Episodic Migraines Explained

What is an episodic migraine?

Migraine is a neurological disorder affecting over one billion people¹ worldwide. If you suffer from migraines, you will usually experience them for many years. Often, you will have episodic migraines throughout your entire lifetime.

Sufferers face debilitating pain that can interfere with day-to-day life, affecting their quality of life. 

Episodic and chronic migraines are two of the many types of migraine conditions, and you can progress from one condition to the next or revert. Women are more likely to suffer from migraines. This is partly due to their ever-changing hormones.

Scientists are focused on finding a way to keep people from progressing to chronic migraines since they're much more debilitating and difficult to deal with.

How is an episodic migraine different from an ordinary headache?

Often, people assume a migraine is just a severe headache, but that's not the case. Headaches don't usually have any other symptoms. Migraine is a neurological disorder that produces a range of debilitating symptoms, one of which can be severe headaches. 

When you suffer from a migraine, it affects the blood flow in your brain along with the surrounding tissue. Your brain activity changes throughout the episodic migraine.

A migraine may cause a severe headache, but a headache isn't always present. The American Migraine Prevalence and Prevention study² determined that only 42.3% of episodic migraine sufferers experienced a severe headache. 

Aside from headaches, you may experience various symptoms with episodic migraine. Some are most common during certain phases of a migraine, but not everyone experiences all four phases. 

Some of the most common symptoms during a migraine include:

• Nausea

• Dizziness

• Extreme fatigue

• Increased sensitivity to light, smell, or sound

Headache is another common symptom, and people can experience mild to severe pain.

The four phases of an episodic migraine

We can divide a migraine episode into four phases. Each phase can cause unique symptoms, but that's not always the case. Some people experience all four phases with several symptoms, while others may only experience one or two. Let's look at the four phases of episodic migraine.

Prodromal phase

The prodromal phase—or the pre-headache phase—appears first, alerting you that a migraine episode is beginning. The symptoms during this phase are usually painless, and they can occur hours to days before the migraine appears. 

During the prodromal phase, you may experience:

• Nausea

• Irritability

• Increased urination

• Fatigue

• Depression

• Difficulty sleeping

• Difficulty concentrating, reading, or speaking

• Excessive yawning

• Food cravings

• Sensitivity to light, smells, or sound

• Stiff muscles 

Aura phase

During the aura phase, you may experience sensory changes that affect your ability to hear, see, touch, or speak. An aura isn't always present before a migraine headache, but it can be alarming if you suddenly experience one for the first time. 

Some examples of auras include:

• Visual disturbances like blurred vision, blind spots, or zig-zag patterns 

• Numbness or tingling in the arms, legs, or face

• Speech problems like slurring or jumbling words

• Experience visual disturbances

Many people who suffer from episodic migraines learn to recognize an aura when it occurs, so they can prepare for the next phase before it begins. Preparation may include taking pain medication or canceling plans so you can stay inside.

Headache phase

The headache phase can cause pain ranging from mild to severe, and some migraine sufferers don't experience a headache at all. Certain physical activities and sensations may increase the pain, so many people try to avoid certain strong smells, loud sounds, and bright lights.

While experiencing an episodic migraine, people often describe the headache as a throbbing, stabbing, or pounding pain. Some people also claim that it feels like intense pressure.

Aside from headaches, the headache phase can also make you feel:

• Nausea (with or without vomiting)

• Dizziness

• Congestion

• Anxious

• Unable to sleep

• Irritable

• Sensitive to light, smell, or sound

• Tired

• Pain and stiffness in their neck

Postdrome phase

Once the headache goes away, the postdrome phase begins. This can cause various symptoms and emotions, most of which are not pleasant. Some of the most common feelings include:

• Confusion

• Exhaustion

• Feeling unwell

What's the difference between episodic migraines and chronic migraines?

Migraines affect 37 million Americans. Scientists continue to reevaluate the definitions of each, and the parameters between the two types of migraines keep changing.

Episodic migraine

Doctors diagnose episodic migraines based on how many days you experience a migraine in a month. When you have 0 to 14 headache days per month,² you have episodic migraines. 

You can suddenly stop having episodic migraines, or you may have them at the same frequency for the rest of your life. They may progress to chronic migraines, which are more debilitating and significantly affect your daily life. Researchers are looking for a successful treatment plan to stop episodic migraines from progressing to chronic migraines.

Chronic migraine

Chronic migraines are much more debilitating, and they come with an increased risk of comorbidities and brain abnormalities. To be diagnosed with chronic migraines, you must suffer from migraine headaches at least 15 days each month for more than three months, where 8 of those headache days have migraine features. 

Because of the constant, debilitating chronic migraine pain, you have a much lower quality of life than someone who suffers from episodic migraines.

In some cases, you may experience chronic migraines less frequently. When you have migraine symptoms less than 15 days each month, you can revert to having episodic migraines. 

Do episodic migraines and chronic migraines have the same triggers?

Migraine triggers vary from person to person, and many people who experience migraines try to avoid their triggers at all costs. A trigger is simply something that causes a migraine to begin. 

Some common triggers include:

• Anxiety

• Hormonal changes in women

• Loud noises

• Too much physical activity

• Certain smells

• Medication

• Sleep problems

• Bright lights

• Weather changes

• Smoking

• Caffeine

• Skipping meals

• Stress

Additionally, some foods trigger migraine episodes for some people. Common culprits include:

• Aged cheese

• Alcohol

• Chocolate

• Fermented food

• Monosodium glutamate (MSG)

• Processed or cured meat

• Yeast

To determine your triggers, many medical professionals suggest keeping a migraine journal. When you feel the first signs of a migraine, document your triggers and log them over time. After several months of tracking your episodes, you'll notice the triggers to avoid.

This could potentially lessen the frequency of migraine episodes.

Risk factors for suffering from episodic migraines

Although scientists still don't know what causes episodic migraines, they've pinpointed a few risk factors that increase your chance of developing the condition. Currently, 37 million Americans suffer from migraines, affecting adults and children alike. Unfortunately, you can't control your risk factors for developing episodic migraines, but you can be aware of them.

Risk factors that can increase your chances of migraines include:

• The sex you were assigned at birth

• Your family history

• Other medical conditions

People assigned female at birth are three times more likely to suffer from migraine episodes. Since hormonal changes can be a trigger, many experience migraine episodes at certain points in their monthly cycles.

There also seems to be a genetic component to suffering from migraine episodes. If you have a family member who experiences migraines, you will be more likely to develop the condition. 

You're more likely to develop migraines if you have certain medical conditions. These include anxiety, depression, sleep disorders, epilepsy, and bipolar disorder. Most people who suffer from episodic migraines don't have other underlying conditions, but they seem to make it more likely for you to suffer from migraine episodes.

Can episodic migraine progress to chronic migraine?

Studies show that 2.5% of people with episodic migraine progress to chronic migraine. Researchers still aren't sure why this happens, but they've been able to predict your likelihood based on various risk factors in two different categories. These are:

• Easily modified risk factors

• Not readily modifiable

Not readily modifiable risk factors include things that you can't change, like:

• Your age

• Being assigned female at birth

• Having a lower educational level or socioeconomic status

• Being white

• Suffering a head injury

On the other hand, you can reduce your risk of progressing to suffering from chronic migraines with modifiable risk factors like:

• Obesity

• Overusing medication

With help from a medical professional, you can change your lifestyle. This can effectively decrease your chances of progressing from episodic migraines to chronic migraines.

Diagnosis of episodic migraine

There isn't a specific test to diagnose migraine. Instead, your doctor will ask questions about your symptoms, risk factors, and family history. When describing your migraine symptoms, include what a migraine episode feels like, how long it lasts, and how often you experience an episode.

Since there is no definitive test for diagnosing episodic migraines, part of your doctor's assessment will include eliminating other potential causes for your symptoms. Your doctor may do a physical exam, draw blood, or ask that you get an MRI or CT scan. That way, they can be sure that you're suffering from migraine, and they can help you prevent episodes before they occur.

Treatment to manage episodic migraine

Unfortunately, there is no cure for episodic migraines, but doctors have plenty of tools to help you manage your condition. They can prescribe several types of treatment based on the severity of your episodes and whether you've progressed to chronic migraines. Many people use several techniques and medications at once to manage their condition from different angles.

Preventive treatment

Doctors prescribe preventive medications, so you have fewer migraine episodes with much shorter durations and less pain. There are many options, but doctors prescribe these most often:

• Methysergide

• Botulinum toxin

• Calcium channel blockers (a type of high blood pressure medication)

• Beta-blockers

• Antidepressants

• Anti-seizure drugs

• Valproic acid, gabapentin

• Calcitonin gene-related peptide (CGRP) antagonists

• Topiramate (Topamax)

Additionally, several supplements can reduce the frequency of migraine episodes. The most common supplements include:

• B2

• Magnesium

• Coenzyme Q10 

Several natural techniques prevent migraine episodes from occurring or decrease their frequency. Some of these methods include:

• Relaxation techniques

• Biofeedback combined with relaxation training

• Acupuncture

Before beginning any treatment, whether natural or not, make sure you talk to your doctor. 

Abortive treatment

Doctors give abortive treatment to you if you've already identified that an episode is beginning. The goal is to stop the symptoms in their tracks so that it doesn't progress into a full-blown attack. Additionally, abortive medications can decrease any pain and nausea you may have.

Many doctors recommend over-the-counter medications like acetaminophen, aspirin, and ibuprofen for when you begin experiencing a migraine. They may also recommend some of the following medicines to alleviate your symptoms:

• Anti-nausea drugs

• Botulinum toxin

• Calcitonin gene-related peptide (CGRP) antagonists

• Ditans

• Dopamine antagonists

• Ergotamines

• Gepants

• Triptans

Rescue treatment

When an abortive treatment doesn't work, doctors prescribe rescue treatment drugs for 7-10 days. These don't stop your migraine from running its course, but they can ease your symptoms. 

These drugs include:

• Anti-nausea drugs

• Anti-seizure drugs

• Dihydroergotamine (DHE)

• Muscle relaxers

• Prescription-strength pain relievers

• Steroids

Your doctor may recommend intravenous medication for severe episodes that don't respond to treatment.

Integrative medicine treatment

Doctors recommend having several treatment methods in your arsenal. They effectively prevent migraines from occurring while decreasing and managing symptoms. Talk with your primary care provider to determine the best medications for your unique needs.

When will a doctor recommend preventive treatment for episodic migraines?

Nearly 38% of people³ who suffer from episodic migraines could find relief from preventative treatment (prophylaxis). Less than 13%³ actually take these medications. Talk to your doctor about your current symptoms to determine whether you need prophylaxis to manage your condition. 

Your doctor will assess your pain level and the frequency of your headaches to determine whether you need preventative treatment in your migraine arsenal. In most cases, doctors will prescribe preventative medication if you suffer from four or more episodes each month³ and debilitating symptoms for at least eight days. 

Risks and side effects of preventive medication for migraines

Preventive medications are generally safe, but each drug poses the potential for side effects. In many cases, migraines can be so debilitating that finding some relief is worth the risk. It's important to weigh each medication's pros and cons with your doctor to determine which one works best for you.

For example, amitriptyline³ has the highest risk of adverse side effects. The most common include:

• Sedation

• Blurry vision

• Constipation

• Dry mouth

• Heart palpitations

• Tachycardia

• Urinary retention

• Cardiac conduction abnormalities

• Orthostatic hypotension

• QT prolongation

• Weight gain

Other preventive medications can cause symptoms like:

• Nausea

• Tremors

• Neural tube defects (if pregnant)

• Stomach pain

• Memory problems

• Difficulty concentrating

• Kidney stones

• Weight loss

• Taste changes

If you think preventive treatment is right for you, discuss it with your doctor. Together, you can determine whether it's worth the risk of any adverse side effects.

When to visit a doctor

Currently, less than 50% of people suffering from migraines visit the doctor to find relief. That means less than half of people with migraines are getting the help they need to feel better.

It's important to consider whether you've got your migraines under control. If you have symptoms every week, or if you can't find a medication that works for your pain, it's time to call the doctor. They'll be able to create a treatment plan so you can control your migraine episodes.

The lowdown

Migraine is a neurological disorder that affects millions of Americans, young and old. Studies estimate that one billion people worldwide suffer from the pain and frustration of migraines. Symptoms include mild to severe headaches, nausea, dizziness, fatigue, and sensitivity to bright lights, smells, and sounds. 

There is no cure for migraines, but doctors can provide a variety of treatment strategies so you can prevent episodes and decrease symptom severity. If your episodic migraines are affecting your day-to-day life and your current treatment method isn't working, speak to your doctor. They will determine a course of action to relieve your episodic migraines.