What is a Migraine?
A migraine is a headache which causes excruciating, pounding pain, generally on one side of the head. Migraine symptoms include nausea, vomiting, and extreme sensitivity to light and sound. It might last for hours to days, and it is so painful that it interferes with daily activities. Some people get warning symptoms known as migraine aura along with the headache or before the headache. Migraine aura includes visual disturbances, like flashes of light or blind spots. Early migraine diagnosis can help to start migraine treatment and make it less painful.
Types of migraine
There are different types of it, and let’s get to know them a bit.
Migraine with aura (complicated migraine): More than 15% of people experience migraine aura. There is a throbbing headache, visual symptoms like seeing spots, lines or vision loss, and sensory symptoms such as pins and needles, etc.
Migraine without aura (common migraine): When the headache strikes without warning, like an aura, it is called common migraine. The symptoms are the same, but that migraine aura phase doesn’t happen.
Without head pain: In this case, one experiences migraine aura, but there is no following headache. That is why it is called “Silent migraine” or “acephalgic migraine”.
Hemiplegic migraine: In this type, the patient can have temporary paralysis (hemiplegia) or neurological or sensory changes on one side of their body. There could be a headache or not. The onset of the headache can bring temporary numbness and extreme weakness on one side of the body.
Retinal or ocular migraine: One might find a temporary, partial or complete vision loss in one of the eyes. It comes with a slight ache behind the eye, which then spreads to the rest of the head. That vision loss could last for a minute or even a few months. One should immediately seek treatment as it could signify a more severe illness.
Chronic migraine: When a migraine occurs at least 15 days per month, it is known as chronic migraine. Migraine symptoms change frequently, and so does the severity of the pain.
Migraine with brainstem aura. In the case of this migraine, the patient could have slurred speech, double vision, loss of balance, and vertigo before the headache. The headache could affect the back of the head. Symptoms may occur suddenly, and there could be an inability to speak properly, ringing in the ears, nausea and vomiting.
Status migrainosus. It is a rare and severe type of migraine. It can last longer than 72 hours. The pain could be excruciating, and nausea can be terrible.
Menstrual migraine. The headache is linked to a woman’s period.
Vestibular migraine. One might or might not have a headache. Still, other symptoms include balance problems, vertigo, nausea, and vomiting. People with motion sickness generally have this.
Abdominal migraine. It causes stomach pain, nausea, and vomiting. It often could be observed in children, and over time it could later change into classic headaches.
Ophthalmoplegic migraine. It causes pain around the eyes, and there could be paralysis of the muscles around it. It is a medical emergency as the symptoms can also refer to pressure on the nerves behind the eye or an aneurysm. There are also symptoms like a droopy eyelid, double vision, or other vision changes.
The classic migraine generally has four distinct stages. Every stage has different migraine symptoms. The stages are as per below.
- Prodrome (premonitory) stage
- Migraine aura (visual symptoms or tingling)
- Headache (main attack) stage
- Postdrome (recovery) stage
Not everybody experiences all the mentioned stages.
Prodrome (premonitory) stage
Hours or even two days before the pulsating pain, one might notice some changes that could be a warning of an upcoming migraine. This stage is called the prodrome stage. The migraine symptoms include:
- Mood changes
- Food cravings
- Neck stiffness
- Increased urination
- Fluid retention
- Frequent yawning
Migraine aura (visual symptoms or tingling)
Migraine aura can occur before or during migraines. They are reversible symptoms of the nervous system. Migraine aura is mainly visual but might also include other sensations. Migraine symptoms build up over several minutes and can last up to 1 hour. Near 30% of people experience migraine aura.
Migraine symptoms of migraine aura include:
- Observe bright spots – migraine aura
- Flashes of light – migraine aura
- Loss of vision –
- Seeing dark spots – migraine aura
- Tingling sensations in an arm or leg
- Speech problems (aphasia) – migraine aura
- Ringing in the ears (tinnitus)
- Numbness – one side of the body or face – migraine aura
- Changes in smell, taste, or touch – migraine aura
Headache (main attack) stage
The main attack stage can last from a few hours to a few days. It depends from person to person. The frequency of it also varies from person to person. It may occur rarely or can happen several times in a month.
The main attack stage includes headache and other migraine symptoms as per below.
- Severe pain on one side or both sides of the head.
- Pain throbs or pulses
- Extreme sensitivity to light, sound, smell and touch
- Nausea and vomiting
- Severe pain during physical activity
- Abdominal pain or heartburn
- Loss of appetite
- Blurred vision
Sleeping for some time can ease the migraine symptoms. One might feel the urge to lie down in a dark and quiet place to escape light, sounds, and disturbances. It is one of the significant differences between migraines and other types of headaches.
Postdrome (recovery) stage
Once the attack stage passes, the postdrome or recovery phase initiates and migraine symptoms eases. One might feel tired, drained and confused. Some people feel ecstatically happy. The throbbing pain fades slowly, and sudden movement could bring back the pain for a brief period.
Migraine Diagnosis and When to see a doctor
Many a time, it is often not diagnosed and left untreated. If one regularly has migraine symptoms, they need to keep a record of the attacks. After that, one needs to make an appointment with a doctor to discuss the headaches.
Your health professional might ask you about your health history and symptoms. It may help if you have kept a record of the symptoms and attacks.
- What migraine symptoms do you have?
- Where exactly does it hurt?
- How frequently do you have headaches?
- How long does the pain last?
- Family history
- Medicines and supplements you intake
Your physician might order tests to rule out other things that could cause your symptoms by incorporating several tests like
- Blood tests
- Imaging tests like MRI or CT scans
- Electroencephalogram (EEG)
Many factors could trigger the headaches. Here is a list of triggers that might cause the throbbing pain.
Stress. Stress is a significant trigger. It could be work-related stress or stress at home.
Sensory stimuli. Loud sounds, bring lights, flashing lights, strong odour, etc., can be the trigger.
Sleep changes. Inadequate sleep or excess sleep also can be a trigger for some people.
Physical factors. Too much physical exertion also can be a trigger.
Medications. Sometimes medication can also act as a trigger. Oral contraceptives and vasodilators can also be the cause.
Hormonal changes in women. Hormonal changes like changes in estrogen level before or during the menstrual periods, during pregnancy and menopause, can also be a trigger.
Drinks. Alcohol or too much coffee (caffeine) can also be a trigger.
Weather changes. Weather change can also be an important trigger.
Foods. Skipping or missing important meals, certain foods such as aged cheese, and processed foods can also be triggers of headaches. Additionally some food additives like food sweeteners (aspartame) and food preservatives (monosodium glutamate) can also be the trigger factor.
Below are a couple of risk factors that can make one prone to migraine symptoms.
Family history. A family history is a risk factor for other family members to develop the problem.
Age. It generally develop during the adolescence period, and it tends to peak during the 30s.
Sex. Women are three times more likely have it than men.
Pain relief medication can treat the migraine symptoms. Some of the common pain relievers are
Always discuss with a health professional before beginning any treatment. The information provided here is for the knowledge purpose only. Your physician is the right person to diagnose and prescribe medication accordingly.
These headaches are chronic. They might not be curable but can be managed. There are two main treatment approaches for migraine treatment.
Abortive migraine treatment
At the very first sign, if these migraine treatment medications are taken, then they could be more effective. Taking them while the pain is mild can stop the headache process. Abortive medications can help with migraine symptoms like pain, nausea, light sensitivity, etc. Some work by constricting the blood vessels and then returning them to normal. This way, the throbbing pain is reduced.
Preventive (prophylactic) migraine treatment
This type of migraine treatment medication is prescribed for severe headaches. Preventive medications reduce the frequency of headaches. They are taken regularly and daily to prevent pain and other symptoms.
Over-the-counter (OTC) migraine treatment medications are effective for many with mild to moderate migraines symptoms. Caution should be taken when taking any OTC pain relievers. Overusing them can cause dependency problems or analgesic-rebound headaches.
Prescription drugs for migraine treatment or headaches include:
- Triptan class of drugs
- Calcium channel blockers
- Calcitonin gene-related (CGRP) monoclonal antibodies
- Antiseizure drugs
The pain medication could be pills, tablets, injections, suppositories or nasal sprays. Your physician will provide specific medicines or a combination of medications and formulations best suit your unique headache.
Preventive migraine treatment medications such as beta-blockers, calcium channel blockers, antidepressants etc., could be beneficial against migraine symptoms. There are some alternative medicinal migraine treatment which could help relieve migraine symptoms.
- Acupuncture – migraine treatment
- Cognitive behavioural therapy
- Vitamins such as riboflavin (Vitamin B-2)
- Magnesium supplements
Some home remedies for migraine treatment are as below
- A hot and cold compress to the forehead or behind the neck.
- Massaging the scalp.
- Resting in a dark and quiet room.
- Applying pressure to the temples in a circular motion.
- Pescador Ruschel, M. A., & De Jesus, O. (2022). Migraine Headache. In StatPearls [Internet] https://www.ncbi.nlm.nih.gov/books/nbk560787/. StatPearls Publishing.
- Teleanu, R. I., Vladacenco, O., Teleanu, D. M., & Epure, D. A. (2016). Treatment of pediatric migraine: A review https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5394581/. Maedica, 11(2), 136–143.
- Weatherall, M. W. (2015). The diagnosis and treatment of chronic migraine. Therapeutic Advances in Chronic Disease, 6(3), 115–123. https://doi.org/10.1177/2040622315579627