Migraines

Migraines occur in both children and adults but affect adult women three times more often than men. Migraines are genetic. Most migraine sufferers have a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders and epilepsy are more common in individuals with migraine than in the general population. Individuals who have pre-migraine symptoms referred to as aura have a slightly increased risk of having a stroke.

Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

Migraines occur in both children and adults but affect adult women three times more often than men. Migraines are genetic. Most migraine sufferers have a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders and epilepsy are more common in individuals with migraine than in the general population. Individuals who have pre-migraine symptoms referred to as aura have a slightly increased risk of having a stroke.

Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraines who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

A number of different factors can increase your risk of having a migraine. These factors, which trigger the headache process, vary from person to person and include:

• Sudden changes in weather or environment
• Too much or not enough sleep
• Strong odors or fumes
• Emotion
• Stress
• Overexertion
• Loud or sudden noises
• Motion sickness
• Low blood sugar
• Skipped meals
• Tobacco
• Depression
• Anxiety
• Head trauma
• Hangover
• Some medications
• Hormonal changes
• Bright or flashing lights

There’s no specific test to diagnose migraines. For an accurate diagnosis to be made, a GP must identify a pattern of recurring headaches along with the associated symptoms and can help you determine whether you have regular headaches or migraine based on the severity of symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Your physician will determine if symptoms include any visual distortions, motor weakness, sensory problems, changes in speech or coordination, vertigo, sensitivity to light or nausea. Work with our healthcare provider to communicate how headaches affect your daily life, headache history and effectiveness of medications.

Preventive treatment involves taking medicines daily to reduce the severity of future attacks or keep them from happening. The U.S. Food and Drug Administration (FDA) has approved the drugs erenumab (Aimovig) for the preventive treatment of headache and galcanezumab-gnlm (Emgality) injections to treat episodic cluster headache. The FDA also has approved lasmiditan (Reyvow) and ubrogepant (Ubrelvy) tablets for short-term treatment of migraine with or without aura. Headache drug use should be monitored by a physician, since some drugs may cause side effects.

Lifestyle changes that reduce or prevent migraine attacks in some individuals include exercising, avoiding food and beverages that trigger headaches, eating regularly scheduled meals with adequate hydration, stopping certain medications and establishing a consistent sleep schedule. Obesity increases the risk of developing chronic daily headaches, so a weight loss program is recommended for obese individuals.

Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks.

Untreated attacks last from four to 72 hours. Other common symptoms include:

• Increased sensitivity to light, noise and odors
• Nausea
• Vomiting

Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain.

Migraine is divided into four phases, all of which may be present during the attack:

1. Premonitory symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention or increased urination.
2. Aura: Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.
3. Headache: A migraine usually starts gradually and builds in intensity. It is possible to have migraines without a headache.
4. Postdrome: Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy again.

The two major types of migraine are:

1. Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness or muscle weakness on one side of the body; a tingling sensation in the hands or face; and confusion. Nausea, loss of appetite and increased sensitivity to light, sound or noise may precede the headache.
2. Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue and increased sensitivity to light, sound or noise.

Other types of migraine include:

• Abdominal migraine, which mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting one to 72 hours, with little or no headache. Additional symptoms include nausea, vomiting and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life.
• Basilar-type migraine, which mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head.
• Hemiplegic migraine, a rare and severe form of migraine that causes temporary paralysis—sometimes lasting several days—on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families, the disorder is called familial hemiplegic migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate.
• Menstrual migraine, which affects women around the time of their period, although most women with menstrually related migraine also have migraines at other times of the month. Symptoms may include migraine without aura, pulsing pain on one side of the head, nausea, vomiting and increased sensitivity to sound and light.
• Migraine without headache, characterized by visual problems or other aura symptoms, nausea, vomiting and constipation, but without head pain.
• Ophthalmoplegic migraine, an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil and double vision that may last for weeks, long after the pain is gone.
• Retinal migraine, a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches.
• Status migrainosus, a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that people need to be hospitalized.

Migraine is the most common disabling brain disorder. Chronic migraine, a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics.

It is important to discuss with your doctor how the headaches originally developed. There are two typical patterns. In one set of cases, patients with a preexisting primary headache disorder (usually, but not exclusively migraine) have attacks that increase in frequency and magnitude. In the other set of cases, patients start to have a headache one day, and it simply never goes away. This is a syndrome that goes under the name “new daily persistent headache” (NDPH). 

Accurate history taking is important in the diagnosis of migraine. It is important to describe your attacks fully, including any associated symptoms that accompany the pain, including symptoms that precede attacks—such as seeing auras, excessive tiredness or lack of energy, yawning, excessive urination, neck stiffness, vertigo, and visual or sensory disturbances. Additional symptoms may include nausea; sensitivity to lights, noises, smells, touch or movement; eye watering; conjunctival infection; nasal congestion; ptosis; eyelid swelling; sweating; agitation; fever; neck stiffness; or rash.

Finally, review your medical and mental health history (including depression, anxiety and sleep disorders), current non-headache medications, allergies, family history (especially of headache) and social history (including occupation, smoking status and levels of alcohol and caffeine consumption). It can also be helpful to talk about recurrent abdominal pain, motion sickness or a greater than expected tendency to experience hangovers.

Migraines occur in both children and adults but affect adult women three times more often than men. Migraines are genetic. Most migraine sufferers have a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders and epilepsy are more common in individuals with migraine than in the general population. Individuals who have pre-migraine symptoms referred to as aura have a slightly increased risk of having a stroke.

Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraines who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. Quick steps to ease symptoms may include:

• Napping or resting with eyes closed in a quiet, darkened room
• Placing a cool cloth or ice pack on the forehead
• Drinking lots of fluid, particularly if the migraine is accompanied by vomiting

Small amounts of caffeine may help relieve symptoms during a migraine’s early stages.

Drug therapy for migraine is divided into acute and preventive treatment. Acute or "abortive" medications are taken as soon as symptoms occur to relieve pain and restore function. Preventive treatment involves taking medicines daily to reduce the severity of future attacks or keep them from happening. The U.S. Food and Drug Administration (FDA) has approved the drugs erenumab (Aimovig) for the preventive treatment of headache and galcanezumab-gnlm (Emgality) injections to treat episodic cluster headache. The FDA also has approved lasmiditan (Reyvow) and ubrogepant (Ubrelvy) tablets for short-term treatment of migraine with or without aura. Headache drug use should be monitored by a physician, since some drugs may cause side effects.

Acute treatment for migraine may include any of the following drugs:

• Triptan drugs increase levels of the neurotransmitter serotonin in the brain. Serotonin causes blood vessels to constrict and lowers the pain threshold. Triptans—the preferred treatment for migraine—ease moderate to severe migraine pain.
• Ergot-derivative drugs bind to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They are most effective during the early stages of migraine.
• Non-prescription analgesics or over-the-counter drugs such as ibuprofen, aspirin or acetaminophen can ease the pain of less severe migraine headaches.
• Combination analgesics involve a mix of drugs such as acetaminophen plus caffeine and/or a narcotic for migraine that may be resistant to simple analgesics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and alleviate pain.
• Nausea relief drugs can ease queasiness brought on by various types of headache.
• Narcotics are prescribed briefly to relieve pain. These drugs should not be used to treat chronic headaches.

Everyone with migraine needs effective treatment at the time of the headaches. Some people with frequent and severe migraine need preventive medications. In general, prevention should be considered if migraines occur one or more times weekly, or if migraines are less frequent but disabling. Preventive medicines also are recommended for individuals who take symptomatic headache treatment more than three times a week. Physicians also will recommend that a migraine sufferer take one or more preventive medications two to three months to assess drug effectiveness, unless intolerable side effects occur.

Several preventive medicines for migraine were initially marketed for conditions other than migraine, including the following:

• Anticonvulsants may be helpful for people with other types of headaches in addition to migraine. Although originally developed for treating epilepsy, these drugs increase levels of certain neurotransmitters and dampen pain impulses.
• Beta-blockers are used to treat high blood pressure and are often effective for migraine.
• Calcium-channel blockers are used to treat high blood pressure treatment and help to stabilize blood vessel walls. These drugs appear to work by preventing the blood vessels from either narrowing or widening, which affects blood flow to the brain.
• Antidepressants work on different chemicals in the brain; their effectiveness in treating migraine is not directly related to their effect on mood. Antidepressants may be helpful for individuals with other types of headaches because they increase the production of serotonin and also may affect levels of other chemicals, such as norepinephrine and dopamine.

Natural treatments for migraine include riboflavin (vitamin B2), magnesium, coenzyme Q10 and butterbur (medicinal plant).

Non-drug therapy for migraine includes biofeedback and relaxation training, both of which help individuals cope with or control the development of pain and the body’s response to stress.

Lifestyle changes that reduce or prevent migraine attacks in some individuals include exercising, avoiding food and beverages that trigger headaches, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Obesity increases the risk of developing chronic daily headaches, so a weight loss program is recommended for obese individuals.

Everyone with migraine needs effective treatment at the time of the headaches. Some people with frequent and severe migraine need preventive medications. In general, prevention should be considered if migraines occur one or more times weekly, or if migraines are less frequent but disabling. Preventive medicines also are recommended for individuals who take symptomatic headache treatment more than three times a week. Physicians also will recommend that a migraine sufferer take one or more preventive medications for two to three months to assess drug effectiveness, unless intolerable side effects occur.

Consider participating in a clinical trial so clinicians and scientists can learn more about migraine and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.