Migraine Overview

Migraine is a neurological disorder that can affect everyday life. From the intense headaches to the nausea, its symptoms can sideline you. The more you know, the easier it is to stop or prevent migraine.

Migraine is a neurological disorder known for the throbbing type of headache it produces, per the National Institute of Neurological Disorders and Stroke (NINDS). Migraine affects almost one in eight Americans, according to the National Institute of Health's digital consumer health site MedlinePlus.

In addition to head pain, according to the American Migraine Foundation (AMF) migraine comes with symptoms such as nausea, fatigue, and sensitivity to light and sound.

Identifying and avoiding migraine "triggers," using medications to prevent migraine, and taking drugs to relieve symptoms when migraine occurs can help many people manage the condition.

Migraine Types

Migraine is a type of primary headache, meaning it's not caused by another health problem (like the headache you get from a blow to the head) or underlying health condition, per the AMF.

Within the umbrella of migraine, the International Headache Society (IHS) describes these main types:

  • Migraine Without Aura
  • Migraine With Aura
  • Chronic Migraine

Migraine Without Aura

This type of migraine occurs without warning. The Migraine Trust explains that you won't have any signs or symptoms to let you know that a migraine is coming. It's also the most common type. You might be diagnosed with migraine without aura if you have a history of least five headache episodes, each lasting four to 72 hours, says the IHS.

Migraine With Aura

This type of migraine typically strikes within an hour of certain neurological symptoms, according to the National Library of Medicine's (NLM) digital site, MedlinePlus. Symptoms are wide-ranging and, per the AMF, may include changes affecting one or more of the following:

  • Vision (such as seeing spots or zig-zag lines)
  • Sensory (having tingling or numbness)
  • Speech or language (which may include slurred or garbled speech)
  • Motor (a feeling of muscle weakness)
  • Brainstem (dizziness, for example)
  • Retinal (temporary vision loss)

Chronic Migraine

Fifteen or more headache days a month over a period of more than three months is considered chronic migraine, according to the IHS. Up to 5 percent of the U.S. population experiences chronic migraine, per the AMF.

Migraine Symptoms

It's not just head pain that you'll feel. Migraine comes with a slew of uncomfortable symptoms that can completely derail your day. In fact, migraine-related disability is a leading cause of lost workdays and productivity, according to a 2021 study in The Journal of Headache Pain.

Everyone has different symptoms, and according to MedlinePlus, a lot depends on what type of migraine you're having and the stage of the attack.

Per MedlinePlus, these are the four phases of migraine:

Prodrome. This pre-headache phase that can occur hours or days before a migraine. MedlinePlus and the AMF describe symptoms such as:

  • Fatigue
  • Problems concentrating
  • Neck stiffness
  • Light sensitivity
  • Nausea
  • Frequent yawning
  • Increased need to urinate
  • Feeling irritable
  • Feeling depressed

Aura. People who have migraine with aura may experience a range of neurological symptoms. According to the American Headache Society, most auras involve visual changes, such as:

  • Flashes of light
  • Blind spots
  • Seeing stars or patterns

Headache. Typically, during the hours or days of the attack, you can have symptoms, per MedlinePlus, that may include:

  • Throbbing pain, often on one side of the head
  • Nausea
  • Vomiting
  • Dizziness
  • Sensitivity to light, sound, or odors

Postdrome. In the hours or days afterward, MedlinePlus notes that you may have:

  • Fatigue
  • Sleepiness
  • Decreased energy
  • Problems concentrating
  • Irritability
  • Nausea
  • Sensitivity to light
  • Pain while moving your head

Migraine Causes

Migraine is believed to be caused by certain genetic mutations, per the NINDS, but genes alone don't account for who develops a migraine. Certain lifestyle habits and environmental changes, called triggers, can influence a person's risk of having an attack, according to The Migraine Trust.

Per MedlinePlus and the AMF, migraine triggers differ from one person to another and may include:

  • Stress
  • Anxiety
  • Hormonal changes
  • Irregular sleeping habits (e.g., too much or too little sleep, going to bed or waking up at inconsistent times)
  • Skipping meals
  • Caffeine or caffeine withdrawal
  • Alcohol
  • Inadequate hydration
  • Weather changes
  • Smoke exposure
  • Strong odors
  • Light
  • Overuse of headache medicines
  • Certain foods (examples include chocolate, cheese, monosodium glutamate, and cured meats)

Migraine Diagnosis

Migraine often goes undiagnosed or misdiagnosed, per the National Headache Foundation. Talk to your health care provider if you have symptoms of migraine. If you are not feeling better, consider seeing a neurologist or headache specialist who cares for people with migraine.

According to MedlinePlus and UCSF Health, when being evaluated for migraine, your provider will take your medical history and ask about your symptoms, including the location, intensity, and duration of your headaches. Your provider may conduct a physical or neurological exam to check your reflexes, motor movement, and vision.

Depending on your symptoms, you may also be evaluated for another health condition that could be causing the headaches. If suspected, an imaging scan, like an MRI, may be ordered to rule out certain problems, like an aneurysm, or tumor, per the AMF.

Migraine Treatment

The goal of treatment is twofold, according to the AMF:

  • to relieve the pain so you can feel well and return to your daily activities
  • to prevent future attacks

Finding the right treatment for your migraine can be challenging, but there are many options available. Your health care provider may discuss with you two main categories of migraine medication.

Acute Medication

These are drugs you take to stop migraine when an attack starts. Acute medicines (sometimes called abortive therapy, according to the Agency for Healthcare Quality and Research ) include:

  • Over-the-counter (OTC) pain relievers (also called analgesics), like nonsteroidal anti-inflammatory drugs (such as ibuprofen) or acetaminophen. A 2018 article in American Family Physician describes these as first-line treatments for mild to moderate migraine.
  • Triptans, a class of prescription medicines for tamping down the pain of moderate to severe migraine, per the review in American Family Physician. Commonly prescribed triptans, per the AMF, include drugs like Imitrex (sumatriptan) and Zomig (zolmitriptan).
  • Gepants, also known as calcitonin gene-related peptide (CGRP) agonists, are a class of drugs that target the CGRP protein, which is linked to inflammation in the brain, according to the AMF. This class includes Nurtec (rimegepant) and Ubrelvy (ubrogepant).
  • Reyvow (lasmiditan), the first FDA-approved drug in a class of medications called ditans. It can stop a migraine without tightening blood vessels, according to a 2020 review in Headache: The Journal of Head and Face Pain.
  • Ergot alkaloids, drugs sometimes prescribed for people whose migraine symptoms do not respond to OTC medicines or triptans. People can take dihydroegotamine, for one, by nasal spray, injection, or intravenous infusion, according to the AMF.

Preventive Medication

If you get more than four migraines per month, experience medication overuse headaches, or have disabling migraines, you may be a candidate for one of the preventative medications, per a 2019 review in American Family Physician.

The AMF describes the following categories of preventive medicines (sometimes called prophylaxis):

  • Drugs to treat high blood pressure (called antihypertensives). This category includes beta blockers and calcium channel blockers
  • Antiseizure medicines (also called anticonvulsants) such as Topamax (topimirate)
  • Antidepressants, such as amitriptyline and Effexor (venlafaxine)
  • Botox (onabotulinumtoxinA) injections for treating chronic migraines, which is defined as having 15 or more headache days per month.
  • Anti-CGRP monoclonal antibodies, a newer class of drugs that target CGRP, a protein involved in migraine pain, per the National Headache Foundation.
    Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab) are delivered by injection.
  • Vyepti (eptinezumab) is given by infusion.
  • Qulipta (atogepant) comes in tablet form, according to the American Headache Society.

Non-Pharmaceutical Treatment

Use of a neuromodulation device is another option for the prevention and/or treatment of migraine. This type of therapy uses magnets or electrical current to change brain activity, per the AMF. Several devices are on the market, including an over-the-counter gadget called Cephaly Dual, cleared by the FDA in 2020.

Neuromodulation treatments may benefit people for whom drug treatment isn't recommended or effective, according to a 2020 review in the Journal of Headache and Pain. However, the article noted that larger, well-controlled studies are needed to confirm how well it works and to quantify the size of the treatment's effect.

Migraine Prevention

Better to prevent a migraine from happening at all than to tamp it down after symptoms develop. Here are some things you can do that may help:

  • Keep a headache diary. Per a 2018 evidence-based review published by the National Library of Medicine (NLM), keeping track of when you experienced migraine, for how long, and under what circumstances, may help you identify what may be triggering your migraines.
  • Manage stress in your life. Using relaxation techniques, such as biofeedback or progressive muscle relaxation, may help, per the NLM review and the AMF.
  • Talk to your health care provider about taking a preventive medication.

A Quick Review

Migraine is a neurological disorder not caused by trauma or an underlying health condition. A diagnosis is typically made based on symptoms. The good news is that there are a number of options for treating migraine pain and preventing these attacks from happening in the first place. If you're having frequent or painful headaches or other migraine symptoms, talk to your health care provider about next steps.

Sources:

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2. National Library of Medicine. Migraine. MedlinePlus.

3. American Migraine Foundation. The timeline of a migraine attack.

4. American Migraine Foundation. Migraine in the emergency room.

5. The International Classification of Headache Disorders.

6. The Migraine Trust. Migraine without aura.

7. MedlinePlus. Migraine: Medlineplus genetics.

8. American Migraine Foundation. Migraine with aura: Types, symptoms & treatments.

9. American Migraine Foundation. What is chronic migraine?

10. Shimizu T, Sakai F, Miyake H, et al. Disability, quality of life, productivity impairment and employer costs of migraine in the workplace. The Journal of Headache and Pain. 2021;22(1). doi:10.1186/s10194-021-01243-5

11. American Migraine Foundation. Migraine Prodrome: Symptoms and prevention.

12. American Headache Society. How to identify migraine with Aura.

13. The Migraine Trust. Genetics and Migraine.

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15. National Headache Foundation. Facts about migraine.

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23. American Migraine Foundation. Dihydroergotamine (DHE) for Migraine Treatment.

24. Ha H, Gonzalez A. Migraine headache prophylaxis. American Family Physician.

25. National Headache Foundation. CGRP: What you need to know.

26. American Headache Society. Atogepant receives FDA approval for the preventive treatment of episodic migraine in adults.

27. American Migraine Foundation. Neuromodulation for migraine treatment.

28. U.S. Food and Drug Administration. Accessdata.fda.gov.

29. Moisset X, Pereira B, Ciampi de Andrade D, Fontaine D, Lantéri-Minet M, Mawet J. Neuromodulation techniques for acute and preventive migraine treatment: A systematic review and meta-analysis of randomized controlled trials. The Journal of Headache and Pain. 2020;21(1). doi:10.1186/s10194-020-01204-4

30. Institute for Quality and Efficiency in Health Care. Migraine Prevention in Adults.

31. American Migraine Foundation. Biofeedback & relaxation training for headache.

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