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Migraines are not the same as a "regular" headaches, tension, sinus, or cluster headaches. All of these types of headaches cause pain, but a migraine has additional warning symptoms and signs, such as:
Migraine causes are not fully known, but may be due to the expansion of blood vessels in the brain along with the release of certain chemicals.
Migraine Types
Migraine headaches typically last from 4 to 72 hours and vary in frequency from daily to less than one a year.
There are several types of migraine headaches, and they vary in severity of pain and the time it takes for the migraine to go away. Migraine types include:Common migraine, also called absence migraine, accounts for 80% of migraines. There is no "aura" before a common migraine.
People with classic migraine headache (also called migraine with aura) experience an aura before their headaches. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Classic migraines are usually much more severe than common migraines.Silent or acephalgic migraine headache is a migraine without head pain, but with aura and other visual disturbances, nausea, and other aspects of migraine.
A hemiplegic migraine can feel like a stroke, with weakness on one side of the body, loss of sensation, or feeling "pins and needles"; however head pain may not be severe.A retinal migraine occurs when a migraine headache causes temporary vision loss in one eye. The vision loss can last from minutes to months, but it is usually reversible. It is often a sign of a more serious medical problem, and patients should seek medical care.
A chronic migraine is a migraine headache that lasts for more than 15 days per month.Status migrainosus is a migraine attack that lasts more than 72 hours.
How Many People Have Migraines?According to the National Headache Foundation, more than 37 million Americans suffer from migraine headaches, and it affects three times as many women as men. About 70% to 80% of people with migraines (called migraineurs) have other members in the family who have them too.
People with classic migraines experience an aura before their headaches. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Classic migraines are usually much more severe than common migraines.What Is the Best Thing to Do for a Migraine?
Home remedies to relieve head pain and other migraine symptoms include lying down and resting in a room with pillows supporting the head and neck, and that has little to no sensory stimulation from light, sound, colors, and odors. Over-the-counter (OTC) drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of medicaitons and prescription drugs can treat migraines.
Migraine headache symptoms and signs vary from person to person and from migraine to migraine. Five phases often can be identified.
Call a doctor or other health care professional if you have any of these symptoms or signs:
Go to a hospital emergency department if you have any of these symptoms and signs:
The exact cause of migraine headaches is not clearly understood, though experts believe they may be caused by a combination of the expansion of blood vessels and the release of certain chemicals, which causes inflammation and pain.
The chemicals dopamine and serotonin are among those involved in migraine. These chemicals are found normally in the brain and can cause blood vessels to act abnormally if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them.
Various risk factors and triggers are thought to cause migraine headaches in certain people prone to developing the condition. Different people may have different triggers. Individual triggers can include:
The diagnosis of migraine headache rests solely on what a patient describes to a doctor or other medical professional. A doctor's physical examination of the patient typically reveals nothing out of the ordinary, but a neurological examination will often be performed to rule out other causes of headache.
Additional tests may be ordered because of other types of headaches such as tension or cluster headache, stroke, tumor, inflammation of a blood vessel, and infection of the brain's coverings (meningitis) or of the sinuses. Other headache tests include:
Most people with migraine headaches can manage the pain of mild-to-moderate attacks with at-home treatments, for example:
Several OTC medications may help with head pain, for example:
Nonsteroidal anti-inflammatory drugs (NSAIDS): These include medicines like aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). Stomach ulcers and bleeding are serious potential side effects. This type of medicine should not be taken by anyone with a history of stomach bleeding. Ask your doctor or pharmacist about possible medicine interactions if you are taking other drugs.
Acetaminophen (Tylenol): Acetaminophen may be safely taken with NSAIDs for an additive effect. Taking acetaminophen by itself is usually safe, even with a history of stomach ulcers or bleeding. Acetaminophen should not be taken if you have a liver disorder or if you consume three or more alcoholic drinks a day.
Combination medications: Some over-the-counter pain relievers have been approved for migraine treatment. These include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine. A similar effect may be achieved by taking two aspirin or acetaminophen tablets with a cup of black coffee.
Despite medical advances, migraines can be difficult to treat. About half of people with migraines stop seeking medical treatments for their headaches because they are dissatisfied with therapy.
This type of chronic headache can be treated with two approaches: abortive and preventive.
The goal of abortive therapy is to prevent an attack or to stop it once it starts. The prescribed medications stop a headache during its prodrome stage or once it has begun and may be taken as needed. Some can be administered as a self-injection into the thigh, wafers that melt on the tongue, or a nasal spray. These forms of medicines are especially useful for patients who vomit while experiencing the headache, and they work quickly.
Abortive migraine treatments include the triptans, which specifically target the chemical serotonin. The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions.
Triptan medications include:
These drugs also are specific and affect serotonin, but they affect other brain chemicals as well. Occasionally, one of these drugs works when a triptan does not.
These drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches.
These drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable choices than the headache drugs. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.
This type of migraine headache treatment is considered if a patient has more than one migraine per week. The goal is to lessen the frequency and severity of the attacks. Medication to prevent a migraine can be taken daily. Different drug classes have been used successfully as preventive therapies. Preventive migraine treatment medicines include:
A new class of drugs approved by the FDA is designed to decrease the number of migraine attacks by preventing them from occurring. These specialized monoclonal antibody drugs work to treat migraine by targeting calcitonin gene-related peptide (CGRP), which is elevated in the blood during migraine attacks. The new FDA-approved drugs are:
Botulinum toxin (Botox) injection has been found to help some migraine sufferers, and has been approved by the FDA to treat chronic migraine in adults. Injections are given at specific points in the head and neck muscles, and the effect lasts up to 3 months.
Regular follow-up care with a doctor or other health care professional is necessary. Keeping a pain journal to monitor the frequency of attacks and the medications you use can be very helpful. It may take several doctor visits before you find an effective migraine treatment plan. After the headaches are under control, the prognosis is very good. Patience is key. It may take several attempts before you find an effective migraine treatment plan. No one treatment or drug is effective for every person. A drug that works well for one person may not provide any relief for another. A combination of different migraine medicine sometimes is needed to treat resistant headaches.
Migraine triggers should be identified and avoided. Making individual lifestyle changes is important. Changes may include avoiding certain types of foods and certain emotional situations. For example, if missing meals triggers headaches, the person should make every effort to eat on a regular basis. In some instances, the use of biofeedback may help reduce the severity and frequency of attacks.
About 5%-10% of school aged children in the US suffer from migraine headaches. The frequency increases throughout adolescence, and peaks around age 44. About 20% have their first attack before age 5. Common symptoms include:
