What is migraine?

Migraines are a type of headache. They’re a neurological condition that affects your nervous system.

Migraines can be severe and debilitating, but they don’t cause permanent damage or harm to the body. They’re often accompanied by symptoms like nausea, vomiting, and sensitivity to light and sound.

Migraines can occur as infrequent episodes, or they may be chronic — meaning they occur frequently over time (for example, several times a week).

The exact cause of migraines isn’t known. The most common theory suggests that certain factors trigger the constriction of blood vessels in the brain (called vasoconstriction), which then causes a release of chemicals that lead to inflammation and pain signals in the brain.

Migraine pain

Migraine pain can be severe, but there are steps you can take to manage it.

If you have migraine headaches, you know how painful they can be. The pain may be dull or piercing and usually affects one side of your head. It may last from four to 72 hours and is often accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound.

Migraine pain can be felt in other parts of the body too, including:

• The back of the head (occipital)
• The neck (cervical)
• The shoulders (axial)

Migraine symptoms

Migraine symptoms can vary from person to person, but they typically include some combination of the following:

Headache. Most migraines begin with a headache that worsens over time. It usually lasts from four to 72 hours. Migraine headaches usually feel like a throbbing or pulsing sensation on one side of the head, but some people describe them as sharp jabs or burning pains. The pain is often accompanied by sensitivity to light and sound.

Nausea and vomiting. About 30 percent of migraine sufferers vomit at some point during an attack, and about 15 percent have diarrhea.

Sensory changes. One-third of migraine sufferers experience visual disturbances during an attack, such as seeing flashing lights or zigzag lines, according to the American Migraine Foundation. Some people also report tingling sensations in their arms and legs, known as paresthesia; numbness; or other unusual sensations in the face, head, neck and shoulders.

Feeling sick to your stomach (nausea). This symptom may occur before or after the onset of pain and may develop into full-blown vomiting during severe attacks.

Migraine types

Migraines are a common and disabling disorder that can affect many aspects of your life. There are several types of migraine, including:

Migraine without aura. This type accounts for about two-thirds of all cases and is defined by the presence of migraine headaches without any warning signs or symptoms (called aura). An aura is a set of visual disturbances that occur before or during a migraine attack, such as flashing lights or blind spots.

Migraine with aura. Less common than migraines without aura, this type describes migraines characterized by auras along with accompanying symptoms like weakness, numbness or tingling in an arm or leg. Auras may also be experienced as tingling sensations in the face or tongue. Auras typically last less than 60 minutes but may continue off and on for up to 24 hours if they’re severe enough.

Complicated migraine syndrome. In this rare form of migraine, people experience migraines accompanied by neurological symptoms like visual changes and difficulty speaking. Complicated migraine syndrome is often mistaken for stroke because it can cause similar effects on speech and vision as well as weakness on one side of the body (hemiplegia).

Types of migraine

There are four main types of migraine:

• Episodic – when the headache occurs less than 15 days each month.
• Chronic – when the headache occurs 15 days or more each month.
• Menstrual – migraine that occurs around the time of a woman’s period.

Probable medication overuse headache – a condition where people have been taking painkillers for headaches on more than 10 days per month for three months or longer.

Migraine causes

Stress. Stress can trigger a migraine in some people, particularly if they are already vulnerable to them.

Hormonal changes. Hormonal changes during puberty, menstruation and menopause may trigger migraines in some women. Pregnancy is another time when hormonal changes can lead to migraines.

Foods and beverages. Eating certain foods or drinking alcohol can trigger an episodic migraine (a migraine that occurs once or twice a month). Common triggers include cheese, chocolate, processed meats, citrus fruits and caffeine.

Migraine prevention

Migraine prevention can be as simple as taking a daily medication or making lifestyle changes.

Medications for migraine prevention

Exercise, diet and stress reduction help prevent migraines. These methods may also reduce the frequency and severity of your headaches.

Medicines that may help prevent migraines include:

Amitriptyline (Elavil, Tryptizol) — This antidepressant is often prescribed in low doses to treat chronic daily headaches. It has anticonvulsant effects that can help relieve pain associated with migraine. Side effects may include drowsiness and constipation.

Dipyridamole (Persantine) — This medicine can help prevent migraine when taken in combination with amitriptyline (see above). It’s not clear how it works; it may increase blood flow to the brain and reduce inflammation there. Dipyridamole has few side effects but can cause complications if you have certain heart or kidney problems, or if you’re taking other medicines that affect blood clotting.

Ergotamine — Ergotamine causes constriction of small blood vessels in the brain, which relieves migraine pain by decreasing the amount of pain.

Migraine diagnosis

The diagnosis of migraine is based on your symptoms, your medical history and the results of a physical examination. The doctor will ask about your medical history, for example:

• If you have had any previous head injuries or brain surgery.
• Whether you have a family history of migraine.
• When your headaches started and how long they last.
• How often you get them and how severe they are (mild, moderate or severe).

The doctor may also ask questions about your diet, drinks and sleeping habits. They can help with the diagnosis by ruling out other conditions that produce similar symptoms, such as cluster headaches or medication overuse syndrome (medication-induced headache).

If the doctor suspects that you have migraine with aura, they may perform an electroencephalogram (EEG) to rule out other causes of seizures (fits). Other tests may be recommended if there are ongoing concerns about your health.

Migraine treatment

Pain relievers. Pain relievers such as aspirin or ibuprofen (Advil, Motrin IB) may help reduce pain during a migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than acetaminophen (Tylenol) for reducing pain from migraine headaches; however, NSAIDs can cause stomach bleeding and other side effects if used for too long. For people with frequent migraines who can’t take NSAIDs regularly because of side effects or other reasons, naproxen sodium (Aleve) may be an option. Some people find that caffeine helps relieve migraine symptoms.

Anti-nausea medications. Some people have nausea with their migraines; anti-nausea drugs such as metoclopramide (Reglan), ondansetron (Zofran) or prochlorperazine (Compazine) may help prevent or ease nausea during a migraine attack. Some anti-nausea drugs also work against vomiting caused by motion sickness and chemotherapy drugs.