A migraine is a type of headache. It may occur with symptoms such as nausea, vomiting, or sensitivity to light and sound. In many people, a throbbing pain is felt only on one side of the head.
Headache - migraine
A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.
Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin later in life. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant.
Migraine attacks may be triggered by any of the following:
Changes in hormone levels during a woman's menstrual cycle or with the use of birth control pills
Changes in sleep patterns
Exercise or other physical stress
Loud noises or bright lights
Odors or perfumes
Smoking or exposure to smoke
Stress and anxiety
Migraines can also be triggered by certain foods. Most common are:
Foods with monosodium glutamate (MSG)
Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
Fruits (avocado, banana, citrus fruit)
Meats containing nitrates (bacon, hot dogs, salami, cured meats)
Peanuts and other nuts and seeds
Processed, fermented, pickled, or marinated foods
True migraine headaches are not a result of a brain tumor or other serious medical problem. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition.
There are two common types of migraines:
Migraine with aura
Migraine without aura
An aura is a group of nervous system (neurologic) symptoms. These symptoms are considered a warning sign that a migraine is coming. Most often the vision is affected and can include any or all of the following:
Temporary blind spots or colored spots
Seeing stars, zigzag lines, or flashing lights
Tunnel vision (only able to see objects close to the center of the field of view)
Other nervous system symptoms include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness and tingling.
An aura often occurs 10 to 15 minutes before the headache, but can occur just a few minutes to 24 hours beforehand. A headache does not always follow an aura.
The headaches usually:
Start as a dull ache and get worse within minutes to hours
Are throbbing, pounding, or pulsating
Are worse on one side of the head with pain behind the eye or in the back of the head and neck
Last 6 to 48 hours
Other symptoms that may occur with the headache include:
Loss of appetite
Nausea and vomiting
Sensitivity to light or sound
Symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms can include:
Feeling mentally dull, like your thinking is not clear or sharp
Needing more sleep
Exams and Tests
Your doctor can diagnose migraine headache by asking about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder.
There is no specific test to prove that your headache is actually a migraine. Your doctor may order a brain CT or MRI scan if you have never had one before. The test may also be ordered if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness.
An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.
There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers.
A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your doctor can plan how to avoid these triggers.
If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include:
Blood pressure medicines
Botulinum toxin type A (Botox) injections may also help reduce migraine attacks if they occur more than 15 days a month.
Some people find relief with minerals and vitamins. Check with your doctor to see if riboflavin or magnesium are right for you.
TREATING AN ATTACK
Other medicines are taken at the first sign of a migraine attack. Over-the-counter (OTC) pain medicines, such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware that:
Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
Taking too much acetaminophen can damage your liver.
Too much ibuprofen or aspirin can irritate your stomach or kidneys.
If these treatments do not help, ask your doctor about prescription medicines. These include nasal sprays, suppositories, or injections.
Some migraine medicines narrow the blood vessels. If you are at risk for having a heart attack or have heart disease, talk with your doctor before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your doctor about which medicine is right for you if you are pregnant or planning to become pregnant.
Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other drugs that treat the migraine itself.
Feverfew is a herb for migraines. It can be effective for some people. Before using feverfew, make sure your doctor approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.
Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337-1345. PMID: 23439705 www.ncbi.nlm.nih.gov/pubmed/23439705
Spector JT, Kahn SR, Jones MR, et al. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. 2010;123:612-624. PMID: 20493462 www.ncbi.nlm.nih.gov/pubmed/20493462
Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.