Migraines: Symptoms, Causes, & Treatment

What Are Migraines?

Migraines have features that distinguish them from other forms of headache, like tension headaches, cluster headaches or dehydration headaches.

Migraine pain is intense and often feels like a throbbing or pulsating pain that interferes with the ability to perform daily tasks, such as working or driving. The pain can appear to radiate from behind one or both eyes, and symptoms may worsen during physical exertion. Feeling nauseous or vomiting are strong indicators that you are suffering from a migraine headache and not another form of headache. Another distinctive migraine symptom is extreme sensitivity to light, sound, or smell. A migraine can last anywhere from a few hours to several days.

Common Migraine Triggers

Migraines appear to come out of the blue but when you pay careful attention, you may discover a pattern of triggering substances or stimuli. Learning your migraine triggers, and taking steps to avoid them, can help you manage your migraines. Keeping a simple migraine diary to track food intake and other activities alongside your migraine incidence, can help you gain a better understanding of your individual migraine pattern.

Here is an outline of some of the most common migraine triggers:

Food Triggers

Foods that most commonly trigger migraines are: red wine; aged cheeses; smoked meats (because of the nitrate preservatives used); Monosodium Glutamate; artificial sweeteners; chocolate; dairy products and alcoholic beverages. If you suspect that any of the above trigger your migraines, experiment with eliminating the worst culprits and see if you feel better. If you suffer from celiac, beware as gluten can trigger a migraine.

Strong Stimuli

Bright lights, loud noises, or strong smells are common migraine triggers. Less obviously, look out for changes in barometric pressure (which can occur as the weather changes) as these can also trigger migraines.

Morning Migraines

Did you ever wake up with a raging migraine after a long catch-up sleep session on the weekend? This happens because too much or too little sleep, or any sleep outside of normal patterns, can trigger a migraine.

Stressful Situations

Moving to a new home? New baby? Juggling multiple jobs? These are significant life stressors and stress is a powerful migraine trigger. Try to identify and anticipate causes of stress in your life and find healthy ways to manage it (see below for more suggestions).

Before Menstruation

Often called a "menstrual migraine,” the hormonal changes which accompany your monthly period can trigger intense headaches. Migraine symptoms tend to resolve with the onset of menopause and may improve by going on birth control pill.

Related Migraine Symptoms

Some or all of the following symptoms can accompany migraine attacks. Please note that while migraine symptoms can be alarming, in most cases they are not indicative of a more serious condition.

Prodrome

One or two days before the onset of a migraine headache, you might notice subtle changes (known as a prodrome) that tell you a migraine is on the way. Some common prodrome symptoms are: constipation, mood changes (from depression to euphoria), food cravings, neck stiffness, increased thirst and urination, and frequent yawning.

Aura

You may experience one or more symptoms (known as a migraine aura) before or during a migraine. Auras are temporary disturbances triggered by the nervous system, which tend to build up gradually and last anywhere from twenty to sixty minutes. Some of the more commonly reported migraine auras are: visual phenomena (e.g. seeing shapes, bright spots or flashes); vision loss; increased sensitivity to light, sound or smell, “pins and needles” in an arm or leg; weakness or numbness in the face or one side of the body; uncontrollable jerking movements or hearing imagined noises or music. Nausea, vomiting or sudden onset of a speech difficulty (such as slurred speech or jumbling words) are also common features of migraine aura. Any of the above mentioned symptoms can precede a migraine attack as part of the aura, and also occur during the migraine itself. If any of the above symptoms are new for you, you should seek immediate medical evaluation

Postdrome

Once the pain of a migraine attack has subsided you could experience a “postdrome” - also known as a “migraine hangover.” Common postdrome symptoms include: fatigue; mental fog; nausea; sensitivity to light; dizziness; body aches and difficulty concentrating. Postdrome Symptoms can last hours or even several days and some sufferers find the postdrome symptoms to be as debilitating as the migraine itself.

How Long Does a Migraine Last?

Anywhere from four hours to 72 hours is a normal time-span for a migraine. Migraine medications and other migraine treatments discussed in this article can reduce the duration.

Types of Migraine

There are many types of migraines, and they can be categorized in different ways, which can be confusing. Here is a summary of the main terms you might hear from your doctor:

Acute or Episodic Migraine

The term episodic migraine (EM) refers to the condition of having 1 to 14 migraine headaches per month. Acute migraine is the general term used for migraines that aren't diagnosed as chronic.

Chronic Migraine

A chronic migraine condition is when the sufferer has 15 or more headache days per month, with at least 8 of those days meeting criteria for migraine.

Ocular Migraines

The term "ocular migraine" means a headache that is accompanied by changes in vision.

Sometimes the term ocular migraine is used interchangeably to refer to a different condition called retinal migraine which is a serious and rare condition involving repeated bouts of short-lasting, diminished vision or blindness. Unlike a migraine aura — retinal migraine affects only one eye. So if you experience visual loss in one eye only, consult with a doctor right away.

How are Migraines Diagnosed?

Your primary care doctor or a neurologist can diagnose migraines based on your medical history, symptoms, and a physical examination.

If your condition is unusual, complex, or deteriorates unexpectedly, your doctor may order further testing to rule out more serious causes of your pain. One such test is an MRI (Magnetic Resonance Imaging) which can help doctors diagnose tumors, strokes, bleeding in the brain, infections, and other neurological conditions. A CT scan may also be ordered to help doctors eliminate the possibility of tumors, infections, brain damage, bleeding in the brain and other potential causes of head pain.

Migraine Medications

Migraine medications either focus on relieving migraine symptoms or on preventing future attacks. You can take pain-relieving medications during a migraine attack to stop the symptoms; however, if you suffer from very severe or frequent migraines, your doctor can advise you about regular or daily medications that could help you manage your condition long-term.

Pain relieving medications

There are several different classes of pain-relieving medication that can be used in the management of migraine pain. Your doctor may prescribe one or several of the medications listed below:

• Triptans - Triptans are prescription drugs that block pain pathways in the brain making them an effective migraine treatment. Some triptans you may be offered are sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt). Triptans can be taken as pills, shots or nasal sprays. If you are at risk of stroke or heart attack, don’t take Triptans without first consulting with your medical practitioner.

• OTC Meds - Over the counter medications should be part of your migraine treatment plan and work best when taken at the first sign of an oncoming migraine. Pain-killers like ibuprofen (Advil, Motrin IB, and others) and migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) are helpful, but usually only against mild migraines. Keep in mind that extended use of OTC pain killers can cause medication-overuse headaches. Other risks include ulcers and bleeding in the gastrointestinal tract so exercise caution.

• Dihydroergotamines (D.H.E.45, Migranal) - Dihydroergotamine belongs to a class of medications called ergot alkaloids. They work by constricting blood vessels in the brain and stopping the release of neurotransmitters that cause swelling. Dihydroergotamines are usually available as nasal sprays or injections and are most effective when taken shortly after the start of migraine symptoms. Beware of side effects including worsening of migraine-related vomiting and nausea. If you are at risk of coronary artery disease, high blood pressure or kidney or liver disease you should avoid dihydrogergotamines.

• Opioid medications - Narcotic opioid medications, especially those containing codeine, can help relieve migraine symptoms and your doctor may prescribe these if for some reason, you cannot take triptans or ergots. This class of drugs is highly addictive and so are generally used as a last resort if no other treatments are effective.

• Anti-nausea drugs - Sometimes a migraine is accompanied by nausea and vomiting. In these instances, it is recommended to take anti-nausea drugs such as chlorpromazine, metoclopramide, or prochlorperazine.

Preventative Medications

If you suffer from frequent or severe migraines, your doctor may prescribe drugs that need to be taken on a regular basis. The effect of such drugs builds over time and it can take weeks or months until you feel the full effect. Here is an outline of some of the classes of drug your doctor may want to use to help you reduce the frequency and severity of your migraines.

• CGRP antagonists - These are the newest group of medications approved for migraine prevention. They work on a protein that’s found around the brain called the calcitonin gene-related peptide (CGRP). CGRP is thought to be responsible for some of the pain accompanying migraine. While this class of medications is expected to grow in the future, some of the ones your doctor may prescribe today are erenumab (Aimovig) or fremanezumab (Ajovy).

• Beta-blockers - While commonly prescribed for high blood pressure, beta-blockers can also help reduce both the frequency and intensity of migraines as they decrease the effect of stress hormones on your heart and blood vessels. Your doctor may prescribe: atenolol (Tenormin), metoprolol (Toprol XL), nadolol (Corgard), propranolol (Inderal), or timolol (Blocadren). Beware of common side effects of beta-blockers such as fatigue, nausea, dizziness when standing, depression or insomnia.

• Calcium channel blockers - Calcium channel blockers are generally used to control blood pressure as they moderate the constriction and dilation of your blood vessels but this also makes them helpful in the management of migraine pain. Some calcium channel blockers your doctor may prescribe are: diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac), nimodipine (Nimotop), verapamil (Calan, Covera, Isoptin, Verelan). If you experience any side effects such as low blood pressure, weight gain, dizziness or constipation consult with your doctor before continuing treatment.

• Antidepressants - These act on various brain chemicals, including serotonin. An increase of serotonin can reduce inflammation and constrict blood vessels, helping alleviate migraines. Some antidepressants used in the treatment of migraines are: amitriptyline (Elavil, Endep), fluoxetine (Prozac, Sarafem), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil, Pexeva), sertraline (Zoloft). venlafaxine (Effexor). Beware as antidepressants can cause unwanted side effects such as weight gain and decreased libido.

• Anticonvulsants - Anticonvulsants are generally used to prevent seizures caused by epilepsy and other conditions but they may also alleviate migraine symptoms by calming overactive nerves in the brain. Some anticonvulsants your doctor might prescribe are: divalproex-sodium (Depakote, Depakote ER), gabapentin (Neurontin), levetiracetam (Keppra) or pregabalin (Lyrica). Watch out for common side effects including nausea, vomiting, diarrhea, weight gain, sleepiness, dizziness or blurred vision.

• Botulinum toxin type A (Botox) - The FDA has approved Botox (Botulinum toxin type A) injections in forehead or neck muscles for the treatment of chronic migraine. Generally, these have to be repeated every three months, and can be expensive.

Always talk with your health-care provider to find the right drug, or combination of drugs, for your specific case.

Migraine Treatment & Prevention - What You Can Do at Home

Here are some simple lifestyle tweaks you can make and migraine remedies you can try:

• Stress management - Try regular exercise, relaxation techniques, and biofeedback (which uses electronic devices to teach you to control body functions such as heartbeat, blood pressure, and muscle tension) - all of which have been shown to reduce the number and severity of migraines in some people.

• Keep a diary - Writing down lifestyle habits like eating, drinking, sleeping, exercise, and stressful events in a log can help you identify what appears to trigger your migraines and what it might be helpful to maintain or avoid in your daily routine. Logging can also help you figure out what positive action to take e.g. establish a consistent sleep schedule or eating regular meals.

• Hormone therapy - If your migraines are related to your menstrual cycle, hormone therapy can offer relief.

• Lose weight - If you are obese, losing weight may help with your migraines.

• Rest with your eyes closed in a quiet, darkened room - Bright lights and loud noises can exacerbate your migraine. Find a quiet spot away from the action and pull down the shades— this can offer immediate relief from the worst symptoms.

• Place a cool cloth or ice pack on your forehead - Cold substances reduce blood flow, so placing a washcloth that's been rinsed in cold water, a frozen gel pack or ice pack on your forehead, scalp, or neck can give migraine relief.

• Drink fluids - Not drinking enough water is a well-known migraine and headache trigger. It only takes mild dehydration to bring on a headache so try to drink more water throughout the day to avoid this problem.

• Natural remedies - Natural remedies such as riboflavin (vitamin B2), coenzyme Q10 or magnesium have proven to offer relief to some migraine sufferers. The herb, butterbur also seems to help although it may not be safe for long-term use. Always check with your health care provider before taking any supplements.

When to Seek Help/When to See a Doctor

You should seek immediate medical attention if you experience any of the following symptoms all of which can be indicative of a more serious condition:

• If you have a severe headache with abrupt onset, like a thunderclap.

• If you experience headache accompanied by fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking.

• If you have a headache after a head injury.

Book an appointment to see your doctor at a convenient time if you experience any of the following symptoms. These are not urgent but you should get them checked out:

• If the pattern of your migraines changes or your headaches suddenly feel different.

• A chronic headache that is worse after coughing, exertion, straining or a sudden movement.

• If you get a new type of headache pain after age 50.

You can always use the K app to assess your symptoms in a two minute chat. You’ll see how people your age with similar symptoms were diagnosed and treated by their doctors, including whether they were treated in an emergency setting, a primary care doctor’s office, or by a neurologist.