Migraine is a headache with pain that can last from four hours to three days
- Pain is usually moderately to severely intense, pulsating, and often occurring on one side of the head
- Telltale signs may be nausea and/or vomiting, and sensitivity to light and sound
- Changes in vision or hearing, called aura, may come just before or just as the migraine begins
There are two types of migraines, which are defined by how often headaches happen.
- Episodic migraine: fewer than 15 headache days per month, some of them being migraine.
- Chronic Migraine: 15 or more days headache per month, with headaches lasting four hours or longer, for at least three months, some being migraine. This is called Chronic Migraine
Symptoms and Triggers
If you suffer from Chronic Migraine, some of those headaches will be migraine. Migraine is often associated with specific symptoms and triggers.
Signs and Symptoms
Migraine may be associated with
- Nausea and/or vomiting
- Sensitivity to light
- Sensitivity to sound
Phases of a Migraine
The phases of a migraine headache may include:
Premonition phase. A change in mood or behavior that may occur hours or days before the headache.
Aura phase. A group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, muscle weakness, and changes in speech, hearing and vision.Aura may also include changes in smell. The symptoms of aura develop gradually over 5 to 20 minutes and last less than 1 hour.
Headache phase. Period during the actual headache. Throbbing pain occurs on one or both sides of the head. Sensitivity to light and motion is common, as are depression, fatigue, and anxiety.
Headache resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.
What are the most common types of migraines?
Migraine classification helps to guide treatment. The categories below help to narrow down the classification process.
Migraine without aura. This more common type of migraine does not include an aura phase (symptoms that come just before the headache).
Migraine with aura. Fewer migraine sufferers have this type of migraine, which is preceded by aura symptoms, such as a flashing light or zigzag lines. These symptoms usually appear within 30 minutes before an attack.
Migraine may be aggravated or triggered by specific factors. In a study of 1207 migraine patients, about 3 out of 4 said they have triggers for their migraine attacks. When given a specific list of triggers to consider; almost 95% of the people said that their attacks were brought on by certain circumstances or environmental influences.
Common triggers may include
How are migraines diagnosed?
Migraine headaches are diagnosed primarily based on reported symptoms, but a thorough medical exam, which may include other tests or procedures, may be used to rule out underlying diseases or conditions.
Tracking and sharing information about your headache with your doctor helps with the process of making an accurate diagnosis. Consider writing down the following information to take to your medical appointment:
Time of day when your headaches occur
Specific location of your headaches
How your headaches feel
How long your headaches last
Any changes in behavior or personality
Effect of changes in position or activities on the headache
Effect of headaches on sleep patterns
Information about stress in your life
Information about any head injuries
Procedures used to diagnose a migraine are generally used to rule out other possible causes of the symptoms. In addition to a complete medical history and physical examination, some procedures that may be used include:
Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.
Sinus x-rays. A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
Spinal tap (also called a lumbar puncture). A special needle is placed into the lower back, into the spinal canal, which is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.
While there is no cure for Chronic Migraine, specific treatment for headaches will be determined by your doctor based on:
Your age, overall health, and medical history
Type of migraine
Severity and frequency of the migraine
Your tolerance for specific medications, procedures, or therapies
Your opinion or preference
The ultimate goal of treatment is to stop migraines from occurring. Adequate management depends on the accurate identification of the type of headache and may include:
Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
Changing eating habits
Resting in a quiet, dark environment
Medications, as recommended by your doctor
There are two types of medications to help manage migraine headaches. Talk to a specialist to find out how acute and preventive medications may benefit your type of migraine.
Acute medications are taken as needed. The goal is to stop the pain once it has begun.
- Over-the-counter (OTC) medications to diminish or stop the headache.
- Prescription medications
- Triptans and Ergots act on specific receptors in both the brain and the blood vessels in the head, stopping a headache once it is in progress.
- Opiate drugs are derived naturally or synthetically from opium
- Combinations of the above medications
Triptans are considered the most powerful targeted treatment for acute migraine pain.
Preventive (prophylactic) medications are taken to prevent headaches before they start. For people who do not respond well to acute medications, experience a great impact on their lives due to migraine, or have a high frequency of migraine attacks, the doctor may consider preventive therapies. Unlike treatments used as the start of a migraine, preventive medications are taken on a regular basis. Common preventive daily medications for migraine are taken as pills and include
- Beta-blockers (medications normally used for heart conditions)
Injection therapy is another option for some patients with chronic migraine. Botulinum toxin or Botox is believed to inhibit the release of peripheral nociceptive neurotransmitters, which may then have a knock-on effect on the central pain processing systems that generate migraine headaches.