Many people use the term "migraine" to describe any severe headache, a migraine headache is the result of specific physiologic changes that occur within the brain and lead to the characteristic pain and associated symptoms of a migraine.
Migraines are recurring attacks of moderate to severe pain. The pain is throbbing or pulsing, and is often on one side of the head.
Migraine is three times more common in women than in men. A migraine can be preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound.
What Causes Migraine?
There is no known cause for migraine, although most people with it are genetically predisposed to migraine. If you are susceptible to migraine there are certain triggers which commonly occur. These include:
Allergies and allergic reactions
Bright lights, loud noises, flickering lights, smoky rooms, temperature changes, strong smells and certain odours or perfumes
Physical or emotional stress, tension, anxiety, depression, excitement
Physical triggers such as tiredness, jet lag, exercise
Changes in sleep patterns or irregular sleep
Smoking or exposure to smoke
Skipping meals or fasting causing low blood sugar
Hormonal triggers such as menstrual cycle fluctuations, birth control pills, menopause
Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs and salami)
Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products and fermented or pickled foods
Medication such as sleeping tablets, the contraceptive pill, hormone replacement therapy.
Doctors used to believe migraines were linked to the opening and narrowing of blood vessels in the head. Now they believe the cause is related to genes that control the activity of some brain cells. Medicines can help prevent migraine attacks or help relieve symptoms of attacks when they happen. For many people, treatments to relieve stress can also help.
Migraine is a complex condition with a wide variety of symptoms. For many people the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in you having to lie still for several hours.
The symptoms will vary from person to person and individuals may have different symptoms during different attacks. Your attacks may differ in length and frequency. Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraine can have an enormous impact on your work, family and social lives.
How is Migraine Diagnosed?
Migraine can be difficult to diagnose, and there are no specific tests to confirm the diagnosis.
The International Headache Society recommends the "5, 4, 3, 2, 1 criteria" to diagnose migraines without aura.
This stands for:
5 or more attacks
4 hours to 3 days in duration
At least 2 of unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
At least 1 additional symptom such as nausea, vomiting, sensitivity to light, sensitivity to sound.
To help diagnose migraines, it can be useful to keep a diary of symptoms noting the time of onset, any triggers, how long the headache lasted, any preceding factors or aura and any other symptoms as well as the headache.
A headache diary is ideally used for a minimum of eight weeks and should record:
The frequency, duration, and severity of headaches
Any associated symptoms
All prescribed and over-the-counter medications taken to relieve headaches and their effect
Relationship of headaches to menstruation.
During the initial diagnosis of migraines, the doctor may suggest some tests to exclude other causes of headache such as electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI) and spinal tap.
Differential diagnosis of migraine
Headaches are notoriously difficult for doctors to diagnose, and sometimes other causes need to be ruled out:
Bleeding within the skull
Blood clot within the membrane that covers the brain
Dilated blood vessel in the brain
Too much or too little cerebrospinal fluid
Inflammation of the membranes of the brain or spinal cord
Nasal sinus blockage
Postictal headache (after stroke or seizure)
Symptoms of Migraines
Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache and after the headache. Although not all migraines are the same, typical symptoms include:
Moderate to severe pain, usually confined to one side of the head during an attack, but can occur on either side of the head
The pain is usually a severe, throbbing, pulsing pain
Increasing pain during physical activity
Inability to perform regular activities due to pain
Feeling sick and physically being sick
Increased sensitivity to light and sound, relieved by lying quietly in a darkened room
Some people experience other symptoms such as sweating, temperature changes, tummy ache and diarrhea.
What is the Treatment?
The complex nature of migraine means that the treatments available are varied and differ from person to person. There is currently no cure for migraine. Treatment is aimed at preventing a full-blown attack, and alleviating symptoms if they come.
Individuals who experience migraines can play a significant role in managing their headache frequency and severity.
Keep track of when migraines occur by using a paper or digital headache diary or log to track pain levels, triggers, and symptoms. This can help identify patterns which precede a migraine, as well as help identify factors which contribute to the development of the headache. Once these contributing factors are known, lifestyle modifications can lessen their impact. These modifications may include:
Maintain a regular schedule for eating and sleeping
Avoid certain foods that might trigger a migraine
Keep well hydrated since dehydration has been identified as a migraine trigger for some people
Relaxation strategies and meditation also have been recognized as effective strategies to prevent migraines and decrease headache severity.
Exercise and Migraine
Some people find that exercises that promote muscle relaxation can help manage the pain of migraines. Don't try it when you're in the middle of a migraine attack, because it can make you hurt more. But when you feel well, a regular workout can prevent headaches. It makes your body release endorphins, chemicals that fight pain. It also eases stress and helps you sleep better.
Examples of types of mind-body exercises that can help encourage relaxation are:
Progressive muscle relaxation
Diet and Migraine
There is no specific diet for people with migraine that helps with symptom relief. However, as mentioned previously, certain foods can be triggers for migraines in susceptible people. These foods include:
preservatives used in smoked meats (nitrates),
Alcoholic beverages can also trigger migraine in some people.
Understanding the particular triggers of your migraines and avoiding these dietary triggers may help some sufferers decrease the frequency of attacks.
Cool It Down
Put an ice pack on your forehead, scalp, or neck to get pain relief. Experts aren't sure exactly why it works, but reducing the flow of blood might be part of it. You can also try a frozen gel pack or a wash cloth that's been rinsed in cold water.
You don't need a prescription to get painkillers called NSAIDs, like ibuprofen and naproxen. They cut down the inflammation that makes your head hurt. You can also buy migraine remedies that have a mix of acetaminophen and aspirin.
It's an ingredient in coffee and some other foods and drinks, and it may give you some mild relief. It could also help your body absorb some migraine drugs faster. But go easy. You can get dependent on your caffeine jolt, which can lead to withdrawal symptoms like fatigue and more headaches.
A Dark, Quiet Room
Bright light and loud noises can make your headache worse. So find a spot away from the action and pull down the shades when you've got a migraine. It can help speed up your recovery.
You find this mineral in dark-green veggies, whole grains, and nuts. It won't help while you're having a migraine, but some studies show it could prevent one. You can also take it in pill form, but always check with your doctor before you take supplements.
Get some regular shut-eye to help stave off migraines. Too little -- or too much -- can trigger headaches and lower your threshold for pain. Aim for 7 to 8 hours each night, and try to go to bed and wake up at the same time every day.
Exercise that gets your heart pumping can prevent migraines, but it can also be a headache trigger for some people. This activity, though, with its slower movements, is a safe alternative. Research shows that regular yoga sessions cut the number of attacks you get and make them less intense when they do happen.
It's also called riboflavin, and you can find it in milk, cheese, fish, and chicken. You can also take it as a pill. Studies show it may help you prevent migraines.
People have used this plant for years to treat pain. Does it work to prevent migraines? When researchers looked at all the evidence, they found that taking the extract reduced the number and intensity of headaches for some people.
Can Migraines be Prevented?
Those individuals who are susceptible to developing migraines will always have some component of risk, but daily use of medications and avoidance of headache triggers are often effective in prevention.
Ways to Identify Migraines
Some people with a migraine experience aura.
The most common auras are visual, such as flickering lights, spots, or lines. You may see a little jagged line...that will develop some cross hatches, and it might sort of move in a curved direction.
Auras typically last between five minutes and an hour, with a 60-minute "skip phase" before the headache pain sets in.
Some people have auras without a migraine-type headache or any headache at all.
Depression, irritability, or excitement
Mood changes can be a sign of migraines.
Some migraine sufferers will feel very depressed or suddenly down for no reason. Others will feel very high. Dutch researchers recently reported a possible genetic link between depression and migraines, especially migraines with aura.
Lack of restful sleep
Waking up tired and having trouble falling asleep are common problems in people with migraines.
Studies have shown an association between lack of restorative sleep and the frequency and intensity of migraines.
When migraines strike, it's tough to get a good night's sleep. "A lot of people will have insomnia as a result of their migraine," says Edmund Messina, MD, medical director of the Michigan Headache Clinic, in East Lansing. This inability to sleep can be the start of a vicious cycle, as research suggests that lack of sleep can also trigger migraines.
Stuffy nose or watery eyes
Some people with migraines have sinus symptoms, such as stuffy nose, clear nasal drainage, droopy eyelids, or tearing, Dr. Messina says.
One large study found that, among people who complained of sinus headaches, nearly 90% were having migraines. (The study was funded by GlaxoSmithKline, which makes migraine medicine.)
Before a migraine attack occurs, some people crave certain foods.
"A common craving is chocolate," Dr. Messina says.
Throbbing pain on one or both sides of the head
Pulsating pain is a classic sign of migraines. The throbbing is often felt on one side of the head.
In an online survey of patients with migraines, it was found that 50% "always" have throbbing on one side, while 34% say they "frequently" have this symptom.
Migraine pain often burrows behind the eye.
People will blame it on eye strain and many will get their eyes checked, but that won't make their headaches any better, Dr. Messina says.
"A lot of people will say, 'My neck gets stiff and then I get a headache.' Well, it's probably the early stage of the migraine," Dr. Messina says. "Or after a migraine they'll get that neck symptom or they'll have throbbing pain at the back of their neck."
If you have to go a lot, it can mean a migraine is coming.
It's one of the many symptoms people experience just before a migraine. These warning signs, also known as the prodome phase of a migraine, can arrive as little as an hour or as much as two days before the start of headache pain.
Yawning a lot is another tip-off that a migraine is about to strike.
Unlike regular "I'm tired" yawning, it may be excessive and occur every few minutes.
In one 2006 study in the journal Cephalalgia, about 36% of migraine patients reported yawning was one of the signs of an impending migraine.
Numbness or tingling
Some people with migraines have sensory aura.
They may have a temporary lack of sensation or a pins-and-needles feeling, typically on one side of the body, moving from the fingertips through the arm and across the face.
Nausea or vomiting
According to data from the American Migraine Study II, a mail survey of more than 3,700 people with migraines, 73% experience nausea and 29% have vomiting. (The study was funded by a drug manufacturer.)
Light, noise, or smells trigger or worsen pain
In the throes of a migraine attack, the migraine sufferer tends to seek refuge in a dark, quiet place. Bright lights and loud noises can trigger a migraine or intensify the pain. The same is true of certain odours.
Once you've already got a migraine, smells can seem more intense and make it worse. But a smell can also trigger a migraine in someone who didn't have one before [he or she] walked past the perfume counter.
Activity triggers or worsens pain
Routine activities such as walking or climbing stairs can make migraine pain worse.
Some migraines are induced by exercise (running, weight-lifting) or exertion (sexual activity). People with exertion-induced headaches require a thorough workup to rule out underlying causes, such as a brain aneurysm.
Can't get the words out? Speech difficulties can be another sign that a migraine is on its way.
"A lot of people with migraines will feel like they're blithering," Dr. Messina says. "It's a common description by patients." If you are experiencing speech problems for the first time, contact a doctor to make sure the problems are not related to a more serious issue, such as a stroke.
Weakness on one side of the body
When an arm goes limp, it can be a sign of a migraine.
Some people experience muscle weakness on one side of the body before a migraine attack. This can also be a sign of a stroke, however, so consult a doctor to rule out any other causes.
Vertigo or double vision
One type of migraine, called a basilar-type migraine, can cause dizziness, double vision, or loss of vision.
Some people with migraines may experience balance problems too.
After the migraine passes, a person may feel like her body has been pummelled.
In a recent study, researchers interviewed migraine patients and found that they commonly experienced symptoms such as fatigue, trouble concentrating, weakness, dizziness, light-headedness, and loss of energy during the post-migraine period.
Migraines with Aura
Many people experience migraines with auras or warning signs just before or during the head pain, but many do not. Auras are perceptual disturbances such as:
Confusing thoughts or experiences
The perception of strange lights, sparkling or flashing lights
Zigzag lines in the visual field
Blind spots or blank patches in the vision
Pins and needles in an arm or leg
Stiffness in the shoulders, neck or limbs
If any migraine sufferer experiences unusual or worrying features that they do not normally have, then they should seek medical help rather than blaming the migraine.
Symptoms such as unusual severe headache, visual disturbance, loss of sensation or power, difficulties with speech are all important features, which, if unusual for the sufferer, should not be ignored.
When migraines with aura affect vision, the patient may see things that are not there, such as transparent strings of objects, not see parts of the object in front of them, or even feel as if part of their field of vision appears, disappears and then comes back again.
It is common for patients to describe the visual disturbance as similar to the sensation one has after being photographed with a very bright camera flash, especially if one walks into a darker room straight away.
For many migraine sufferers, the auras act as a warning, telling them that the headache is soon to come.
Quick Facts on Migraines
Here are some key points about migraines.
The cause of migraines is still largely unknown.
Migraines can be preceded by an aura of sensory disturbances followed by a severe one-sided headache.
Migraine tends to affect people between 15-55 years of age.
Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches such as allergies, light and stress.
Some people get a warning prodrome, preceding the onset of a migraine headache.
Many migraine sufferers can prevent a full-blown attack by recognizing and acting upon the warning signs.
Over-the-counter medications can eliminate or reduce pain.
Specific medications can help some sufferers.
People who suffer from severe attacks can take preventive medicines.
What is the Prognosis for Migraines?
Most patients who have migraines find that their headaches may be controlled with the preventive medications and lifestyle changes. Patients with a diagnosis of migraine need to be aware of how their lifestyle may directly impact the frequency and severity of their headache. Controlling migraine triggers may provide substantial benefit. It has been identified that as patients get older, there may be a decrease in the frequency of headaches and migraines may disappear after a number of years.