What is a migraine headache?
A migraine is usually an intense pounding headache that can last for hours or even days. The pounding or pulsing pain usually begins in the forehead, the side of the head, or around the eyes. The headache gradually gets worse. Just about any movement, activity, bright light, or loud noise seems to make it hurt more. Nausea and vomiting are common during a migraine.
Migraines may happen only once or twice a year, or as often as daily. Women are more likely to have migraines than men.
There are different types of migraine headaches. The most common types of migraines are classic migraines and common migraines.
Classic migraines (also called complicated migraines) start with a warning sign called an aura. These types of migraines are sometimes also called “migraines with aura.” The aura involves changes in the way you see. You may see flashing lights, colors, a pattern of lines, or shadows. You may temporarily lose some of your vision, such as your side vision.
You may also feel a strange prickly or burning sensation or have muscle weakness on one side of your body. You may have trouble speaking/communicating. You may also feel depressed, irritable, and restless.
Auras last about 15 to 30 minutes. Auras may occur before or after your head pain. Sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic migraines may occur on one side of your head or on both sides.
Common migraines don’t start with an aura. For this reason, these types of migraines are also called “migraines without aura.” Common migraines may start more slowly than classic migraines, last longer, and interfere more with daily activities. The pain of common migraines may be on only one side of your head. Most people who have migraines have common migraines (they don’t have an aura).
Migraines without head pain, sometimes called “silent migraines,” may cause you to feel other migraine symptoms, but not pain. This means you may not the usual migraine pain around your eyes and temples. This type of migraine may even include an aura phase. You may also feel the same sensitivity to light and sound as with a typical migraine.
Hemiplegic migraines cause one side of your body to become weak, similar to having a stroke. These symptoms are only temporary. They are a part of the migraine attack. Areas of the body affected by the weakness may include your face, arm, or leg. The weakness may last from an hour to even days. It most often goes away within 24 hours. For this type of migraine, the head pain can come before or after the weakness. This type of migraine is rare.
Retinal migraines (also called ocular migraines) cause changes in vision that are not related to aura vision changes. For retinal migraines, symptoms involve vision problems or even blindness in one eye. These symptoms do not last long. They can occur before or after head pain. If you experience this type of migraine, contact your doctor.
Icepick headaches are not migraine headaches. They produce a stabbing pain around your eyes and temples. These stabbing pains may occur repeatedly in the same place or jump around to different areas each time. This type of headache can occur at any time and without warning. If you are a person who has migraine headaches, you are more likely to get icepick headaches, too.
Cluster headaches are not migraine headaches. They are rare headaches that occur in patterns, known as cluster periods. These periods can mean having a headache at the same time every day for a week or even a month. Cluster headaches can be extremely painful. They usually cause pain on one side of your head. This pain can be so severe that it makes your eyelid droop and your nose get stuffy.
Cervicogenic headaches are not migraine headaches. They are headaches caused by another illness or physical condition, usually a problem in your neck. Many times, this type of headache can be brought on by a sudden movement of your neck. You might also get a cervicogenic headache after keeping your neck in the same position for too long. The pain can last for hours or days. It may be limited to one side of your head or face.
What does a migraine feel like?
The pain of a migraine headache can be intense. It can interfere with your daily activities. Migraines aren’t the same for everyone. Possible symptoms of migraines are listed below. You may have a “premonition” several hours to a day before your headache starts. Premonitions are feelings you feel a migraine is coming. These feelings can include intense energy, fatigue, food cravings, thirst, and mood changes.
Symptoms of migraines
Possible symptoms of migraines include:
- Intense throbbing or dull aching pain on one side of your head or both sides
- Pain that worsens with physical activity
- Nausea or vomiting
- Changes in how you see, blurred vision or blind spots
- Being bothered by light, noise, or odors
- Feeling tired and/or confused
- Stuffy nose
- Feeling cold or sweaty
- Stiff or tender neck
- Tender scalp
What causes migraines?
Researchers do not yet understand all of the factors that cause migraines. It appears they may be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body and effects blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems. Another cause being studied is that migraine headaches go along with a spreading pattern of electrical activity in the brain.
Some research suggests there could be a heredity factor for migraines, meaning they may run in families. Researchers have identified some genes associated with migraines. They are unsure why these genes impact some people more than others. The American Migraine Foundation reports that if one of your parents has migraines, there is a 50% chance that you will, too. If both of your parents have migraines, your chances jump up to 75%. Ultimately, migraines seem to be caused by a combination of factors: genetic, environmental, and lifestyle.
Women are more likely to have chronic migraines (migraines that occur 15 days a month or more). This is likely linked to hormones. Hormones fluctuate each month around the time of your period. They can also fluctuate if you are pregnant or going through menopause.
What are some migraine risk factors and triggers?
Some risk factors make you more likely to get migraine headaches. Other things may trigger a migraine.
Common migraine risk factors include the following:
- Family history: You are much more likely to have migraines if one or both of your parents had migraines.
- Sex: Women are more likely than men to have migraines.
- Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.
Common migraine triggers include the following:
- Food and drink: Certain food and drink (see list below) may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
- Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
- Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work. But you can also become stressed by exercising too much or not getting enough sleep.
- Senses: Loud sounds, bright lights (such as flashing lights or sunlight), or strong smells (such as paint fumes or some perfumes) may trigger migraines.
- Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
- Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.
Foods that may trigger migraines:
- Aged, canned, cured, or processed meat (including bologna, game, ham, herring, hot dogs, pepperoni, and sausage)
- Aged cheese
- Alcoholic beverages (especially red wine)
- Beans (including pole, broad, lima, Italian, navy, pinto, and garbanzo)
- Brewer’s yeast (including fresh yeast coffee cake, donuts, and sourdough bread)
- Caffeine (in excess)
- Canned soup or bouillon cubes
- Chocolate, cocoa, and carob
- Cultured dairy products (such as buttermilk and sour cream)
- Meat tenderizer
- Monosodium glutamate (MSG)
- Nuts and peanut butter
- Onions (except small amounts for flavoring)
- Passion fruit
- Pea pods
- Pickled, preserved or marinated foods (such as olives and pickles, and some snack foods)
- Red plums
- Seasoned salt
- Snow peas
- Soy sauce
How are migraines diagnosed?
Your doctor can diagnose migraines by the symptoms you describe. If the diagnosis is not clear, your doctor will perform a physical exam. Your doctor might want to do blood tests or imaging tests, such as an MRI or CAT scan of the brain. These tests can ensure there are no other causes for the headache. You may also be asked to keep a headache journal. This can help your doctor identify the things that might cause your migraines.
Can migraines be prevented or avoided?
Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.
Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide (CGRP) inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.
There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines as well.
What else can I do to prevent migraines?
While there are no sure ways to keep from having migraine headaches, here are some things that may help:
- Eat regularly and do not skip meals.
- Keep a regular sleep schedule.
- Exercise regularly. Aerobic exercise can reduce tension and keep your weight in check. Obesity can contribute to migraines.
- Keep a migraine journal to track what triggers your migraines and what treatments are most helpful.
There are 2 types of medicines for migraine treatments. One type, called “abortive,” focuses on stopping the headache from becoming severe and relieving the headache pain. You should start this type of treatment as soon as you think you’re getting a migraine. The other type, called “prophylactic or preventive” includes medicines that are taken every day to reduce how often headaches occur (outlined in the section above).
Talk to your doctor about which of these two types of medicine is best for you. Some people use both types. Nonprescription and prescription medicines that are used often or in large doses may cause other problems.
What medicines help relieve migraine pain?
For mild to moderate migraines, over-the-counter medicines that may help relieve migraine pain include:
- Acetaminophen (one brand name: Tylenol)
- An acetaminophen, aspirin, and caffeine combination (one brand name: Excedrin Migraine)
- Ibuprofen (one brand name: Motrin)
- Naproxen (brand name: Aleve)
- Ketoprofen (brand name: Orudis KT)
People who have more severe migraines may need to try “abortive” prescription medicines. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful. Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan.
If the pain won’t go away, stronger pain medicine may be needed, such as a narcotic, or medicines that contain a barbiturate (sleep-inducing medicine). These medicines can be habit-forming and should be used cautiously. Your doctor may prescribe these only if they are needed and only for a short period of time.
What else can I do?
To help manage your migraine pain, try the following:
- Lie down in a dark, quiet room.
- Put a cold compress or cloth over your forehead or behind your neck.
- Massage your scalp using a lot of pressure.
- Put pressure on your temples.
- Have some caffeine.
Living with migraines
Migraines can come on quickly, many times without warning. They can ruin your day—or even several days at a time. They can make you miss work, miss important events, miss out on fun. If you have recurring migraines, you probably feel like you don’t have total control of your life.
Work with your doctor to take back control. Keep a migraine journal. Document when you get migraines and what you were doing and eating. Keep a record of what the weather was like and if you were exposed to unusual smells or environments. Knowing your triggers can help you prevent migraines. You doctor also may prescribe different medicines or combinations of medicines. Doing this helps sort out which will be most effective for preventing migraines or stopping them when they start.
Discussion on migraines with Dr. Duren Michael Ready and Nick Haines
Talking about migraine symptoms, prevention strategies, and treatment options.
Questions to ask your doctor
- How can I prevent a migraine? Are there lifestyle habits I can change?
- What about medicine? Can migraines be cured?
- What are some possible side effects of migraine medicine?
- What should I be writing in my migraine journal?
- Will my child grow out of having migraines?
Funding and support for this material have been provided by The Allergan Foundation.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.