Doctor's Notes on Migraine Headache FAQs
Migraines are a type of disabling headache stems from problems with the nerves and blood vessels in the head. Migraine headaches typically last from 4-72 hours and may occur anywhere from several times a week to just once a year. The types of migraine headache include migraine without aura (common migraine), migraine with aura (classic migraine), and status migrainosus (a long-lasting migraine that does not go away by itself).
Symptoms of migraine can vary and they often follow 5 phases: prodrome (warning phase) symptoms include changes in mood (happiness, irritability, sadness) or sensation (funny tastes or smells), fatigue, and muscle tension; visual or auditory disturbances (auras) symptoms include blind spots, seeing geometric patterns, vision on only one side, and less commonly, hearing hallucinations; headache symptoms include throbbing pain on one or both sides of the head, nausea, vomiting, sensitivity to light and sound; headache termination phase where the pain usually goes away with sleep; and postdrome symptoms which may include not feeling well for some time after the migraine stops, loss of appetite, problems with thinking, and tiredness.
Migraine Headache FAQs Symptoms
Symptoms are different for different people and are sometimes different from migraine to migraine. The following 5 phases have been noted:
- Prodrome (a period of warning symptoms): Many symptoms can precede a migraine headache. These include changes in mood (happiness, irritability, sadness) or sensation (funny tastes or smells). Many people experience fatigue and muscle tension before a migraine headache.
- Visual or auditory disturbances (auras): Some people develop scotomas (blind spots), see geometric patterns, experience hemianopsia (vision on only one side), or, less commonly, have auditory (hearing) hallucinations.
- Headache: Although migraine pain usually appears on one side of the head, some migraineurs have them on both sides. Throbbing pain may occur. Many migraineurs feel nauseated, and may vomit. Many people become photophobic (sensitive to light) and phonophobia (sensitive to sound). This phase may last 4-72 hours.
- Headache termination: Even if untreated, the pain usually goes away with sleep.
- Postdrome: Migraineurs may not feel well for some time after the migraine stops. They might not be able to eat right away. Problems with thinking and tiredness are common.
Migraine Headache FAQs Causes
No one fully understands the exact cause(s) of migraine headaches. Many experts think that a migraine begins with abnormal brainstem (a part of the brain) activity that leads to spasm (rapid contraction) of blood vessels in the cerebrum (main part of the brain) and dura (the covering of the brain). The first wave of spasm decreases blood supply, which causes the aura that some people experience. After the first spasm, the same arteries become abnormally relaxed, which increases blood flow and gives rise to migraine headache pain.
Certain chemicals normally found in the brain (namely, dopamine and serotonin) may be involved in causing migraines. These chemicals are called neurotransmitters because they transmit signals within the brain. Neurotransmitters can cause blood vessels to act in unusual ways if they are present in abnormal amounts or if the blood vessels are particularly sensitive to them.
Various triggers are thought to bring about migraine in people who have a natural tendency for having migraine headaches. Different people may have different triggers.
- Certain foods, especially chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG) can trigger migraines. (MSG is a food enhancer used in many foods, including Chinese food.)
- Missing a meal may bring on a headache.
- Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress.
- Birth control pills are a common trigger. Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache.
A migraine is a throbbing painful headache, usually on one side of the head, that is often initiated or "triggered" by specific compounds or situations (environment, stress, hormones, and many others). They occur more often in women (75%, approximately) and may affect a person’s ability to do common tasks.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.