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Migraine – Causes, Symptoms, Treatment, and Prevention

Medically reviewed by Dr. Naveed Rafique, MBBS, FCPS—Written by Dr. Ramisha Farooq, MBBS. Updated on August 15, 2021.

Migraine is a powerful headache that can last from 4 hours to 3 days, this can be accompanied by nausea, vomiting, sensitivity to light, and some other signs. It is a chronic headache disorder that is experienced by the patient throughout his life. Throbbing pain, which is characteristic of a migraine usually occurs in one side of head but can also be experienced at one point in head, in the forehead, or even in the whole head.

Symptoms of migraine

Different patients come up with different symptoms. Usually, patients report a prodrome of malaise, irritability, food cravings, and behavioral change for some hours or days. But different people experience different types of migraines and report to have different symptoms.

  • There is a dull ache at the beginning which grows into throbbing pain that gets worse due to exertion
  • Pressure in head behind eyes
  • Sensitivity to light, noise, and smell
  • Temporary loss of vision
  • Difficulty speaking clearly
  • Stomach ache and diarrhea in a few cases
  • Migraine and vomiting are closely related which usually begins with nausea
  • Loss of appetite and fatigue
  • Dizziness, blurred vision, and ringing sensation in ears in migraine with aura

Most migraine headaches last a few hours but in some cases, they can last for up to 3 days. The frequency may differ for everyone, some people may get migraine headaches every other day while others get them once or twice a year. It is common to get two or three headaches per month.

Character and duration of Pain

Pain is typically throbbing, pounding, and pulsating in character. The pain lasts four to seventy-two hours on average, becoming debilitating with the passage of time. But the duration and no of episodes vary from person to person.

Causes of migraine

The cause of migraines is still unknown but there is a genetic predisposition. A migraine begins when over-reactive nerve cells send out signals to the trigeminal nerve (a nerve that supplies sensation to our head and face). Activation of this nerve leads to the release of certain chemicals which cause blood vessels in the scalp of our brain to swell up, a process called vasodilation. This releases excess neurotransmitters that can cause inflammation and the sensation of pain.

Factors that can trigger a migraine attack

  • Foods and drinks like cheese, alcohol, caffeine and food additives like MSG may be the cause for 30% of migraines
  • Hormone headache is very common in young females
  • Estrogen-containing oral contraceptives, increase the very small risk of stroke in patients who suffer from migraine with aura.
  • Irregular eating habits
  • Disturbed sleeping pattern, neck tension, poor posture, or tiredness
  • Bright lights, severe heat, severe cold, or loud noises
  • Unusual smells, smoking, skipping meals, or traveling
  • When psychological factors contribute, migraine attack often occurs after a period of stress, more likely at the end of a working week or the beginning of a holiday.

Phases of migraine

A migraine attack is divided into four phases. 

Prodrome phase: The symptoms of a migraine attack begin a day or two before the beginning of the actual headache. These symptoms are mood disorders, cravings, anxiety, and depression.

Aura: During this phase, the person faces issues with hearing and vision. Flashes of light appear in front of eyes and may also experience ringing of ears. Other than this pricking sensation on arms, face and legs are also experienced.

Attack: During the attack phase patients experience all the general symptoms of a migraine but higher in severity and intensity along with a debilitating headache.

Postdrome phase: This phase marks the resolution of the headache. A dull headache might still persist along with certain mood changes other than these, the person feels better. 

Risk factors

Some people are more prone to develop migraines than the rest, the risk factors which are responsible for this are as under:

  • Depression
  • Irritable bowel syndrome
  • Sleeping disorders
  • Anxiety or obsessive-compulsive disorder
  • People with a family history of migraines
  • The age group of 10 to 40 years is most likely to develop migraines, but most females begin to have these headaches in their late fifties
  • Females are affected by this more than males

Types of migraine

Two major types of migraine; migraine with auras (classic) and without auras (common) only differ in the prodrome symptoms that are present in classic migraine but are absent in common migraine. Another, less common type includes isolated Auras.

Migraine without auras:

Most people experience characteristic headaches but not auras and are known as migraine without auras. Migraine often run in families and have a genetic predisposition. Although painful, migraine without auras are not life-threatening. These are caused due to vasodilation of extracranial blood vessels due to hypothalamic activity and the release of neurotransmitters. 

Migraine with auras:

The auras in migraine are neurological symptoms, often visual, sometimes leaving behind a trail of temporary visual field loss. Sensory symptoms spreading over from one part of the body to another are more common than motor ones. These have all the features of a common migraine with some additional neurological symptoms like photophobia and phonophobia that are followed by a migraine attack.

Isolated auras:

In some cases, people are reported to have experienced isolated auras where the neurological symptoms may occur but are not followed by any headache.

Migraine and other headaches

A migraine is different from other headaches. Other headaches usually just have one trigger or are experienced differently in means of character and duration of pain. The characteristic migraine usually develops in phases while all the other headaches just develop in response to a trigger and go away sometime after the trigger is removed.

Migraine in pregnancy

Most women stop getting migraines during pregnancy due to consistent hormone levels. However, a few who experience migraines should be more cautious and take this seriously. A trigger, in this case, can be high blood pressure or any change that may also prove harmful for the baby. According to several pieces of research conducted across the globe, Acetaminophen is safest to consume during pregnancy for migraines and provides relief from the symptoms too. If you are pregnant and experiencing frequent migraine attacks, you should consult your physician before taking any sort of medication.

Migraine in children

Children experience the same intensity and type of migraine as adults and should be addressed as soon as possible because their headache is accompanied by mood and depressive disorders which affect their performance in school and can have a negative effect on their confidence and character development. They experience pain on both sides of head or on one side, lasting for a duration of 2 to 72 hours. 

In children, the triggering factors such as diet, sleep deprivation, stress, and fatigue should be addressed along with the treatment that includes Acetaminophen.

Management of migraine

Migraine is a common illness experienced by a number of people worldwide. It can be easily managed by taking some precautions and some on-the-spot medical treatment.

Precautions:

  • Quit smoking and alcohol consumption
  • Stay hydrated
  • Avoid taking larger spaces in meals
  • Take proper sleep
  • Exercise regularly
  • Try relaxation techniques like yoga, meditation, and acupuncture
  • OTC pain killers should be carefully administered. Excessive use can lead to rebound headaches or dependence and medication overuse headache
  • Blood pressure-lowering medications can decrease the blood pressure which may trigger a migraine attack
  • Women who experience migraines with auras should avoid estrogen replacement treatment because of an increased risk of ischemic stroke
  • Single-pulse transcranial magnetic stimulation devices (sTMS) are placed at the back of the head and they help with symptoms of an aura

Medical Treatment:

For an acute attack:

  • Acetaminophen
  • Aspirin
  • Caffeine
  • Ibuprofen

If you’re taking any of these more than twice a week, you should see your doctor.

For nausea:

An antiemetic like metaclopramide can help

For severe attacks:

Sumatriptan is a good medication. It works by releasing serotonin that constricts the blood vessels in the scalp and helps relieve the pain.

Other drugs for migraine:

  • Ergotamine-derived medications like migergot and ergomar help balance the neurotransmitters
  • Lasmiditan helps with auras
  • CGRP receptor antagonists come to the rescue when every other treatment fails

Surgical treatment:

  • Botulinum toxin is injected around the effected nerve to cause a numbing affect
  • Decompression of the nerves is also employed to relieve the severe pain during migraines if nothing else helps

Life style changes and home remedies

  • Lie down in a quiet dark room
  • Avoid exposure to light and sound
  • Drink plenty of water, hydrate yourself
  • Use cold compresses on the forehead
  • Apply pressure to painful areas
  • Discontinue estrogen replacement therapy if you’re having one
  • Avoid alcohol consumption
  • Take vitamin and mineral supplements
  • If you manage to identify and avoid factors that trigger migraines and keep track of your symptom patterns in a headache diary, you can figure out what’s causing them. You can successfully manage to decrease the number of episodes you have been having per month
  • Stress management and relaxation training can help in migraine prevention or making the attacks less severe
  • Cognitive-behavioral therapy can also help with triggers such as stress, anxiety, and depression

FAQ

Can auras exist without an episode of headache?

Yes, This is known as isolated auras. The visual symptoms are not followed by a headache.

What are the major triggers for a migraine attack?

Triggers may vary from person to person but some common triggers are:
Processed carbs, aged cheese, MSG containing food, caffeine, and loud noises.

How can any other headache be misdiagnosed as a migraine?

This is a common illusion that a headache on one side of head is always a migraine. But there are other headache conditions as well which can have similar symptoms such as paroxysmal hemicranias, TACs, arthritis headache, vestibular migraines, and TMJ Headache, etc.

I often get a headache before the onset of menstruation, why is it so?

Migraines are triggered due to hormonal changes occurring in the body. A drop in the estrogen levels can trigger an episode.

Last medically reviewed on July 15, 2021.