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Migraine

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What is a Migraine?

What is a Migraine?

Migraine is an inherited primary headache disorder that has two basic forms: with aura and without aura. Though migraine is typically not life-threatening, it can be severely debilitating, making it harder for those suffering to participate in daily activities.

While the main feature of migraine is moderate to severe pain in the head — sometimes just on one side of the head, felt in the forehead or throughout the face — migraine headaches can also include nausea and vomiting. Migraines can last for hours or days, tend to recur, and, if the headache pain is severe, can interfere with daily activities.

Diagnosis of migraine is based on the patient’s history and symptoms rather than blood or imagining tests. Migraine can be a lifelong disorder; while currently there is no cure, medications can help with symptoms of migraine and reduce the frequency and intensity of episodes. Other therapies and lifestyle changes may also help to treat migraine headaches.

Classifications of Migraine

Migraine is classified into two categories: primary and secondary. Migraine is a primary headache disorder, meaning it originates on its own, whereas secondary headaches are typically the result of another disorder or injury.

Migraine, furthermore, is typically classified into two main types: with and without aura.

What Is an Aura?

“Aura” refers to single or multiple visual and sensory symptoms, including seeing blind spots, dots, and zig zags; numbness on one side of the body; difficulty speaking clearly; weakness; or dizziness. Aura can start shortly before or during a migraine and can last for 30 minutes or longer.

One in four people who have migraine pain also experience aura. Migraine aura might be caused by an electrical or chemical change in the brain that creates a wave that moves across the brain without damaging it.

Types of Migraine

Types

There are several variations of migraine, including:

  • Migraine without aura, sometimes referred to as common migraine, is a moderate to severe headache that can pulsate and is usually worse with activity. Other symptoms can include nausea, vomiting, or sensitivity to light and sound.
  • Migraine with aura is the classic case of migraine. Aura refers to visual or other neurological symptoms that can begin shortly before or during a migraine headache and can last around five to 60 minutes.
  • Aura without headache, also called a silent migraine, consists of an aura, nausea, and other symptoms, but without head pain
  • Chronic migraine is diagnosed when a patient suffers headaches at least 15 days a month, and specifically migraine symptoms for at least eight days a month, for at least three months
  • Status migrainosus is a migraine that lasts longer than 72 hours. Most migraine episodes last four to 72 hours, but some people experience pain that can last more than three straight days.
  • Hemiplegic migraine is a rare type of migraine aura that may feel like a stroke and includes weakness on one side of the body, often with visual aura and other symptoms

Other forms of headache include:

  • Cluster headaches feature severe pain around and above the eyes, at the temples, and toward the back of the head. Other symptoms include red or swollen eyes and a runny nose. Cluster headaches are one of the most painful types of headache.
  • Ice pick headache is more common in people with migraine or cluster headache. It feels like a series of pain episodes, each of which lasts for a few seconds and may feel like being stabbed in the head with an ice pick. This can be a primary or secondary headache.
  • Cervicogenic headache is a secondary headache caused by a disorder of the cervical spine. This type of headache often requires physical therapy in addition to medication or other treatment.
  • New daily persistent headache (NDPH) is a rare primary headache disorder characterized by chronic pain in people with no prior history of headaches. Many people with NDPH have refractory pain (not able to be managed with treatment), making it debilitating. It is important to exclude secondary causes.

 

More to Explore

Stages of Migraine

Stages

The four stages commonly associated with migraine are prodrome, aura, migraine episode, and postdrome. Some people don’t experience all the stages. The stages and their typical symptoms are:

  • Prodromal phase: Some symptoms, such as mood changes, appear up to two days before a migraine.
  • Aura phase: Visual and other sensations that can last up to 60 minutes and may occur before or during a migraine.
  • Migraine phase: Symptoms usually include severe headache on one or both sides of the head, sensitivity to light, nausea, vomiting, and other migraine symptoms. A migraine can last from a few hours up to 72 hours and can occur a few times a month or not very often.
  • Postdrome phase: After a migraine, people often feel tired and drained.

Signs & Symptoms of Migraine

Symptoms

People experience different symptoms in each stage of a migraine. Symptoms may include:

  • Prodromal phase
    • Mood changes
    • Irritability
    • Difficulty concentrating
    • Muscle stiffness
    • Food cravings
    • Constipation
    • Difficulty sleeping
  • Aura phase
    • Visual sensations, such as blind spots or shapes such as dots and zig zags, and flashes of light
    • Vision loss
    • Difficulty speaking
    • Feeling pins and needles in the arm or legs
    • Weakness or numbness in the face or one side of the body
  • Migraine phase
    • Moderate or severe throbbing pain, often on one side of the head but can be on both sides
    • Nausea and vomiting
    • Loss of appetite
    • Sensitivity to light, sound, and smell
  • Postdrome phase
    • Lethargy (feeling tired and drained)

What Causes Migraine?

Causes

Migraine is an inherited neurological disorder. Migraine episodes may be a result of unusual brain activity that affects nerve signals, chemicals, and blood vessels in the brain. Family history is a common indicator for risk of developing migraine.

Triggers of migraine

Triggers are external or internal factors that alone or in combination can induce a migraine episode. Common triggers include:

  • Hormonal changes: Fluctuations in hormones can trigger migraine in biologically female people but do not appear to trigger migraine in men. Migraines are often more common around the time of menstruation, and many people who suffer from migraine have fewer episodes after menopause.
  • Emotional triggers: Stress is one of the most common triggers of migraine. Other emotional triggers include anxiety, depression, and excitement.
  • Dehydration: Loss of body fluid can trigger migraine symptoms in some people.
  • Specific foods and beverages. Alcoholic beverages, coffee, chocolate, and food additives may trigger a migraine episode.
  • Exhaustion or extreme tiredness: Whether caused by lack of sleep, jet lag, or shift work can trigger migraine in some people.
  • Sensory experiences: These may include the bright light of a computer screen or TV, fluorescent and other light sources, loud sounds, and strong smells.
  • Weather changes. Some people get more migraine episodes when the temperature or humidity changes.
  • Pain-relieving medications: When used too often, medicines such as NSAIDs or other painkillers can sometimes cause migraine. This is referred to as a rebound headache or medication-overuse headache.

Risk Factors for Migraine

Risk Factors

Risk factors for migraine include:

  • Family history: Migraine is hereditary and passed on from a parent to a child. However, it may also skip a generation, making it difficult to determine from whom the disorder was inherited.
  • Age: Migraine can begin at any age. Typically, people start having migraines in adolescence and they are most common in people in their 30s. Many biologically female people have fewer migraines after menopause.
  • Sex: Biologically female people are two to three times more likely to have migraine than those who are biologically male.
  • Hormonal changes: Hormonal fluctuations seem to trigger migraine in biologically female people but not in biologically male people. In these cases, migraines may be more frequent around the time of menstruation. Episodes may start around puberty, and many people have fewer migraines after menopause.

Migraine Prevention

Prevention

Currently, there is no cure for migraine, but there are ways to reduce the number of migraine episodes and reduce their length. Keeping a headache diary can help patients learn about their migraine triggers to determine how they can better prevent future episodes. Data suggests that in some cases, certain medications can reduce migraines by 50 percent or more.

Abortive medications are used at the onset of a migraine episode to counteract symptoms as they occur.

Preventive medications are taken regularly to reduce the number of migraines. These medications include:

  • Antidepressants including tricyclic antidepressants, SSRIs, SNRIs, serotonin antagonists, and monoamine oxidase inhibitors (MAOIs) have been shown to improve symptoms in more than a third of patients. These drugs typically have an array of side effects, such as weight changes and nausea.
  • Antiepileptic (anti-seizure) drugs may help but can cause side effects such as dizziness, weight changes, and nausea and are not recommended for pregnant people or those trying to get pregnant.
  • Blood pressure medications, such as beta-blockers like propranolol, or calcium channel blockers like verapamil, have been shown to help nearly half of migraine sufferers in some studies.
  • Botox injections (onabotulinumtoxinA) can be administered every 12 weeks to help prevent chronic migraine.
  • CGRP monoclonal antibodies are newer drugs that are given monthly or quarterly by injection.

Healthy lifestyle – Some practices and routines can help people reduce migraine frequency. These practices and routines include:

  • Avoiding triggers such as excessive caffeine, tannins in wine, or certain chemicals in foods can help some people with migraine.
  • Exercising regularly can help reduce the frequency of migraine episodes.
  • Staying hydrated can be essential in reducing migraine frequency and intensity.
  • Establishing a healthy sleeping routine, including not sleeping too much or too little, and following a regular schedule, may improve symptoms.
  • Maintaining a healthy diet and eating routine, including eating balanced meals and not skipping meals, can help some people with migraine.
  • Relaxation techniques such as meditation can help in managing stressful situations that can trigger migraine.
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Trust NewYork-Presbyterian for Migraine Care

NewYork-Presbyterian’s headache and facial specialists, including neurologists, pain psychologists, pediatric neurologists, and acupuncture specialists, have training in the evaluation and treatment of headaches to relieve symptoms of migraine pain. Learn more about the treatment options for migraine available at NewYork-Presbyterian. Contact us to make an appointment.