A migraine headache is a neurological disorder that causes severe head pain along with other symptoms such as sensitivity to light, sound, or smells.
There are four main stages of a migraine, which are described below.
First Stage of Migraine (Prodrome)
The start of a migraine is called the prodrome, in which warning signs occur before the actual migraine. Most people who have migraines experience a prodrome, but not with every migraine attack. The prodrome can happen anywhere from a few hours to days before the migraine attack.
During the prodrome the start of the migraine may feel like:
- Changes in mood
- Difficulty focusing
- Sensitivity to light and sound
- Constipation or diarrhea
- Muscle tension, especially in the neck and shoulders
- Cravings for certain foods
- Frequent urination
- Subtle changes in sensations such as an unusual taste or smell
Second Stage of Migraine (Aura)
The second phase of a migraine is the aura phase, in which visual disturbances that come before the headache phase occur. About one-third of people with migraines experience aura before a headache. Symptoms of an aura can last up to an hour, though in about 20% of people they may last more than an hour. Not all auras are followed by headaches, and in some cases, the aura may occur after the headache has already started.
During the aura phase, symptoms may include:
- Geometric patterns or flashing, colorful lights
- Blind spots (scotomas)
- Loss of vision on one side (hemianopsia)
- Blurred vision
- Numbness and tingling on part of the body
Third Stage of Migraine (Headache)
The headache phase of the migraine may last 4 to 72 hours. Headaches usually occur on one side of the head, but may occur on both sides. Migraine headaches feel like throbbing pain that can range from mild to debilitating.
Other symptoms that may accompany a migraine headache include:
- Inability to sleep
- Sensitivity to light (photophobia)
- Sensitivity to sound (phonophobia)
- Sensitivity to smell (hyperosmia)
Fourth Stage of Migraine (Postdrome)
The last stage of a migraine is the postdrome (headache termination), in which the headache pain usually goes away with sleep, even if the migraine is not treated.
Other signs that may linger after the pain goes away (postdrome) may include:
- Problems concentrating
- Inability to eat
What Causes Migraine?
The cause of migraine is unknown, but genetics and environment are factors.
- Stress, which is a trigger for up to 70% of people with migraine
- Poor sleep
- Caffeine use or withdrawal
- Weather changes or changes in barometric pressure
- Certain foods and drinks, such as chocolate, processed foods with monosodium glutamate (MSG), foods with histamine, cheese and other dairy products, artificial sweeteners such as aspartame, cured meats, and foods with a strong smell
- Bright lights (photophobia)
- Certain smells such as perfumes, strong food smells, chemicals, and gasoline
- Medication overuse (taking acute migraine prescription medication more than 10 days in a month)
- Certain prescription medications, such as nitroglycerin and estrogen
- Hunger/skipping meals
- Exposure to smoke
- Concussions and traumatic brain injuries
What Is the Treatment for Migraine?
Treatment for migraine headaches includes:
- Non-medical treatments
- Drinking plenty of fluids
- Deep breathing
- Darkened room/covering your eyes
- Pain relievers (analgesics)
- Other medications
- Trigger point injections
- OnabotulinumtoxinA (Botox)
- Anti-nausea medications (antiemetics)
- Selective serotonin 1F receptor agonist
- Calcitonin-gene related peptide (CGRP) antagonists
- Ergotamine preparations
- Peripheral nerve blocks
Migraines and Headaches Resources
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