Migraine

• There are several different types of migraine, each with their own specific symptoms.
• Migraines can cause big disruptions to people’s quality of life, work, sleep, and mood. 
• The good news is that there are a variety of treatment options available to help relieve migraine symptoms and reduce their effect on your life.

Migraines affect around 1 in 7 people worldwide. They’re most commonly experienced as headaches on one side of the head and may be accompanied by various symptoms depending on the type of migraine. This guide provides a practical outline of the different types of migraines, their symptoms, risk factors, and treatment options.

A migraine is a type of headache that results in a pulsating or throbbing pain, usually on one side of the head. This headache is often quite intense and may be accompanied by other symptoms. Untreated attacks last anywhere between 4 and 72 hours. According to the American Migraine Foundation, migraines affect about 12% of people in the US. 

While the exact cause of migraines isn’t fully understood, we know that they result from inflammation near the nerves and blood vessels of the head. 

Most people experience migraines for the first time during puberty and are often affected by the condition for their entire lives, as migraine attacks are often recurring. Luckily, there are migraine treatments that can decrease the impact of this condition on everyday activities. 

Women are more commonly affected by this condition due to the effects of the hormonal cycle on migraines. 

Different migraine types exist, each with its possible symptoms and characteristics. Variants of migraine headaches include: 

1. Migraine with aura (classic migraine)
2. Migraine without aura (common migraine)
3. Migraine with brainstem aura
4. Chronic migraine
5. Migraine in children (abdominal migraine)
6. Menstrual migraine 
7. Retinal migraine 
8. Hemiplegic migraine 
9. Vestibular migraine 
10. Silent migraine
11. Status migrainosus 

Migraine symptoms can range from mild headaches to severe effects. What you may experience depends on the stage and type of migraine you have.

Migraines can have up to 4 stages, though only some people experience all of them. Here’s a quick look at each stage:

1. Prodrome stage (up to 24 hours before the migraine) may involve frequent yawning, mood changes, or cravings for certain foods.

2. Aura stage can include visual disturbances like flashing or bright lights.

3. Headache stage.

4. Postdrome stage (after the headache) often includes general tiredness that can last about a day.

Types of migraine and their symptoms:

The most common symptoms of a common migraine include:

• Throbbing, pulsating pain on one side of the head. This pain may affect the eye area but can occur anywhere in the head or the neck.
• Sensitivity to light, sound, and/or smell
• Vision changes
• Nausea
• Vomiting

Besides these common symptoms of a migraine, it’s also possible to experience: 

• Loss of appetite  
• Muscle tenderness  
• Impaired concentration  
• Fatigue  
• Anxiety
• Other symptoms

Between 10% and 30% of people affected by migraine headaches experience additional accompanying neurological disturbances called an aura. This often results in a temporary loss of vision or visual disturbances, such as flashing lights. The aura often occurs right before the headache attack begins but may also occur during the attack, afterward, or on its own.

The typical migraine aura is characterized by visual symptoms, including:

• Colored or blind spots in the field of eyesight
• Sparkles, stars, or flashing lights
• An arc or band of absent vision, often with a shimmering border or zigzag lines
• Tunnel vision
• Temporary blindness

People with chronic migraine symptoms experience:

• migraine headaches for more than 15 days per month
• additional symptoms of migraine for at least 8 days per month. 

Common chronic migraine symptoms include:

• Frequent headaches
• High sensitivity to light, sound, or smells
• Nausea 
• Vomiting
• Migraine aura
• Dizziness or vertigo 

Abdominal migraine usually occurs in children, although adults can also suffer from this condition. Some of the typical symptoms of this sort of migraine are:

• A dull pain or soreness around the belly button 
• Loss of appetite
• Nausea
• Vomiting
• Light and noise sensitivity
• Headaches (less frequent) 

Menstrual migraines cause the same symptoms as a regular migraine. However, the attacks are typically more severe than migraines at other times of the month. Common menstrual migraine symptoms include:

• Throbbing or pulsating headache on one side of the head
• Sensitivity to light
• Sensitivity to sound
• Vision changes
• Nausea
• Vomiting

People who experience a silent migraine experience the symptoms of a migraine aura but without the headache. The symptoms of a migraine aura include:

• Vision difficulties, such as seeing zigzag lines or flashing lights
• Numbness or the feeling of pins and needles
• Feeling dizzy
• Difficulty speaking

The symptoms of status migrainosus can be very severe, with intense pain that can even lead to hospitalization. You can experience:

• Severe headache for over 72 hours
• Severe nausea 
• Migraine aura symptoms

There are other types of migraine that can cause vertigo, temporary paralysis, visual loss, and ringing in the ears and are linked to the part of the head most affected. 

Some of the combinations of symptoms might also be present in more serious emergency conditions. If you haven’t been diagnosed with migraines and experience acute brain or vision symptoms, seek medical advice urgently. This helps rule out any serious conditions that may need investigation.

There are some factors that increase the chances of being susceptible to migraines, such as having a member of the family affected. Women are 3 times more likely to develop migraines than men, mainly due to hormonal changes at puberty, pregnancy, and menopause.

Migraines can be triggered by various factors, which can differ from person to person. Common triggers include:

• Environmental: Loud noises, bright or flashing lights, strong smells, extreme temperatures, and poorly ventilated spaces.
• Physical: Fatigue, poor posture, smoking, lack of sleep, sudden and strenuous exercise, head and neck tension, motion sickness, and low blood sugar.
• Dietary: Caffeine, alcohol, dehydration, irregular meal times, certain food additives, like aspartame and monosodium glutamate (MSG), chocolate, aged cheeses, salty foods, citrus fruits, and even skipping meals.
• Emotional: Stress, anxiety, and low mood.
• Hormonal: Menstruation, pregnancy, and menopause.
• Medications: Particularly the combined contraceptive pill, hormone replacement therapy, and sleeping tablets. It’s important to check with a doctor or consult the medication packet to understand if they could be associated with headaches.

A healthcare provider can diagnose a migraine by:

• Checking symptoms along with medical, family, and overall health history.
• Looking at headache details to find triggers and see how attacks affect daily life.
• Using CT or MRI scans to rule out other causes of headaches by examining the brain.
• Performing a complete neurologic exam to check nerve function. Since migraines don’t cause lasting nerve damage, any nerve issues might suggest another problem. This exam usually includes tests of motor and sensory nerves, cranial nerves, reflexes, coordination, gait, and signs of irritation in the brain’s protective layers.

A migraine diagnosis is given when other causes are ruled out. After diagnosing a migraine, a healthcare provider can recommend treatments to help reduce the impact on daily life.

There is a range of treatments for migraines. They can be broken down into those that help relieve attacks and those that help prevent them.

A variety of treatments and medications, which are suitable for adults and children, are available to reduce the acute symptoms during a migraine attack. These include:

NSAIDs such as ibuprofen and aspirin can help reduce headache pain. Their anti-inflammatory properties are thought to help relieve the migraine’s characteristic throbbing/pulsing sensation. Depending on the type and strength, they can be purchased over the counter or prescribed.

However, NSAIDs are not suitable for long-term use, as they can cause complications, including gastrointestinal disorders. People who experience frequent migraine attacks and need regular pain relief should consult their doctor to explore the most appropriate treatment options.

Triptan medications should be taken at the first sign of a migraine starting. They work on the blood vessels and pain pathways that are associated with migraines. Your doctor might prescribe these if other medications haven't helped.

Ergotamine is derived from a fungus called ergot, and these medications can be used to provide instant migraine relief. Using ergotamine too frequently can, however, result in the development of chronic, persistent headaches.

Opioid medications are more rarely prescribed and usually reserved as a short-term treatment where the above ones have not helped and are not recommended for long-term use. 

Preventing migraines relies on a combination of lifestyle changes and medications. 

Behavioral changes that are recommended for preventing migraine attacks include:

• Developing techniques to manage and reduce stress, such as deep breathing exercises and regular physical activity
• Keeping a diary to identify migraine triggers, such as exposure to strong smells, which can then be avoided if possible
• Sleeping well, and establishing a consistent sleep cycle
• Staying hydrated, by drinking water and other non-alcoholic, non-caffeinated beverages throughout the day
• Establishing regular meal times, and adopting a healthy, balanced diet
• Devising a new medication plan with the healthcare provider if any medications that a person takes regularly are thought to be causing the headaches
• Following a safe weight-loss program is recommended, for obese people affected by migraine headaches

Where people have frequent attacks, medication may be prescribed to prevent migraine headaches. The medications that have been found most effective at migraine prevention include:

• Anticonvulsant medications (commonly used for epilepsy)
• A couple of blood pressure medications: Beta-blockers and calcium channel blockers.
• Antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs)
• OnabotulinumtoxinA (Botox®) injections are approved by the FDA as a treatment for chronic migraine

Finding the right preventative and relieving treatment, as well as the best lifestyle changes, can have a positive impact on reducing the frequency and severity of attacks and their negative effects on life, work, and sleep. Talk to your doctor about what options might be best suited to you.

Migraines can cause a range of symptoms and can be difficult to manage. However, they're manageable, and quality of life can be improved with the right lifestyle adjustments and treatments. Talk to your healthcare provider to explore what might work best for you.

Q: What are the common symptoms of a migraine?
A: Common symptoms of a migraine are a throbbing or pulsating headache on one side of the head, visual disturbances such as seeing flashing or zigzag lines, nausea, and vomiting.

Q: What triggers migraines?
A: Migraine can be triggered by a number of factors, out of which the most common ones are loud noises, bright lights, strong smells, fatigue, intense exercise, certain foods and drinks, stress, menstruation, certain medication, and head trauma. 

Q: How are migraines diagnosed?
A: Migraines are diagnosed by excluding other conditions that might be causing the headache. A healthcare provider will evaluate the headaches and their triggers, review medical and family history, and conduct tests such as CT scans, MRIs, or neurologic examinations.

Q: What are the best home remedies for treating migraine?
A: Migraine relief can be achieved by staying hydrated, using a hot or cold compress, relaxing in a dark, quiet room, and drinking ginger or chamomile tea.

Q: Can lifestyle changes help manage migraines?
A: Yes. Managing stress, anxiety, dietary triggers, and specific physical triggers can help reduce the frequency of migraines.

Q: Are there any new treatments for migraines?
A: Scientists are constantly working on new treatments for migraines. One new option is Atogepant, a new type of anti-calcitonin gene-related peptide drug. It blocks certain receptors found in the nerves of the head and neck, which are thought to be related to migraines. 

Q: What's the worst type of migraine?
A: Status migrainosus is often referred to as the worst type of migraine, as the pain can be so severe and debilitating that some people even require hospitalization. The pain also lasts longer than with regular migraine attacks.

Q: How long does a migraine last? 
A: A migraine attack usually lasts between 4 and 72 hours. Certain types of migraines can last a bit longer, such as chronic migraine, which can be present for 15 days per month, and status migrainosus, which can last for longer than 72 hours.