Migraine is a neurological condition that can cause multiple symptoms. It’s frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages.
The diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headache are those without aura (previously known as common migraines) and those with aura (previously known as classic migraines).
Migraines can begin in childhood or may not occur until early adulthood. Women are more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.
Migraines are different from other headaches. Find out about different types of headaches and how to tell if your headaches might be migraines.
Migraine symptoms may begin one to two days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
- food cravings
- depression
- fatigue or low energy
- frequent yawning
- hyperactivity
- irritability
- neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, you may have problems with your vision, sensation, movement, and speech. Examples of these problems include:
- difficulty speaking clearly
- feeling a prickling or tingling sensation in your face, arms, or legs
- seeing shapes, light flashes, or bright spots
- temporarily losing your vision
The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine can vary from person to person. Some symptoms may include:
- increased sensitivity to light and sound
- nausea
- dizziness or feeling faint
- pain on one side of your head, either on the left side, right side, front, or back, or in your temples
- pulsing and throbbing head pain
- vomiting
After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic. A mild, dull headache may persist.
The length and intensity of these phases can occur to different degrees in different people. Sometimes, a phase is skipped and it’s possible that a migraine attack occurs without causing a headache.
People describe migraine pain as:
- pulsating
- throbbing
- perforating
- pounding
- debilitating
It can also feel like a severe dull, steady ache. The pain may start out as mild, but without treatment will become moderate to severe.
Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides, or shift.
Most migraines last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraines with aura, pain may overlap with an aura or may never occur at all.
More than half of the people who get migraines have nausea as a symptom. Most also vomit. These symptoms may start at the same time the headache does. Usually, though, they start about one hour after the headache pain starts.
Nausea and vomiting can be as troubling as the headache itself. If you only have nausea, you may be able to take your usual migraine medications. Vomiting, though, can prevent you from being able to take pills or keep them in your body long enough to be absorbed. If you have to delay taking migraine medication, your migraine is likely to become more severe.
Treating nausea and preventing vomiting
If you have nausea without vomiting, your doctor may suggest medication to ease nausea called anti-nausea or antiemetic drugs. In this case, the antiemetic can help prevent vomiting and improve the nausea.
Acupressure may also be helpful in treating migraine nausea. A
Treating nausea and vomiting together
Rather than treating the nausea and vomiting separately, doctors prefer to ease those symptoms by treating the migraine itself. If your migraines come with significant nausea and vomiting, you and your doctor may talk about starting preventive (prophylactic) medications. See how to cope with the nausea and vertigo that may accompany your migraine.
Doctors diagnose migraines by listening to your symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes. Imaging scans, such as a CT scan or MRI, can rule out other causes, including:
- tumors
- abnormal brain structures
- stroke
Migraines can’t be cured, but your doctor can help you manage them so you get them less often and treat symptoms when they occur. Treatment can also help make the migraines you have less severe.
Your treatment plan depends on:
- your age
- how often you have migraines
- the type of migraine you have
- how severe they are, based on how long they last, how much pain you have, and how often they keep you from going to school or work
- whether they include nausea or vomiting, as well as other symptoms
- other health conditions you may have and other medications you may take
Your treatment plan may include a combination of these:
- self-care migraine remedies
- lifestyle adjustments, including stress management and avoiding migraine triggers
- OTC pain or migraine medications, such as NSAIDs or acetaminophen (Tylenol)
- prescription migraine medications that you take every day to help prevent migraines and reduce how often you have headaches
- prescription migraine medications that you take as soon as a headache starts, to keep it from becoming severe and to ease symptoms
- prescription medications to help with nausea or vomiting
- hormone therapy if migraines seem to occur in relation to your menstrual cycle
- counseling
- alternative care, which may include biofeedback, meditation, acupressure, or acupuncture
You can try a few things at home that may also help remedy the pain from your migraines:
- Lie down in a quiet, dark room.
- Massage your scalp or temples.
- Place a cold cloth over your forehead or behind your neck.
Many people also try herbal home remedies to relieve their migraines.
Medications can be used to either prevent a migraine from happening or treat it once it occurs. You may be able to get relief with OTC medication. However, if OTC medications aren’t effective, your doctor may decide to prescribe other medications.
These options will be based on the severity of your migraines and any of your other health conditions. Medication options include both those for prevention and those for treatment during an attack.
Medication overuse headache
The frequent and recurring use of any kind of headache drugs can cause what’s known as
When determining how to deal with your migraine headaches, talk to your doctor about the frequency of your medication intake and alternatives to medications.
There are a couple of surgical procedures that are used to treat migraine. However, they haven’t been approved by the U.S. Food and Drug Administration (FDA). The procedures include neurostimulation procedures and migraine trigger site decompression surgery (MTSDS).
The American Migraine Foundation encourages anyone considering migraine surgery to see a headache specialist. A headache specialist has completed an accredited headache medicine fellowship or is board certified in headache medicine.
Neurostimulation surgeries
During these procedures, a surgeon inserts electrodes under your skin. The electrodes deliver electrical stimulation to specific nerves. Several types of stimulators are currently being used. These include:
- occipital nerve stimulators
- deep brain stimulators
- vagal nerve stimulators
- sphenopalatine ganglion stimulators
Insurance coverage for stimulators is rare. Research is ongoing as to the ideal role of nerve stimulation in the treatment of headaches.
MTSDS
This surgical procedure involves releasing nerves around the head and face that may have a role as trigger sites for chronic migraines. Onabotulinumtoxin A (Botox) injections are typically used to identify the trigger point nerves involved during a migraine attack. Under sedation, the surgeon deactivates or decompresses the isolated nerves. Plastic surgeons usually perform these surgeries.
The American Headache Society doesn’t endorse treatment of migraine with MTSDS. They recommend that anyone considering this procedure have an evaluation by a headache specialist to learn the risks first.
These surgeries are considered experimental until further studies show they work consistently and safely. They may however have a role for people with chronic migraines that haven’t responded to other treatment. So, is plastic surgery the answer to your migraine woes?
Researchers haven’t identified a definitive cause for migraines. However, they have found some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in levels of the brain chemical serotonin.
Other factors that may trigger a migraine include:
- bright lights
- severe heat, or other extremes in weather
- dehydration
- changes in barometric pressure
- hormone changes in women, such as estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
- excess stress
- loud sounds
- intense physical activity
- skipping meals
- changes in sleep patterns
- use of certain medications, such as oral contraceptives or nitroglycerin
- unusual smells
- certain foods
- smoking
- alcohol use
- traveling
If you experience a migraine, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you were taking before your migraine began can help identify your triggers. Find out what else might be causing or triggering your migraines.
Certain foods or food ingredients may be more likely to trigger migraines than others. These may include:
- alcohol or caffeinated drinks
- food additives, such as nitrates (a preservative in cured meats), aspartame (an artificial sugar), or monosodium glutamate (MSG)
- tyramine, which occurs naturally in some foods
Tyramine also increases when foods are fermented or aged. This includes foods like some aged cheeses, sauerkraut, and soy sauce. However, ongoing research is looking more closely at the role of tyramine in migraines. It may be a headache protector in some people rather than a trigger.
There are many types of migraines. Two of the most common types are migraine without aura and migraine with aura. Some people have both types.
Many individuals with migraines have more than one type of migraine.
Migraine without aura
This type of migraine used to be called common migraine. Most people with migraine don’t experience an aura.
According to the International Headache Society, people who have migraine without aura have had at least five attacks that have these characteristics:
- Headache attack usually lasting 4 to 72 hours if it’s not treated or if treatment doesn’t work.
- Headache has at least two of these traits:
- it occurs only on one side of the head (unilateral)
- pain is pulsating or throbbing
- pain level is moderate or severe
- pain gets worse when you move, like when walking or climbing stairs
- Headache has at least one of these traits:
- it makes you sensitive to light (photophobia)
- it makes you sensitive to sound (phonophobia)
- you experience nausea with or without vomiting or diarrhea
- Headache isn’t caused by another health problem or diagnosis.
Migraine with aura
This type of migraine used to be called classic migraine, complicated migraine, and hemiplegic migraine. Migraine with aura occurs in 25 percent of people who have migraines.
According to the International Headache Society, you must have at least two attacks that have these characteristics:
- An aura that goes away, is completely reversible, and includes at least one of these symptoms:
- visual problems (the most common aura symptom)
- sensory problems of the body, face, or tongue, such as numbness, tingling, or dizziness
- speech or language problems
- problems moving or weakness, which may last up to 72 hours
- brainstem symptoms, which includes:
- difficulty talking or dysarthria (unclear speech)
- vertigo (a spinning feeling)
- tinnitus or ringing in the ears
- hypacusis (problems hearing)
- diplopia (double vision)
- ataxia or an inability to control body movements
- decreased consciousness
- eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur they’re called retinal migraines)
- An aura that has at least two of these traits:
- at least one symptom spread gradually over five or more minutes
- each symptom of the aura lasts between five minutes and one hour (if you have three symptoms, they may last up to three hours)
- at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
- aura occurs with the headache or one hour before the headache begins
- Headache isn’t caused from another health problem and transient ischemic attack has been excluded as a cause.
An aura usually occurs before the headache pain begins, but it can continue once the headache starts. Alternatively, an aura may start at the same time as the headache does.
Chronic migraine used to be called combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine and can be caused by medication overuse.
People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura. Check out more differences between migraine and chronic migraines.
Compared to people who have acute migraines, people with chronic migraines are more likely to have:
- severe headaches
- more disability at home and away from home
- depression
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), such as high blood pressure
- previous head or neck injuries
Acute migraine is a general term for migraines that aren’t diagnosed as chronic. Another name for this type is episodic migraine. People who have episodic migraines have headaches up to 14 days a month. Thus, people with episodic migraines have fewer headaches a month than people with chronic ones.
Vestibular migraine is also known as migraine-associated vertigo. About 40 percent of people who have migraines have some vestibular symptoms. These symptoms affect balance, cause dizziness, or both. People of any age, including children, may have vestibular migraines.
Neurologists typically treat people who have difficulty managing their migraines, including vestibular migraines. Medications for this type of migraine are similar to ones used for other types of migraine. Vestibular migraines are also sensitive to foods that trigger migraines. So you may be able to prevent or ease vertigo and the other symptoms by making changes to your diet.
Your doctor may also suggest you see a vestibular rehabilitation therapist. They can teach you exercises to help you stay balanced when your symptoms are at their worst. Because these migraines can be so debilitating, you and your doctor may talk about taking preventive medications. Keep reading about vestibular migraine.
Optical migraine
Optical migraine is also known as eye migraine, ocular migraine, ophthalmic migraine, monocular migraine, and retinal migraine. This is a rarer type of migraine with aura, but unlike other visual auras, it affects only one eye.
The International Headache Society defines retinal migraines as attacks of fully reversible and temporary vision problems in only one eye. The symptoms may include:
- flashes of light, called scintillations
- a blind spot or partial loss of vision, called scotomata
- loss of vision in one eye
These vision problems usually occur within an hour of the headache. Sometimes optical migraines are painless. Most people who have an optical migraine have had another type of migraine before.
Exercise may bring on the attack. These headaches aren’t caused from an eye problem, such as glaucoma. Find out more about the causes of this type of migraine.
Complex migraine isn’t a type of headache. Instead, complex or complicated migraine is a general way to describe migraines, though it’s not a very clinically accurate way to describe them. Some people use “complex migraine” to mean migraines with auras that have symptoms that are similar to symptoms of a stroke. These symptoms include:
- weakness
- trouble speaking
- loss of vision
Seeing a board-certified headache specialist will help ensure that you get a precise, accurate diagnosis of your headaches.
Menstrual-related migraines affect up to 60 percent of women who experience any type of migraine. They can occur with or without an aura. They can also occur before, during, or after menstruation and during ovulation.
Research has shown that menstrual migraines tend to be more intense, last longer, and have more significant nausea than migraines not associated with the menstrual cycle.
In addition to standard treatments for migraines, women with menstrual-related migraines may also benefit from medications that affect serotonin levels as well as hormonal treatments.
Acephalgic migraine is also known as migraine without headache, aura without headache, silent migraine, and visual migraine without headache. Acephalgic migraines occur when a person has an aura, but doesn’t get a headache. This type of migraine isn’t uncommon in people who start having migraines after age 40.
Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur with symptoms spreading over several minutes and move from one symptom to another. After visual symptoms, people may have numbness, speech problems, and then feel weak and unable to move a part of their body normally.
Also known as menstrual migraines and exogenous estrogen withdrawal headaches, hormonal migraines are linked with the female hormones, commonly estrogen. They include migraines during:
- your period
- ovulation
- pregnancy
- perimenopause
- the first few days after you start or stop taking medications that have estrogen in them, such as birth control pills or hormone therapy
If you’re using hormone therapy and have an increase in headaches, your doctor may talk with you about:
- adjusting your dose
- changing the type of hormones
- stopping hormone therapy
Stress migraine isn’t a type of migraine recognized by the International Headache Society. However, stress can be a migraine trigger.
There are stress headaches. These are also called tension-type headaches or ordinary headaches. If you think stress may be triggering your migraines, consider yoga for relief.
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