What Is It?

A migraine is a very common, but very particular, type of headache. Most people who get migraines have repeated attacks of headaches that occur over many years. 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.

Up to 20 percent of people in the United States will experience migraine headaches at some point in life. In about half of those, migraine headaches first appear during childhood or adolescence. Two-thirds of people who get migraines are women, probably because of the influence of hormones. Migraines also tend to run in families.

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. However, the causes of changes in brain stem activity and serotonin levels are not well understood.

A migraine usually is a throbbing headache that occurs on one or both sides of the head. The headache typically is accompanied by nausea, vomiting or loss of appetite. Activity, bright light or loud noises can make the headache worse, so someone having a migraine often seeks out a cool, dark, quiet place. Most migraines last from four to 12 hours, although they can be shorter or much longer. One unique feature of migraines is an unusual sensation that a migraine is about to occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and nervousness. Migraines also have typical aftereffects, such as a feeling of exhaustion that lasts a day or two after a severe migraine headache has faded. Not all people who get migraines have prodromes or aftereffects.

Another unique feature of migraines is an aura. In a typical aura, a person suddenly will develop blurry or distorted vision or will see pulsating lights. These changes in vision will come and go over 15 to 30 minutes and alert someone that a headache is about to begin. Sometimes, auras affect the sense of hearing, smell or taste. Only some people who get migraines have auras, and they don’t accompany every headache. An aura also can occur without being followed by a headache. Rarely, migraines can cause unusual neurological symptoms such as dizziness, loss of vision, passing out, numbness, weakness or tingling.

Migraines can be triggered by certain activities, foods, smells or emotions. Some people are more likely to experience migraines when they are under stress, while others develop migraines when stress is relieved (for example, the day after exams or an important meeting). Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods.

A doctor 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. However, your doctor may recommend additional testing if your headaches have features that are not typical for migraines, or you develop other worrisome symptoms. Your doctor also may recommend a consultation with a neurologist, a doctor specializing in illnesses of the nerves and brain, if there is any doubt about your diagnosis.

Migraine headaches can last from a few hours to a few days. A typical migraine sufferer will have several headaches each month. However, some people have only one attack in a lifetime, while others have more than three attacks per week.

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

• Caffeine (either using too much or 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 certain pain-relieving medication

Some people learn to decrease their migraine attacks through biofeedback, yoga, acupuncture, massage or regular exercise.

Daily use of a preventive medication can be helpful for those with frequent migraine headaches, or headaches that cannot be controlled easily by pain-relieving medication.

Many people with mild or infrequent migraine headaches learn to treat their own symptoms. Some people control their headaches with an over-the-counter pain reliever such as acetaminophen (Tylenol), aspirin or ibuprofen (Advil, Motrin and others). Other people feel better when they take a nap, drink a cup of coffee or rest for a while.

However, other people suffer from severe headaches that interfere with personal activities, work or other daily responsibilities. When this happens, prescription medications can help to control or prevent symptoms.

Medications used to treat headaches generally fall into one of three broad categories:

• Abortive medications are used to stop (abort) a headache once it begins. These medications tend to work best when taken at the beginning of a headache. Abortive medications can lose their effectiveness when used too often (for example, more than three times a week), so they generally are not given to people who have headaches daily. Examples of abortive medications include triptans such as sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig) and rizatriptan (Maxalt); ergotamines such as ergotamine (Ergomar) and dihydroergotamine (Migranal); and isometheptene (Midrin and several other brand names).



• Preventive (or prophylactic) medications are used to prevent headaches from occurring. These medications usually are taken daily, whether a headache is present or not. Prophylactic medications often are taken for an indefinite period, but can be tapered off slowly if headaches are well controlled. Preventive medications don’t always eliminate headaches completely. However, they will:
  
  
  • Reduce the number of headaches
  • Improve quality of life for those with severe headaches
  • Reduce the need for pain-relieving and abortive medications, especially for those who need these medications frequently
  
  
  Examples of prophylactic medications include tricyclics, such as amitriptyline (Elavil) and desipramine (Norpramin); anticonvulsants, such as valproate (Depakote and others), gabapentin (Neurontin) and topiramate (Topamax); and beta-blockers such as propranolol (Inderal), atenolol (Tenormin) and nadolol (Corgard).



• Pain relievers or analgesics treat the pain of headaches. They usually are taken after a headache has started. Analgesics generally do not prevent headaches, and don’t always stop a headache that has started. However, many headache sufferers find that pain relievers are all they ever need. A variety of prescription and over-the-counter pain relievers are available including acetaminophen (Tylenol), aspirin, nonsteroidal anti-inflammatories such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve and others), butalbital (found in Fiorinal and Fioricet), and narcotics such as codeine (Tylenol #3) or butorphanol (Stadol).

Each medication used to treat headaches has advantages and disadvantages. It may not be possible to predict which medication will work best for your headaches. By understanding the general principles, you and your doctor can choose which one to try first. If the first medication does not work or causes bothersome side effects, you may need to try others until you find one that works for you.

Most people who get migraines do not need to see a doctor. However, you should see a doctor if you have any “red flag” symptoms that could indicate a serious, underlying medical problem. These include:

• Migraines that get worse over time
• New migraines in a person over age 40
• Severe headaches that start suddenly (often known as thunderclap headaches)
• Migraine that worsen with exercise, sexual intercourse, coughing or sneezing
• Headaches with unusual symptoms such as passing out, loss of vision, or difficulty walking or speaking
• Migraines that start after a Head injury
• Migraines that always occur on the same side of the head
• Migraines in a person with certain medical problems including high blood pressure, cancer or AIDS
• Migraines in a person with a family history of brain aneurysms

In addition, you may want to see your health care professional if you have headaches that do not get better with over-the-counter medications; severe headaches that interrupt work or the enjoyment of daily activities; or daily headaches.

Most people who develop migraines will continue to have intermittent headaches over many years. However, many people learn to control or to live with their headaches. In addition, migraines often diminish when people reach their 50s or 60s.

Recent studies have linked migraines to minor brain changes seen on MRI scans. However, there is no evidence that migraines increase the likelihood of strokes, dementia or other serious brain conditions.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.