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Migraine Headaches: Causes, Symptoms, and Treatments


Migraines are a type of complicated headache that present in repeated attacks. This neurological condition is painful and can happen with other physical symptoms. Symptoms can vary and may be brief or quite long. Migraine headaches are severe and can be draining.

What causes migraines?

Migraines were once believed to be caused by constricting vessels in the brain. Current theories suggest inflammation in the brain causes blood flow changes that affect the nerves. Unfortunately, migraines are not fully understood, so exact causes are not yet known.

Several theories are currently being tested. Current questions include:

  • Do neurotransmitters like dopamine or serotonin play a part?
  • Is brain development related to migraines?
  • Are nutrient deficiencies related?

Environmental factors may also play a role in migraines. Environmental and non-environmental triggers can prompt migraine flare-ups. Triggers may include:

  • Alcohol, especially wine with sulfates
  • Caffeine
  • Stress
  • Hormonal changes in women
  • Hormonal medications
  • Sensory stimulation from bright or flashing lights or strong smells
  • Smoke
  • Altered sleep patterns, too much or too little sleep
  • Foods like processed foods or food additives such as nitrates and artificial sweeteners
  • Physical exertion
  • Weather changes or changes in barometric pressure
  • Medications
  • Missing a meal
  • Not drinking enough water

Who gets migraines?

Migraines can affect anyone, from children to adults. Migraines are hereditary up to 70% of the time. Most people with migraines have a first-degree relative who also has migraines.

Women are three times more likely to develop migraines than men.

Risk factors for migraines can include:

  • Being overweight or obese
  • High blood pressure
  • High cholesterol
  • Stroke
  • Heart disease
  • Abnormal insulin sensitivity
  • Inflammatory disease
  • Using pain killers can cause rebound or medication-overuse headaches. This means medications stop relieving headaches and then begin causing headaches.
    • Aspirin, acetaminophen, and caffeine combination meds
    • Aspirin
    • Ibuprofen
    • Migraine rescue meds

Symptoms of migraines

Migraine symptoms are often complex and not the same for everyone. They can include:

  • Throbbing or pulsing headaches that are moderate to severe.
  • Pain increases with activity and movement.
  • Pain is on one side or in one place, often the front over the eye or temple, but may be anywhere in the head or neck.
  • Pain can increase over one to two hours.
  • Sensitivity to light and sound.
  • Nausea and vomiting may happen.
  • Headaches can last four to 72 hours.
  • Vision changes.
  • Tender scalp.
  • Tiredness.

Symptoms can move through four stages, though not everyone has all four stages. The stages include prodrome, aura, headache, and postdrome. Not everyone has the prodrome and aura or is aware of symptoms before the headache begins.

Prodrome: Can begin hours or days before the headache. May include [subtle] warning signs if you are aware of them, including:

  • Mood changes
  • Food cravings
  • Neck pain or stiffness
  • Constipation
  • Fluid retention
  • Increased urination

Aura: Visual or sensory symptoms that occur before the headache. Often gradually building up before the headache begins and lasts up to 60 minutes. Auras can include:

  • Visual disturbances, seeing shapes, spots, colors, flashes of light
  • Temporary vision loss
  • Difficulty speaking
  • Weakness or numbness in the face or one side of the body
  • Pins and needles sensations in an arm or leg
  • Ringing in ears
  • Seeing lines

Headache: Lasting several hours.

  • Frequency varies
  • Sensitivity to light or sound, possibly smell or touch
  • Nausea or vomiting
  • Sharp, stabbing, “ice pick” sensation

Postdrome: Can last a day or two.

  • Confusion
  • Exhaustion
  • Excitement

Types of migraines

Migraine symptoms can vary for each person. There are different types of migraines and not everyone experiences each type.

Migraine with aura (complicated migraine) occurs in 15 to 20% of people with migraines.

Migraine without aura (common migraine) happens without warning, but the symptoms are the same.

Migraine without headache, or silent migraine, the aura is present, but no head pain follows.

Hemiplegic migraine occurs with temporary paralysis, neurological, or sensory changes on one side of the body. This can include numbness, weakness, tingling, dizziness, or vision changes. It may or may not include headaches.

Retinal migraine is a dull ache behind the eye with part or complete vision loss. This pain can spread to the rest of your head. This may be a sign of serious health issues, notify your healthcare provider.

Chronic migraines occur at least 15 days per month. Symptoms and severity change frequently.

Migraine with brainstem aura causes sudden pain at the back of the head. It can cause slurred speech, blurred vision, loss of balance, ringing in the ears, and vomiting.

Status migrainosus is rare and severe, with nausea and extreme pain lasting more than 72 hours. It may result from medications or medication withdrawal.

Diagnosing migraines

If you suspect you are having migraines, talk to your healthcare provider. It can be beneficial to keep a record of your headaches to help your provider diagnose and treat you. Be sure to note how often and how long headaches affect you. Note any medications you take and anything else that may relate to the headaches.

Your provider can diagnose migraines and provide treatment. The provider will ask if you have a family history of headaches or migraines. You will have a physical and neurological examination. You may be referred to a neurologist who specializes in treating headaches.

Testing may not be necessary. If the provider determines further testing is important, you may have a CT scan or MRI of the brain. These tests can help your provider ensure there is no physical cause for the migraines. This could include tumors, bleeding, stroke, infection, or injury to the brain.

Treating and managing migraines

There are many treatment options for migraines. Migraines can be managed, but there is no cure.

Treatment plans include abortive (or rescue) medications and preventative medications.

Abortive medications are taken at the first sign of migraine when the pain is mild. The goal of these is to stop the migraine before it gets worse.

Preventative medications are for more frequent or more severe migraines. These are taken daily to prevent migraines from occurring. These medications are generally given by prescription and include:

  • Triptans (Sumatriptan, Zolmitriptan)
  • Calcium channel blockers (Verapamil)
  • Calcitonin gene-related monoclonal antibodies (Erenumab)
  • Beta blockers (Atenolol, Propranolol)
  • Antidepressants (Amitriptyline, Venlafaxine)
  • Antiseizure drugs (Valproic acid, Topiramate)
  • Nonprescription (Vitamin B12, Magnesium, Feverfew)

Over-the-counter medications are available but come with a caution. Examples are Excedrin Migraine and Motrin Migraine. These medications can lead to overuse or rebound headaches and a dependency issue. If using these medications more than three times per week, notify your healthcare provider.

How to prevent migraines

Actively managing migraines can make it possible to prevent or decrease their frequency.

  • Keep a migraine journal. Track triggers, foods, or other causes you might relate to migraines so you can avoid them later.
  • Get seven to nine hours of sleep each night.
  • Eat regular meals and don’t skip. Stay hydrated, drinking plenty of water.
  • Exercise regularly and maintain a healthy weight.
  • Manage your stress. Talk to a counselor for help if needed.
  • Take your medications as directed.

Conclusion

Migraines can be complex and painful. Migraine management is available, but there is no cure. Understanding your migraines is the best route to controlling them. Avoid triggers and work with your provider to determine the best treatment plan for you.

Key takeaways

Migraines are a type of complicated headache that present in repeated attacks.

Environmental factors may also play a role in migraines.

Migraines can affect anyone, from children to adults. Migraines are hereditary up to 70% of the time. Women are three times more likely to get migraines than men.

Symptoms can move through four stages, though not everyone has all four stages.

If you suspect you are having migraines, talk to your healthcare provider.

Treatment plans include abortive (or rescue) medications and preventative medications.

Resources:

Medscape. Migraine Headache.

Cleveland Clinic. Migraine Headaches.

Mayo Clinic. Migraine.

Science Direct. Migraine.

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