Migraines: Symptoms, treatments, and causes

A migraine is a severe and painful headache. They can be preceded or accompanied by sensory warning signs, such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound.

The excruciating pain that migraines bring can last for hours or even days; migraines are a common problem in the United States

According to the American Migraine Association, they affect 36 million Americans; that’s about 12 percent of the population

Migraines can be preceded by an aura of sensory disturbances followed by a severe, often one-sided headache. The cause is still largely unknown and they tend to affect people aged 15-55.

Fast facts on migraines:

• Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, such as allergies, light, and stress.
• Some people get a warning symptom before the start of a migraine headache.
• Many migraine sufferers can prevent a full-blown attack by recognizing and acting upon the warning signs.
• Over-the-counter medications can eliminate or reduce pain, and specific medications can help some sufferers.
• People who have severe attacks can take preventive medicines.

Symptoms of migraines

Symptoms of migraine can start a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

• Moderate to severe pain, usually confined to one side of the head, but can occur on either side of the head.
• The pain is usually a severe, throbbing, pulsing pain.
• Increasing pain during physical activity or when straining.
• Inability to perform regular activities due to pain.
• Feeling sick and physically vomiting.
• Increased sensitivity to light and sound, relieved by lying quietly in a darkened room.
• Some people experience other symptoms such as sweating, temperature changes, stomach ache, and diarrhea.

Migraines with aura

For many migraine sufferers, the auras act as a warning, telling them that the headache is soon to come. However, many people do not experience auras. Auras are perceptual disturbances, such as:

• Confusing thoughts or experiences.
• The perception of strange, sparkling or flashing lights.
• Zig-zag lines in the visual field.
• Blind spots or blank patches in the vision.
• Pins and needles in an arm or leg.
• Difficulty speaking.
• Stiffness in the shoulders, neck, or limbs.
• Unpleasant smells.

If any migraine sufferer experiences unusual or worrying features that they do not normally have, then they should seek medical help rather than blaming the migraine.

If the following symptoms are unusual for the sufferer, they should not be ignored:

• unusual severe headache
• visual disturbance
• loss of sensation
• difficulties with speech

When migraines with aura affect vision, the patient may see things that are not there, such as transparent strings of objects, not see parts of the object in front of them, or even feel as if part of their field of vision appears, disappears, and then comes back again.

It is common for patients to describe the visual disturbance as similar to the sensation one has after being photographed with a very bright camera flash, especially if one walks into a darker room straight away.

Treatments for migraines

There is currently no single cure for a migraine; treatment is aimed at preventing a full-blown attack, and alleviating symptoms if they come.

Some lifestyle alterations might help reduce migraine frequency, including:

• getting enough sleep
• reducing stress
• drinking plenty of water
• avoiding certain foods
• regular physical exercise

If the above changes do not alleviate the symptoms or frequency of migraines, then treatment and prevention focus on avoiding triggers, controlling symptoms, and taking medicines.

Migraine medication

There are many different types of migraine medication including:

Painkillers

Painkillers should be taken early rather than allowing the headache to develop.

Over-the-counter medications include:

• naproxen
• ibuprofen
• acetaminophen

Other analgesics, like aspirin with caffeine and acetaminophen, can often stop a headache or substantially reduce pain.

Nausea treating (antiemetic) drugs

Metoclopramide may be used to control symptoms such as nausea and vomiting. Serotonin agonists, such as sumatriptan, may also be prescribed for severe migraines or for migraines that are not responding to over-the-counter medications.

Selective serotonin reuptake inhibitors (SSRIs) and antidepressants such as tricyclics are prescribed to reduce migraine symptoms, although they are not approved in all countries for this purpose.

Ergots

Another class of treatments is called ergots, which are usually effective if administered at the first sign of a migraine.

Preventive medications

Migraine prevention begins with avoiding things that trigger the condition. The main goals of preventive therapies are to reduce the frequency, painfulness, and duration of migraine headaches and to increase the effectiveness of other therapies.

There are several categories of methods used to prevent a migraine, ranging from diet changes and exercise to prescription drugs; these include:

• prescription beta blockers
• anticonvulsants
• antidepressants
• gabapentin
• botulinum toxin A (Botox)
• herbs and vitamins such as cannabis, coenzyme Q10, feverfew, magnesium citrate, riboflavin, B-12, melatonin
• spinal cord stimulator implantation
• hyperbaric oxygen therapy
• vision correction
• exercise, sleep, sexual activity
• visualization and self-hypnosis
• acupuncture

Some people find that special diets such as gluten-free can help. It is worth noting that some people can get a medication overuse headache (MOH) – or rebound a headache – when taking too many medications in an attempt to prevent a migraine.

Surgery

In the last decade, novel approaches the treatment of migraines have been developed. Botulinum toxin (Botox) injection and surgical decompression of the extracranial sensory branches of the trigeminal and cervical spinal nerves have been shown to reduce or eliminate migraines in patients who don’t respond to traditional medical management. This was highlighted in a review published in the journal Plastic and reconstructive surgery in 2014.

What causes migraine headaches?

The exact cause of migraine headaches is unknown; it is thought to be due to abnormal brain activity causing a temporary alteration in the nerve signals, chemicals, and blood flow in the brain.

How common are migraines?

A migraine and headache are leading causes of outpatient and emergency department visits; migraines remain an important public health problem, particularly among women during their reproductive years. This was highlighted in a large review of migraines published in Headache: The Journal of Head and Face Pain.

The National Headache Foundation states that healthcare providers have properly diagnosed fewer than half of all migraine sufferers. Migraine is commonly misdiagnosed as tension-type headache or sinus headache.

Migraine triggers

Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include:

• allergies and allergic reactions
• bright lights, loud noises, flickering lights, smoky rooms, temperature changes, strong smells, and certain odors or perfumes
• physical or emotional stress, tension, anxiety, depression, and excitement
• physical triggers such as tiredness, jet lag, and exercise
• changes in sleep patterns or irregular sleep
• smoking or exposure to smoke
• skipping meals or fasting causing low blood sugar
• dehydration
• alcohol
• hormonal triggers such as menstrual cycle fluctuations, birth control pills, and menopause
• tension headaches
• foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
• other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods
• medication such as sleeping tablets, the contraceptive pill, and hormone replacement therapy

Triggers do not always cause migraines and avoiding triggers does not always prevent migraines.

How is a migraine diagnosed?

Migraine can be difficult to diagnose, and there are no specific tests to confirm the diagnosis. The International Headache Society recommends the “5, 4, 3, 2, 1 criteria” to diagnose migraines without aura.

This stands for:

• 5 or more attacks.
• 4 hours to 3 days in duration.
• At least 2 of unilateral location, pulsating quality, moderate to severe pain, aggravation by, or avoidance of routine physical activity.
• At least 1 additional symptom such as nausea, vomiting, sensitivity to light, or sensitivity to sound.

To help diagnose migraines, it can be useful to keep a diary of symptoms noting the time of onset, any triggers, how long the headache lasted, any preceding factors or aura and any other symptoms as well as the headache.

A headache diary is ideally used for a minimum of 8 weeks and should record:

• The frequency, duration, and severity of headaches.
• Any associated symptoms.
• All prescribed and over-the-counter medications taken to relieve headaches and their effect.
• Possible triggers.
• Relationship of headaches to menstruation.

During the initial diagnosis of migraines, the doctor may suggest some tests to exclude other causes of a headache such as electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI), and spinal tap.

 

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