Migraines

What is a Migraine?

The typical migraine headache is throbbing or pulsating, and often is associated with nausea and changes in vision. While many migraines are severe, not all severe headaches are migraines, and some migraines can be quite mild. Two-thirds of people who get migraines are women, probably because of the influence of hormones. Migraines also tend to run in families.

What Causes Migraines?

Despite years of research, scientists do not know exactly why migraines occur. The pain of migraines almost certainly results from swelling in blood vessels and nerves that surround the brain. This swelling probably is triggered by changes in brain chemicals and electrical activity in a primitive part of the brain known as the brain stem. The brain chemical serotonin appears to play an important role in this process as it does in other conditions, including depression and eating disorders.

Symptoms

Migraines may progress through four stages: prodrome, aura, headache and postdrome, though you may not experience all stages.

Prodrome (Few Hours to Days)	Aura (5-60 Minutes)	Headache (4-72 Hours)	Postdrome (24-48 Hours
Irritability	Visual disturbances (blurred vision, flashing lights, etc.)	Throbbing	Inability to concentrate
Depression	Temporary loss of sight	Drilling	Fatigue
Yawning	Numbness and tingling on part of the body	Icepick in head	Depressed mood
Increased need to urinate		Burning	Euphoric mood
Food cravings		Nausea	Lack of comprehension
Sensitivity to light/sound		Vomiting
Problems concentrating		Giddiness
Fatigue and muscle stiffness		Insomnia
Difficulty in speaking and reading		Nasal congestion
Nausea		Anxiety
Difficulty sleeping		Depressed mood
		Sensitivity to light, smell, sound
		Neck pain and stiffness

Most people with migraines experience prodromal symptoms, but only about one-third of people with migraines experience an aura. Prodrome and aura may not occur before every migraine.

Diagnosis

A health care provider usually will diagnose migraine based on your history and symptoms. In most cases, a physical and neurological examination will be entirely normal. There are no special tests to diagnose migraines. For example, a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain usually will be normal, but may be performed in order to rule out other pathologies.

Treatment

Identifying Triggers

Not all migraine headaches can be prevented. However, identifying your migraine triggers can help to reduce the frequency and severity of migraine attacks. Common migraine triggers include:

Caffeine (either using too much or suddenly cutting back on regular use)
Certain foods and beverages, including those that contain tyramine (aged cheeses and meats, fermented beverages), sulfites (preserved foods, wines) and monosodium glutamate (MSG), a common flavor enhancer
Stress, or relief from stress
Hormone levels (menstrual cycles, hormone-containing medication such as birth control pills or estrogen)
Lack of sleep or disrupted sleep patterns
Travel or changes in weather or altitude
Overuse of pain-relieving medications

If you are unsure what your triggers may be, there are numerous headache tracking apps that may be able to help. These apps allow you to track such things as sleep, food, drinks and symptoms before, during, and after a migraine in order to identify patterns.

Medications

There are many medications that are approved to help treat migraine symptoms. These include:

Acute treatments: These medications are taken at first sign of prodrome, aura or headache. They are only taken when a migraine occurs. This may include over-the-counter medications such as ibuprofen if the symptoms are mild, or prescription medications if the symptoms are more severe.
Preventive treatments: These medications are taken daily to prevent migraines from occurring. These medications are usually prescribed when a person is experiencing frequent recurring severe migraines.