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Migraine

Definition

A migraine is a type of headache. It may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, including vision changes. An aura is a warning sign that a bad headache is coming.

Alternative Names

Headache - migraine

Causes

A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin later in life. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, may have fewer migraines when they are pregnant.

Migraine attacks may be triggered by:

  • Caffeine withdrawal
  • Changes in hormone levels during a woman's menstrual cycle or with the use of birth control pills
  • Changes in sleep patterns
  • Drinking alcohol
  • Exercise or other physical stress
  • Loud noises or bright lights
  • Missed meals
  • Odors or perfumes
  • Smoking or exposure to smoke
  • Stress and anxiety

Migraines can also be triggered by certain foods. Most common are:

  • Baked goods
  • Chocolate
  • Dairy foods
  • Foods with monosodium glutamate (MSG)
  • Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
  • Fruits (avocado, banana, citrus fruit)
  • Meats containing nitrates (bacon, hot dogs, salami, cured meats)
  • Onions
  • Peanuts and other nuts and seeds
  • Processed, fermented, pickled, or marinated foods

True migraine headaches are not a result of a brain tumor or other serious medical problem. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition.

Symptoms

Vision disturbances, or aura, are considered a warning sign that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

  • A temporary blind spot
  • Blurred vision
  • Eye pain
  • Seeing stars or zigzag lines
  • Tunnel vision

Other warning signs include yawning, difficulty concentrating, nausea, and trouble finding the right words.

Not every person with migraines has an aura. Those who do usually develop one about 10 to 15 minutes before the headache. But an aura can occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.

The headaches usually:

  • Start as a dull ache and get worse within minutes to hours
  • Are throbbing, pounding, or pulsating
  • Are worse on one side of the head with pain behind the eye or in the back of the head and neck
  • Last 6 to 48 hours

Other symptoms that may occur with the headache include:

  • Chills
  • Increased urination
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Numbness, tingling, or weakness
  • Problems concentrating, trouble finding words
  • Sensitivity to light or sound
  • Sweating

Symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms can include:

  • Feeling mentally dull, like your thinking is not clear or sharp
  • Needing more sleep
  • Neck pain

Exams and Tests

Your doctor can diagnose migraine headache by asking about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder.

There is no specific test to prove that your headache is actually a migraine. Your doctor may order a brain CT or MRI scan if you have never had one before. The test may also be ordered if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.

An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.

Treatment

There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers.

A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your doctor can plan how to avoid these triggers.

If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include:

  • Antidepressants
  • Blood pressure medicines
  • Seizure medicines

Botulinum toxin type A (Botox) injections may also help reduce migraine attacks if they occur more than 15 days a month.

TREATING AN ATTACK

Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medicines, such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware that:

  • Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
  • Taking too much acetaminophen can damage your liver.
  • Too much ibuprofen or aspirin can irritate your stomach.

If these treatments do not help, ask your doctor about prescription medicines. These include nasal sprays, suppositories, or injections.

Some migraine medicines narrow the blood vessels. If you are at risk of heart attack or have heart disease, talk with your doctor before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your doctor about which medicine is right for you if you are pregnant or planning to become pregnant.

Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other drugs that treat the migraine itself.

Feverfew is an herb for migraines. It can be effective for some people. Before using feverfew, make sure your doctor approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Support Groups

American Headache Society - www.achenet.org

The National Migraine Association - www.migraines.org

National Headache Foundation - www.headaches.org

Outlook (Prognosis)

Each person responds differently to treatment. Some people have migraines only rarely and need little to no treatment. Others need to take several medicines or even go to the hospital sometimes.

Migraine headache is a risk factor for stroke. Risk is higher in people who have migraines that occur with aura. People with migraines should avoid other risk factors for stroke. These include smoking, taking birth control pills, and eating unhealthy foods.

When to Contact a Medical Professional

Call 911 if:

  • You are experiencing "the worst headache of your life."
  • You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before.
  • A headache starts suddenly.

Schedule an appointment or call your doctor if:

  • Your headache pattern or pain changes.
  • Treatments that once worked no longer help.
  • You have side effects from your medicine.
  • You are taking birth control pills and have migraine headaches.
  • Your headaches are more severe when lying down.

References

Garza I, Swanson JW, Cheshire WP Jr, et al. Headache and other craniofacial pain. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 69.

Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011;83:271-280.

Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337-1345.

Spector JT, Kahn SR, Jones MR, et al. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. 2010;123:612-624.


Review Date: 10/29/2013
Reviewed By: Joseph V. Campellone, M.D., Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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