Migraine: Types, Symptoms, Causes, Triggers, and Treatments
What is a migraine?
A migraine is a type of headache that typically results in intense throbbing or pulsating pain on one side of the head. However, a migraine is more than just a little headache pain. Instead, it is a neurological condition that often causes excruciating head pain and other symptoms that can be disabling.
Migraine headaches frequently come with nausea, vomiting, and heightened sensitivity to light and sound. Migraine episodes can persist for several hours or even days, and the discomfort can be so intense that it disrupts your ability to perform everyday tasks.
How common is migraine?
Migraine is prevalent, affecting more than 1 billion people globally. In the United States, more than 39 million people experience migraines (1, 2)
However, it is impossible to determine the exact prevalence of this condition because around 50% of migraineurs are never diagnosed (3). This means that either healthcare providers did not recognize migraine symptoms or, more likely, the sufferers never visited a doctor for their headache pain.
What is a migraine aura?
An aura is a cluster of sensory, speech, and motor symptoms that can indicate an imminent migraine attack. Unfortunately, this warning sign is sometimes misinterpreted as a seizure or stroke and can happen before, during, or after the headache pain.
About 15% to 20% of people suffering from migraines experience the aura, which typically lasts 10 to 60 minutes.
Symptoms of an aura include visual disturbances, such as seeing flashing lights or lines, and numbness or weakness in the face or limbs. Speech can also be affected, leading to slurred speech or difficulty finding the right words. Other symptoms include ringing in the ears (tinnitus), changes in smell and taste, and a weird or “funny” feeling.
These warning signs can be a valuable indicator of a migraine attack, helping people prepare and take preventative measures.
Aura symptoms are fleeting and clear up after the migraine attack.
What are the types of migraines?
Many types of migraines exist, including:
- Migraine without aura (common migraine): This headache occurs suddenly, without the typical warning signs of an aura. Although the symptoms are identical, the aura phase is absent. Most migraine headaches occur without the aura.
- Migraine with aura (complicated migraine): This migraine headache occurs with an aura. Typically, the aura precedes the headache. However, only about 15% to 20% of migraineurs experience an aura phase (4).
- Migraine without headache: The aura occurs without head pain in this type of migraine. This type is also called “silent migraine” or “acephalgic migraine.”
- Chronic migraine. Chronic migraines are experienced when a person suffers from migraines for at least 15 days per month. The symptoms can vary in intensity and frequency. According to the American Migraine Foundation, as many as 148 million people globally suffer from chronic migraine (5). People who suffer from chronic migraines may use headache pain medications for more than 10 to 15 days a month, which can increase the frequency of headaches. This used to be called rebound migraines or headaches, but now doctors use the term medication overuse headache (MOH). (6)
- Retinal migraine (ocular migraine): If you experience a retinal migraine, you may observe a transient, partial, or complete vision loss in one eye. Additionally, you may feel a mild ache behind the eye, which could extend to the entire head. This vision loss could last a few seconds or extend for several months. It is highly recommended to inform a healthcare professional about a retinal migraine since it might indicate a more severe problem. Prompt diagnosis and treatment of a retinal migraine can minimize the risk of long-term vision loss. It is important to remember that the experience of a retinal migraine is not the same for everyone and can vary in intensity and duration.
- Hemiplegic migraine: If you experience hemiplegic migraine, you may notice temporary paralysis (hemiplegia) or sensory and neurological changes on one side of your body. The onset of the headache may coincide with temporary numbness, tingling sensations, extreme weakness on one side of your body, vision changes, or dizziness. While head pain may or may not be present, it is crucial to seek medical attention if you experience any of these symptoms. Hemiplegic migraine is rare and can be challenging to diagnose, so you must provide your healthcare provider with a detailed list of your symptoms.
- Migraine with brain stem aura: If you experience this migraine type, you may notice symptoms such as vertigo, slurred speech, loss of coordination, double vision, ringing in the ears, or loss of balance before the headache begins. The pain from the headache may affect the back of your head. This type was once called basilar-type migraine because it was thought to be caused by a spasm in the basilar artery. The artery mentioned above is responsible for supplying blood to crucial parts of the brain, including the brainstem. However, further studies revealed that the aura comes from the brainstem, making this an exceedingly rare migraine type.
- Abdominal migraine. Abdominal migraine is a condition that primarily affects young children, causing moderate to severe pain in the middle of the abdomen for a duration of one to 72 hours, with little or no headache. Other symptoms include nausea, vomiting, and loss of appetite. It is worth noting that many children who experience abdominal migraine may also develop migraine headaches later on in life.
- Status migrainosus. Have you heard of a migraine lasting longer than 72 hours? It's a rare and severe form that can bring excruciating headache, pain, and nausea. Certain medications or medication withdrawals can trigger this type of migraine. Status migrainosus requires immediate medical attention, as it can be life-threatening.
What are the stages of migraines?
There are four stages of a migraine, though not everyone will experience all of them. For example, only about 30% of migraineurs experience an aura before the headache pain begins.
The 4 phases in chronological order are as follows:
- Prodrome. During this initial phase, which can last for a few hours or even days, you may or may not experience what is commonly referred to as the "preheadache" or "premonitory" phase. Symptoms include mood swings, increased urination, food cravings, depression, irritability, hyperactivity, fatigue, and/or neck stiffness. This phase does not occur every time.
- Aura. It's possible for the aura phase to persist for up to an hour or as little as five minutes. Not all individuals encounter an aura; a few may face both an aura and a headache concurrently. When experiencing an aura state, specific individuals may witness flashing or bright lights or what appear to be heat waves, either before or during a migraine. Others may feel muscle weakness or the sensation of being touched. Additional symptoms may include difficulty speaking, double vision, temporary vision loss, or feeling a tingling sensation in your arms, legs, or face.
- Attack. During the attack phase, the most severe and acute migraine pain can sometimes overlap with an aura. The duration of this phase can vary from hours to days. Migraine symptoms may differ from one individual to another. Symptoms can include pulsing or throbbing pain on one side of your head, nausea, increased sensitivity to light and sound, dizziness, or vomiting.
- Postdrome. The postdrome phase occurs a day two after the migraine headache has subsided. During the postdrome phase, you may notice changes in mood and emotions. These changes can vary from feeling elated and overjoyed to feeling exhausted and indifferent. The postdrome stage is extremely common, as it’s experienced by an estimated 80% of those with migraines (7).
What causes a migraine attack?
Although researchers have not identified a definitive cause for migraines, it is believed that the condition results from "abnormal" brain activity, which impacts nerve signaling, chemicals, and blood vessels in the brain.
Experts do not know precisely why this “abdormal” brain activity occurs, but they believe it involves genetics and environmental factors. After all, migraine has been demonstrated to run in families, so the condition has a hereditary component.
What triggers a migraine attack?
Many individuals who suffer from migraines experience spontaneous attacks, which means that the attack is not triggered by anything they did or did not do. This is simply the natural behavior of the disease. However, some people may have attacks that can be traced back to a specific cause. While everyone's triggers may vary, a few common culprits affect a significant number of people.
Common migraine triggers include the following:
- Changes in weather or barometric pressure
- Artificial sweeteners
- Sleeping to much
- Sleep deprivation
- Bright or flashing lights
- Skipping meals
- Foods containing MSG
- Cured meats
- Severe heat or cold
- Hormonal fluctuations in women
- Traumatic brain injuries
What are the migraine risk factors?
Although it's challenging to anticipate who may experience migraines and who may not, certain risk factors can make one more susceptible. These risk factors may include:
Gender: Migraine is a condition that can impact individuals of all genders, ages, races, ethnicities, and backgrounds. However, it is more prevalent in women. Studies suggest that hormones play a significant role in this disparity, with women being three times more likely to experience migraines than men (8). It's also worth noting that girls may start experiencing migraines during their first period, and women are more likely to suffer during their childbearing years.
Genetics. Migraines are strongly associated with genetics. For example, it has been observed that as many as 80% of individuals who experience migraine headaches have a family member with the same condition, particularly a first-degree relative (9).
Elevated stress level. Numerous studies suggest that a highly stressed state can trigger a migraine. Indeed, stress and anxiety have been found to be the most common migraine triggers. So, if you suffer from migraines, you might want to manage your stress levels.
Smoking. Based on a research report released by Spain's Foundation for Science and Technology in 2009, researchers found that smoking can indeed trigger migraine episodes, especially if patients smoke more than five cigarettes a day (10).
How do I prevent migraines?
If you have been diagnosed with migraines, there are several options available that can help prevent an attack.
For example, avoiding triggers such as bright lights, stress, or certain foods can be helpful. Taking preventive medications regularly can also help reduce the frequency and intensity of migraines. Additionally, lifestyle changes such as getting plenty of sleep, exercising regularly, and eating a balanced diet can help reduce the risk of migraines.
What are some preventive medications?
Your doctor may recommend preventive medications if you suffer from frequent and severe migraine attacks that disrupt your daily routine. However, while these medications may alleviate and manage migraine symptoms, they do not completely cure the condition.
It is important to remember that preventive medications are not a one-size-fits-all solution for migraines. You may need to try several different medications before you find the one that works for you.
Additionally, it's essential to keep track of your migraine symptoms to determine if the medication has the desired effect.
There are two classifications of migraine medications: abortive and preventative.
- Abortive medications. Abortive migraine medications, also known as acute treatments, are used to manage migraine symptoms as they occur.
- Preventative medications. These medications can be taken as a preventive measure to reduce the risk and severity of migraine episodes. These medications can be taken daily or only when migraine symptoms are present. Common preventive migraine medications include beta-blockers, antidepressants, and anticonvulsants. Consult with a doctor for the best preventative treatment plan.
Your healthcare provider may prescribe preventative medications along with others to increase the positive treatment effects.
What are some devices that help migraines?
Managing migraines has become easier with the increasing availability of medical devices that can prevent headaches and alleviate pain by impacting neuronal activity in the brain. These devices, called neuromodulation devices, offer several benefits, such as no medication side effects, including medication overuse headaches.
Neuromodulation devices can be used to treat a variety of conditions, including migraines, chronic headaches, and chronic pain. They are non-invasive and allow for precise targeting of affected areas. Additionally, these devices are relatively low-cost and have few side effects.
The FDA approved three of these medical devices, which are currently being utilized. While some may require a prescription, others can be obtained over the counter (OTC). These devices employ distinct methods to influence neuronal activity: e-TNS, sTMS, and non-invasive vagus nerve stimulation.
External Trigeminal Nerve Stimulation (e-TNS)
The Cefaly device, marketed under its brand name, is a groundbreaking neurostimulator that utilizes transcutaneous electrical nerve stimulation (TENS) technology to alleviate pain. This technology is commonly used in physical therapy to relieve back and other types of pain.
Cefaly was the first neurostimulator to be FDA-approved for the prevention of migraines. It is now authorized for both the treatment and prevention of migraines and is available over the counter.
The diamond-shaped device is roughly the size of a palm and magnetically attaches to a self-adhesive electrode at the forehead's center. The machine produces minor electrical pulses that activate the trigeminal nerve involved in migraine headaches.
Single Pulse Transcranial Magnetic Stimulator (sTMS)
The eNeura sTMS device is a safe and effective solution for treating migraines with and without aura and has been approved by the FDA. It is available only through a healthcare provider's prescription and is sold under the brand name eNeura.
The device is designed to comfortably cradle the back of the head and is shaped like a curved rectangle. It contains a magnet that emits a powerful pulse of magnetic energy for a split second. The eNeura sTMS mini can be rented for a period of three months.
How does it work? The primary cause of migraine with visual aura is a phenomenon called cortical spreading depression (CSD), which is characterized by unusual electrical activity in the brain. The sTMS device uses magnetic energy pulses to interrupt and relieve this process.
GammaCore Non-Invasive Vagus Nerve Stimulator
The gammaCore Sapphire was initially developed to alleviate cluster headaches, but it has now received FDA approval for treating and preventing migraines in adults.
This handheld device is about the size of a deck of cards and has two stimulation surfaces located on one end. It is meant to be held against the skin close to the vagus nerve in the neck.
By stimulating the nerve, the gammaCore Sapphire effectively blocks pain signals associated with migraines, as the vagus nerve regulates pain sensations.
What are some natural alternative treatments for migraine?
Several natural treatment options exist for migraines, including the following:
Acupuncture is a procedure that entails inserting thin needles into specific areas of the skin to alleviate a range of health issues.
According to a randomized controlled study conducted in 2020 (11), individuals with a history of episodic migraine without aura experienced more significant relief from migraine after undergoing 20 sessions of manual acupuncture in combination with usual care compared to those who received sham acupuncture alongside standard care. (Sham acupuncture is a control procedure used in scientific studies to test the effectiveness of actual acupuncture. It’s a fake acupuncture procedure replicating real acupuncture. Essentially, the needles are not inserted as deeply, or they are not inserted into actual acupuncture points.)
Magnesium is a mineral that is essential for proper bodily function.
Did you know that there is a link between magnesium deficiency and headaches or migraines? It’s true.
It is believed that taking magnesium oxide supplements can help prevent migraines with aura and menstrual migraines.
Recently, a study conducted in 2021 discovered that taking 500 milligrams of magnesium oxide twice a day for 8 weeks can be as effective in preventing migraines as valproate sodium medication and with fewer side effects (12).
You can take magnesium in supplement form or through magnesium-rich foods, including:
- Sesame seeds
- Peanut butter
Yoga is a comprehensive approach to improving overall health and wellness through breathing techniques, meditation, and various body postures.
A 2015 study (13) found that practicing yoga can reduce migraine attacks' frequency, duration, and intensity. This is because yoga has the ability to ease anxiety, release tension in areas that trigger migraines, and promote vascular health.
The study's findings suggest that incorporating yoga as a complementary therapy can effectively treat migraines.
Biofeedback is a relaxation technique that empowers you to control your body's automatic reactions to stress. The therapy involves attaching electrodes to your skin to monitor physiological processes that respond to stress, such as muscle tension, heart rate, and blood pressure.
During a biofeedback session, you collaborate with a therapist to manage stress by modifying your physiological responses based on the feedback provided.
Recent research in 2019 (14) suggests that biofeedback and cognitive behavioral therapy are beneficial mind-body interventions for treating migraines with no adverse side effects. These interventions may be a viable alternative to medication for some individuals.
Drink enough water
Staying hydrated is crucial for individuals suffering from migraines, as approximately one-third identify dehydration as a potential trigger (15).
Drinking ample water throughout the day is essential, especially when engaging in physical activity. In addition, consuming more water than usual on days with high temperatures is also crucial.
Aim to drink at least eight glasses of water daily to ensure you are adequately hydrated.
Get a massage
It is believed that massage may reduce migraine frequency. Low serotonin levels in the brain are associated with migraines, and massage is known to increase this level.
While there is limited evidence that massage can be helpful for migraine relief, it is generally considered safe and has a low risk of adverse effects.
Plus, massage has been proven to reduce stress, a primary migraine trigger. So if you’re able to reduce stress through massage, a reduction in the frequency and severity of your migraines could follow.
Dealing with frequent migraine headaches can significantly hinder your daily routine, activities, and overall health. In addition, the pain and discomfort caused by these episodes can be overwhelming.
However, there are ways to minimize the symptoms and intensity of your migraines. It is advisable to consult with a medical professional regarding the various medication options available and their effectiveness in managing your symptoms. Additionally, non-medication methods can be used to prevent migraine episodes.
To learn more about your specific type of migraine and long-term prevention strategies, it's best to seek advice from your doctor.