofeedback

Doctors are looking into alternative therapies to treat migraines, such as biofeedback. Biofeedback involves practices and techniques to help you reduce tension in your head and neck to ease the pain. This method is typically used alongside relaxation training. 

Transcranial magnetic stimulation

Transcranial magnetic stimulation is a relatively new treatment option for migraines. It is a non-invasive procedure that involves holding a small electrical device to your head, which delivers magnetic pulses. 

It's unclear exactly how this device works, and it's not always effective for everyone with migraines. In a 2017 review of studies² on the effectiveness of this treatment method for migraines, researchers found that while it was adequate for treating migraines with aura, it wasn't very effective for chronic migraines. 

Surgery

Surgery may be recommended in situations where a person doesn't benefit from medical treatment for their migraines. However, if you've been diagnosed with a mental health condition, you may not qualify for surgery. 

Surgical procedures used to treat migraines include:

• Neurolysis: This is a semi-invasive surgery in which the nerve endings that register pain are severed. This prevents them from sending pain messages to the brain and treats your headache.

• Nerve decompression: This procedure removes tissues surrounding the nerves that trigger pain, which relaxes the nerves and reduces pain.

• Neuromodulation: Occipital nerve stimulation (ONS)³ is the most common type of neuromodulation used for migraines. It involves surgically placing electrodes around nerves that are causing pain. 

Coping with migraines

Aside from medication, there are other things you can do to get some relief and make life with migraines more functional. They include:

• Using an ice pack or cool cloth to ease some of the tension when your headache starts. Place it on your forehead, the painful side of your head, or your neck for as long as it feels comfortable.

• Finding a quiet, dark room and closing your eyes can help relax you and ease some of the pain.

• Keeping a migraine journal helps to document your symptoms. Your journal should include information such as when your migraines occur, how long they last, any other symptoms you experience, and how you've been responding to treatment.

While you might not be able to prevent migraines from occurring entirely, you can take specific measures and address your triggers to reduce their severity and frequency. Here are some ways you can do this:

• Make sure you are getting enough sleep (7 to 9 hours each night)

• Keep yourself well hydrated

• Eat a nutritious, balanced diet, avoiding any dietary triggers

• Keep your stress in check

• Learn your triggers (such as places, smells, events, and weather changes) and try to avoid them

For people who experience frequent and severe migraine episodes, your doctor might prescribe migraine prevention medications¹ such as propranolol (Inderal), divalproex (Depakote), topiramate (Topamax), and amitriptyline (Elavil) taken daily to help prevent them from occurring.

If you've been experiencing migraine symptoms, your first call should be to a general practitioner. They'll help you determine if the painful headaches you are having are due to migraine syndrome, a neurological condition, or if they are just ordinary headaches. 

If your prescribed treatments are not helping or you have signs of an underlying condition, they will likely refer you to a neurologist for a more extensive evaluation and testing. A neurologist is a doctor who specializes in conditions that affect your brain and nervous system. 

If you've been prescribed medication for your migraines by your healthcare professional, you must take the medicines as directed. Don't discontinue them because you've begun to feel better; this could cause your migraines to return with more severity. 

If you are experiencing troubling side effects from your medication, speak to your doctor about it. They might adjust your dosage or switch to an alternative drug that your body will tolerate better. It's helpful to know that mild side effects can occur when you first begin a medicine and tend to pass after you've been taking it for a while. But don't disregard them if they do not improve over time.