What to Know About Migraine

Migraine is a complex brain condition that affects more than 1 billion people each year worldwide. Besides a severe headache, migraine attacks cause other symptoms like nausea, light sensitivity, and temporary visual changes. Despite the variable and disabling nature of migraine attacks, numerous treatment and preventive options are available.

This article will review essential facts about migraine, including symptoms, triggers, diagnosis, and treatment. It will also provide insight into seeking migraine care.

Types of Migraine

Migraine is classified as either a migraine without aura or a migraine with aura. An aura is a series of reversible neurological symptoms, most commonly visual, like seeing various patterns or flashes of light.

Migraines with aura are further categorized into subtypes depending on the specific symptoms of the aura. These subtypes include:

• Migraine with brain stem aura: An uncommon subtype associated with brain stem symptoms like difficulty speaking, loss of balance, and vertigo (sensation of spinning)
• Hemiplegic migraine: A rare subtype associated with temporary weakness on one side of the body
• Retinal or ocular migraine: A rare subtype associated with vision changes in one eye

Other types of migraines include:

• Menstrual migraine: Migraine attack that develops within a specific time frame of the menstrual cycle (two days before and up to the first three days of menstrual flow)
• Vestibular migraine: When people with a history of migraine experience episodes of vertigo
• Abdominal migraine: A type of migraine seen mainly in children associated with abdominal pain and other symptoms (e.g., nausea and light sensitivity)
• Chronic migraine: A headache occurring 15 or more days a month for over three months.\ that is migraine-like at least eight days a month

What Are the Symptoms of a Migraine?

Migraine attacks cause intensely throbbing or pounding pain on one or both sides of the head. Any movement commonly aggravates the pain, which can be severe enough to make you miss school or work.

Symptoms that commonly accompany a migraine headache include:

• Nausea or vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Sensitivity to smells (hyperosmia)
  
• Neck stiffness or pain
  
• Trouble sleeping
  
• Mood changes, like anxiety or depression

Stages of a Migraine

Migraine attacks occur in four distinct stages or phases, although not everyone with migraine cycles through all four. These are:

• The preheadache stage, or prodrome stage, signals the beginning of a migraine attack. It can last several hours to days. Excessive yawning, irritability, and food cravings are symptoms that may occur during this phase.
• Aura is the least common stage. It typically develops before the onset of head pain of the migraine attack and fully resolves in 60 minutes or less.
• The headache stage is the most common phase, lasting up to three days. It's marked by moderate to severe pain on one or both sides of the head.
• The "migraine hangover," or postdrome stage, lasts up to two days and is experienced by around 80% of people with migraine. Fatigue and poor concentration are common during this stage.

Migraine Risk Factors

Several factors may make a person vulnerable to developing migraines.

One significant risk factor is having a family history of migraine. If one or both of your parents have migraine, there is a 50% to 75% chance that you will too.

Female sex (due to fluctuating estrogen levels) and age are additional migraine risk factors. Migraines can develop at any age, but they are most common before age 45.

(Note that when research or health authorities are cited, the terms for sex or gender from the source are used.)

Specific lifestyle factors are linked to an increased risk for migraine. They include caffeine misuse, smoking, and physical inactivity.

Various health conditions may also influence migraine development, although the connection is likely complex. Examples of such conditions include:

• High blood pressure
• Having obesity
• History of head trauma
• Sleep disorders like obstructive sleep apnea or insomnia
• Anxiety and depression

What Triggers Migraines?

Migraine occurs as an episode or attack of symptoms followed by a recovery period. A migraine attack can occur spontaneously or be triggered by an outside factor.

Common triggers of migraine include:

• Emotional stress
• Menstruation
• Sleep disturbances
• Alcohol
• Certain foods, like those containing monosodium glutamate (MSG), nitrates, and aspartame
• Skipping meals
• Weather changes, like changes in barometric pressure

Diagnosing Migraine

Diagnosing migraine requires a healthcare provider to take a medical history and conduct a neurological exam.

Imaging tests are unnecessary unless there is something abnormal on the neurological exam, migraine symptoms are atypical, or other causes need to be ruled out based on the person's medical history (e.g., they have cancer or a weakened immune system).

Two standard brain imaging tests are computed tomography (CT) scan and magnetic resonance imaging (MRI). They can help detect alternative diagnoses, such as stroke, brain bleeds, tumors, or blood vessel abnormalities.

Migraines in Women

Females experience migraines at about twice the rate of males, mainly due to the link between the sex hormone estrogen and migraine attacks.

Higher estrogen levels generally prevent migraines, whereas lower or fluctuating estrogen levels can trigger them. This concept is why migraine-prone females may experience a migraine just before menstruating when estrogen levels reach their lowest point.

Estrogen changes during pregnancy, perimenopause, and menopause may also trigger (or protect against) migraines, depending on the estrogen level.

How to Find Migraine Relief

There are several treatment options for migraine. Keep in mind what works well for one person may or may not work well for another.

Medication

You can alleviate mild to moderate migraine headaches with an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) like Aleve (naproxen sodium) or Advil and Motrin (ibuprofen).

NSAIDs reduce the body's production of prostaglandins (chemicals that cause inflammation and pain). NSAIDs are associated with possible health risks, such as ulcers and an increased risk of heart attack or stroke.

More severe or persistent migraine headaches may be treated with triptans such as mitrex (sumatriptan) or Maxalt (rizatriptan), or a combination triptan/NSAID, like Treximet (sumatriptan/naproxen).

Triptans are prescription medications targeting serotonin docking sites in the brain. Serotonin is a chemical messenger relaying communication between nerve cells. Triptans are available in several formulations, including pills, tablets that dissolve on your tongue, nasal sprays, and injections.

Besides triptans, other prescription drugs used to treat migraine include Reyvow (lasmiditan) or Nurtec ODT (rimegepant).

Home Remedies

Napping in a quiet, dark room and drinking water may help relieve migraine headaches. A gentle scalp massage can also be soothing.

In addition, research suggests that placing a cold compress on the neck at the onset of a migraine attack can reduce pain.

Keeping a Migraine Journal

A journal or diary is often considered paramount to migraine management. Whether handwritten in a notebook or recorded electronically through a computer or app on your phone, a journal can help track your migraine symptoms, patterns, and triggers.

It can also help you and your provider determine which medication is most helpful for relieving or reducing migraine attacks.

How to Prevent Migraine

Migraine prevention often involves a combination of lifestyle interventions, trigger avoidance, and various medication or complementary therapies.

Lifestyle

Lifestyle habits that can help prevent migraines include:

• Avoiding trigger foods, sounds, and smells
• Eating healthy meals on a regular schedule
  
• Regulating caffeine consumption
• Ensuring adequate water intake
• Sticking to a regular sleep schedule
• Engaging in daily relaxation (e.g., journaling, meditating, and breathing exercises)
• Getting exercise regularly
  

Medication

If you are experiencing four or more migraines per month or your migraines are lasting longer than 12 hours, your healthcare provider may prescribe a preventive drug.

A migraine preventive medication aims to reduce the number and severity of your migraine attacks and improve your daily functioning and quality of life.

Several oral medications were developed to treat other health conditions—high blood pressure, seizure, and depression—but were later found to help prevent migraine attacks.

These drugs must be taken daily to work and have unique side effect profiles and effectiveness levels. They include:

• Beta-blockers like Toprol (metoprolol), Inderal XL (propranolol), and Timoptic (timolol)
• Anticonvulsants like Topamax (topiramate) and Depakote (valproate)
• Antidepressants like the tricyclic antidepressant Elavil (amitriptyline)

Calcitonin gene-related peptide (CGRP) blockers are the newest preventive migraine drugs. They are monoclonal antibodies that block the effects of CGRP, a protein involved in migraine pain transmission.

Approved CGRP blockers for migraine prevention include:

• The injectables Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab)
• The intravenously (IV)-infused drug Vyepti (eptinezumab)
• The pill Nurtec ODT (rimegepant)

Other Therapies

Specific complementary therapies, notably acupuncture and yoga, may also help improve migraine control. However, more studies are needed.

Magnesium supplements are another migraine preventive option, especially if you want to avoid possible side effects or you are considering pregnancy and want to avoid other medications. Discuss these with your healthcare provider.

Lastly, Botox (onabotulinumtoxin A) injections may be recommended if you are diagnosed with chronic migraine. Botox is believed to prevent migraines by altering pain receptors and blocking the release of chemicals involved in pain transmission.

When to Seek Care for Migraine

Most migraines are not problematic. However, it's essential to seek care if you suspect you are experiencing a migraine for the first time or if your migraine attacks prevent you from engaging in activities at home, work, or school.

Other indications for seeking care are if the pattern of your migraine headaches is changing, such as becoming more severe or occurring more often.

You should also be evaluated for migraine (or any headache) during or after pregnancy, or if you are being treated for cancer or any conditions associated with a weakened immune system, such as human immunodeficiency virus (HIV).