Migraine Headache

About

What is a migraine headache?

A migraine headache can cause severe, throbbing, or pulsing pain, usually on one side of the head. It often includes nausea, vomiting, and extreme sensitivity to light and sound. The pain can be so severe that it interferes with your daily activities. Migraine is much more than a severe headache, it’s a neurological (nervous system) disease that can be debilitating and cause wide-ranging symptoms. 

The cause is unknown but most people who have migraines also have a close family member with the disease. Migraines are recurring, and can occur rarely or several times a month. Attacks can last for four hours to days if not treated. 

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, can help.

Causes

What causes migraine headaches?

The cause of migraines is complicated and not fully understood. For unknown reasons, nerves in your blood vessels start sending pain signals to your brain. This releases inflammatory substances into the nerves and blood vessels of your head. Another factor is an imbalance in brain chemicals (serotonin and others) that help regulate pain in your nervous system. 

Heredity is also a factor in migraines. Most (80%) of migraine patients have a first-degree relative with migraines. If one parent has a history of migraines, their child has a 50% chance of also having them. If both parents have migraines, the child’s risk jumps to 75%. 

There are many factors that can trigger a migraine. The most common trigger is stress, which causes brain chemicals to be released that can deal with the stressful situation. Called the "flight or fight" response, these chemicals can bring on a migraine. 

Other triggers vary from person to person but can include:

  • Anxiety
  • Hormonal changes in women around the time of their menstrual periods, and from birth control pills or hormone replacement therapy 
  • Bright or flashing lights, including light from a TV, computer screen, fluorescent lights or sunlight 
  • Loud noises
  • Strong smells
  • Certain medicines cause blood vessels to swell (nitroglycerin)
  • Too much or not enough sleep
  • Sudden changes in weather (storm fronts, barometric pressure changes, strong winds or changes in altitude)
  • Too much physical activity; being overly tired
  • Smoking tobacco
  • Too much caffeine or caffeine withdrawal
  • Medication overuse (taking migraine medicine too often)
  • Skipped meals
  • Certain foods trigger 30% of migraines (alcohol, wine, chocolate, aged cheeses, monosodium glutamate (MSG), aspartame sweetener, fermented or pickled foods, yeast, cured or processed meats)
  • Dehydration
  • Exposure to smoke, perfumes or other odors
  • Changes in normal sleep habits

Who’s at risk for migraine headaches?

About 12% of Americans of all ages get migraines. You risk of having migraines is greater if you:

Are a woman, which makes you three times more likely to have migraines as men. 

Have a family history of migraines. 

Have other medical conditions, such as anxiety, depression, bipolar disorder, epilepsy, or sleep disorders.

Have a high-stress personality, or a high-stress job.

Smoke tobacco.

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Symptoms

What are the symptoms of migraine headaches?

Migraines progress through four different phases, although sometimes you skip a phase. Each phase has different symptoms. All four phases can last from eight to 72 hours. 

Migraine phases are:

Prodrome can start 24-48 hours before the migraine headache begins. It may include:

  • Food cravings
  • Mood changes
  • Irritability
  • Constipation 
  • Depression
  • Problems concentrating
  • Uncontrollable yawning
  • Fatigue
  • Muscle stiffness
  • Difficulty speaking or reading
  • Sleep problems
  • Nausea
  • Sensitivity to light and sound
  • Fluid retention
  • Increased urination

Aura, which can occur before, during or after a migraine in about 20% of patients, can last from 10 to 60 minutes. Symptoms may include: 

  • Seeing flashing or bright lights, or zig-zag lines
  • Muscle weakness; weakness on one side of the body
  • Speech changes
  • Numbness and tingling
  • Ringing in the ears
  • Blind spots in vision; vision loss
  • Changes in smell or taste
  • Feeling like you’re being touched
  • Pins and needles sensation in an arm or leg

Headache is the primary symptom and usually starts slowly, becoming more severe. Symptoms can include:

  • Throbbing or pulsing pain on one side of the head; described as an icepick in the head
  • Pain shifting from one side of the head to the other
  • Pain in the front or back of the head, or the whole head
  • Pain around the eye, temple, face, sinuses, jaw, or neck
  • Increased sensitivity to light, noises, and odors
  • Nausea and vomiting
  • Insomnia
  • Nasal congestion
  • Neck pain and stiffness
  • Mood changes
  • Pain that worsens with movement, coughing or sneezing

Postdrome is after the headache, and 80% of patients have this phase. Symptoms can last 24-48 hours and may include:

  • Exhaustion
  • Weakness
  • Confusion; inability to concentrate
  • Depression
  • Lack of comprehension
  • Euphoric mood

Migraines vary from person to person but general symptoms can include:

  • More common to wake up with a migraine
  • Can occur at predictable times
  • Stomach pain or upset
  • Loss of appetite
  • Sweating or having chills
  • Pale skin color
  • Tender scalp
  • Dizziness and blurred vision

Diagnosis

How are migraine headaches diagnosed?

Your doctor will take your medical history, history of your family’s migraines, listen to your symptoms, and do physical and neurological exams. It’s important to rule out other medical conditions that can cause the same symptoms. Blood tests and imaging scans (MRI, CT scan) may also be used. 

Being able to provide your doctor with a diary of symptom details is very helpful for diagnosing migraines. For every headache, list the date, approximate time of each phase, symptoms, causes of stress, weather changes before the headache, amount of sleep you got the night before, food and water intake, type and location of pain, triggers, how you treated the headache, and what made it better or worse. Include a list of all medications, vitamins or supplements you take, and all medications you use to treat headaches. Cell phone apps are available to help you track symptoms and other factors related to your migraines.

Treatment

How are migraines treated?

The process of having a migraine is unique to each individual. Treatment plans also need to be unique to your needs. Your active participation in treatment is important for effective headache management. Identifying and avoiding your personal migraine triggers, managing symptoms, practicing preventive methods, following the advice of your doctor, and immediately reporting any significant changes will provide the best outcome. 

While there is no cure for migraine headaches, they can be managed and, in many cases, their severity, length and frequency can be improved. Medications are available to decrease symptoms, and to prevent them. Your treatment plan will depend on the frequency and severity of your headaches, if you have nausea and vomiting, and other medical issues you have. 

Pain-relieving or abortive medications treat the pain and are most effective when used at the first sign of a migraine. They may stop the headache process, or at least decrease symptoms. Some medications work by constricting blood vessels to relieve the throbbing pain. The Food and Drug Administration has approved three nonprescription medications for migraine pain: Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain. Overusing these medications by taking them more than two to three times a week can cause rebound headaches or a dependency problem. Ask your doctor if a prescription medication might be more effective. 

Preventive medications may be prescribed if your headaches are severe, occur more than four times a month, and interfere with your normal activities. They help by reducing the frequency and severity of headaches, and are usually taken daily.

Prescription medications include:

  • Triptan class of drugs (sumatriptan, zolmitriptan, naratriptan) block pain pathways in the brain
  • Calcium channel blockers (verapamil) lower blood pressure
  • Calcitonin gene-related monoclonal antibodies
  • Beta blockers
  • Antidepressants
  • Antiseizure drugs
  • Botox injections
  • Corticosteroids
  • Antinausea drugs

Home remedies refers to non-drug options, including:

  • Rest in a dark, quiet, cool room
  • Apply cold compress (or heat if you prefer) to your forehead, and back of the neck
  • Drink plenty of fluids
  • Massage your scalp with pressure on your temples in a slow, circular motion

Lifestyle changes can be very helpful:

  • Lose weight and maintain a healthy weight; obesity is a contributing factor to migraines
  • Exercise regularly
  • Biofeedback can teach you how to detect your body’s stress responses and reduce them
  • Staying calm with any healthy stress-reducing techniques that work for you (meditation, yoga, deep breathing, exercise, etc.)
  • Get seven to nine hours of sleep every night and maintain a consistent sleep-wake schedule
  • Eat at regular times and don’t skip meals, even if you just have a light snack
  • Stay hydrated with plenty of water
  • If you cannot control your stress, get a referral to counseling from your doctor
  • Acupuncture, tested in clinical trials, has been found to be helpful for headache pain

References

Mayo Clinic. (2021, July). Migraine. Retrieved 1-26-22, {https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201#:~:text=A%20migraine%20is%20a%20headache,sensitivity%20to%20light%20and%20sound.}
Mayo Clinic. (2021, July). Migraine Diagnosis and Treatment. Retrieved 1-26-22, {https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207}
MedlinePlus. (N.d.) Migraine. NIH Library of Medicine. Retrieved 1-26-22, {https://medlineplus.gov/migraine.html}
Cleveland Clinic (2021, March) Migraine Headaches. Retrieved 1-26-22, (https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches}

Information

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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Affordable –
with or without insurance

With Insurance

Neurology

Your copay
Depending on insurance

Without Insurance

Neurology

$149

Initial Visit

$75

Follow Up