Everything you need to know about migraine

A migraine episode is a type of headache. An episode usually occurs in stages and can last for several days. Severe cases can affect a person’s daily life, including their ability to work or study.

Migraine can affect people in different ways, and the triggers, severity, symptoms, and frequency can vary. Some people have more than one episode each week, while others have them only occasionally.

In 2018, researchers found that more than 15% of adults in the United States had experienced a migraine episode or a severe headache within the last 3 months.

Research from 2015 found that migraine affects just over 19% of females and 9% of males. Episodes often occur in people aged 18–44 years, but they can happen at any time, including during childhood.

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Symptoms of migraine tend to occur in stages:

Before the headache: According to research from 2008, 20–60% of people with migraine experience symptoms that start hours or days before the headache.

At this stage, a person might experience a “prodrome,” which may involve emotional changes, specifically depression and irritability. A prodrome can also include yawning, dizziness, thirst, frequent urination, and sensitivity to light and sound.

Sometimes an aura can occur. This involves physical or sensory symptoms, such as flashing lights in the field of vision.

During the headache: Alongside a mild to severe, throbbing or pulsing headache, symptoms may include nausea, vomiting, neck pain, dizziness, and nasal congestion.

Resolution: After the headache, tiredness and irritability may last another 2 days. This is sometimes called the “migraine hangover.”

Other common features of migraine are:

• head pain that worsens during physical activity or straining
• an inability to perform regular activities due to the pain
• increased sensitivity to light and sound that can sometimes be relived by lying quietly in a darkened room

Other symptoms may include sweating, feeling unusually hot or cold, a stomachache, and diarrhea.

Find out what else can cause a headache, nausea, and fatigue here.

A migraine episode is different from a typical headache. The experience is different, and they can have different causes.

Writing down the symptoms and when they occur can help a person and their healthcare professional identify migraine episodes. Keep this journal for at least 8 weeks, and note down:

• the time that symptoms start
• possible triggers, such as stress or menstruation
• the nature of the headache
• any other symptoms
• how long the symptoms last
• any noticeable indicators of migraine, such as an aura
• any medications and their effects

Learn more about the differences between migraine and a headache here.

Experts think that migraine episodes may stem from changes in the brain that affect the:

• way nerves communicate
• balance of chemicals
• blood vessels

Genetic features may also play a role — having a family history of migraine is a common risk factor.

Migraine triggers vary from person to person. They commonly include:

• hormonal changes, such as those related to menstruation
• emotional triggers, such as stress, depression, anxiety, and excitement
• dietary factors, including alcohol, caffeine, chocolate, nuts, cheese, citrus fruits, and foods containing the additives tyramine and monosodium glutamate (MSG)
• medications, such as sleeping pills, hormone replacement therapy (HRT), and some birth control pills
• environmental factors, including flickering screens, strong smells, secondhand smoke, loud noises, humidity, stuffy rooms, temperature changes, and bright lights

Some other possible triggers include:

• tiredness
• a lack of sleep
• shoulder and neck tension
• poor posture
• physical overexertion
• low blood sugar
• jet lag
• irregular mealtimes
• dehydration

Avoiding triggers, when possible, may help reduce the frequency of migraine episodes.

What causes headaches? Find out here.

Migraine can be a debilitating condition that is underdiagnosed and challenging to treat. This can be seen especially in BIPOC (Black, Indigenous, and People of Color) populations. People of Color are less likely to receive the diagnosis of migraine and the treatment than white people.

In fact, only 47% of African Americans have an official migraine diagnosis, compared with 70% of white people in the country. And other research found that Latino people are 50% less likely to receive a formal migraine diagnosis than white people. These disparities can impact treatment and therapies.

While these figures could lead to the conclusion that white people experience more migraine episodes than other groups, an analysis of nine studies looking at the average prevalence of severe headache or migraine from 2005 to 2012 in the U.S. found that the prevalence rates of episodes across all groups were similar:

• 17.7% of Native American people
• 15.5% of white people
• 14.5% of Hispanic people
• 14.45% of Black people
• 9.2% of Asian people

Furthermore, females in all groups were approximately twice as likely to experience migraine episodes than males.

Overall, studies that discuss migraine and use racial and ethnic differences for clarity often do not consider contributing factors. Further research is warranted, and this should consider behavioral, environmental, genetic, and socioeconomic factors, as well as access to healthcare.

Risk factors

Anyone can develop migraine, and there is a slightly higher risk for people with:

• depression
• bipolar disorder
• fibromyalgia
• irritable bowel syndrome
• overactive bladder
• sleep disorders
• obsessive-compulsive disorder
• anxiety

Is there a link between migraine and COVID-19?

While it is not always possible to prevent migraine episodes, there are ways to reduce their frequency and severity.

Medications

The following prescription drugs may help reduce the number of episodes that a person with severe migraine experiences:

• topiramate (Trokendi XR), an antiseizure drug
• propanolol (Inderal), for treating high blood pressure
• antidepressant medications
• Botox
• gepants and CGRP inhibitors

It may take several weeks to see an improvement.

The best treatment in children or adolescents may be different from that in adults. A healthcare professional can help recommend the most effective approach.

Identifying and avoiding triggers

A migraine episode sometimes happens in response to a trigger. To identify a trigger, a person might keep a diary and record how they felt and what they did, ate, and drank before the symptoms appeared.

It may be particularly helpful to avoid:

• low blood sugar
• physical overexertion
• stress
• certain foods, such as chocolate and any that contain tyramine or MSG
• certain medications, including HRT and some birth control pills
• bright lights and flickering screens

The following strategies may help reduce the frequency of migraine episodes:

• getting enough sleep
• reducing stress
• drinking plenty of water
• having healthy posture
• avoiding known dietary triggers, such as caffeine, alcohol, and cheese
• getting regular physical exercise

If making these changes does not ease the severity and frequency of migraine episodes, a doctor may suggest medication or other options.

There are various types of migraine. A major distinguishing factor is whether they involve aura — sensory changes.

Migraine with aura

Aura is a disturbance of the senses in the early stages of a migraine episode.

Aura can involve:

• having confusing thoughts or experiences
• seeing strange, sparkling, or flashing lights that are not there
• seeing zig-zagging lines of light
• having blind spots or blank patches in the field of vision
• having a pins and needles sensation in an arm or leg
• having difficulty speaking
• having weakness in the shoulders, neck, or limbs
• seeing things that are not there out of one eye, such as transparent strings of objects
• not being able to see part of something clearly
• having part of the field of vision disappear, then reappear

A visual aura may feel like the aftermath of a very bright camera flash, but the visual changes may last for several minutes or up to 1 hour.

Anyone experiencing an aura for the first time should contact a healthcare professional to rule out serious neurological problems, such as a stroke or a brain tumor.

Find out more about migraine aura here.

Migraine without aura

More commonly, a person experiences no sensory disturbances before an episode. According to the Migraine Trust, 70–90% of episodes occur without aura.

Other types

Some other types of migraine include:

• Chronic migraine: This involves having an episode on more than 15 days per month.
• Menstrual migraine: This occurs in a pattern that follows the menstrual cycle.
• Hemiplegic migraine: This causes temporary weakness on one side of the body, and it is very rare.
• Abdominal migraine: This involves migraine episodes with irregular function in the gut and abdomen, often with nausea or vomiting. It mainly affects children under 14 years of age.
• Vestibular migraine: Severe vertigo is a symptom of this type.
• Basilar migraine: This rare type is also called “migraine with brainstem aura,” and it can affect neurological functions, such as speech.

Anyone who may be experiencing any neurological symptoms should get medical attention. And people who need treatment for migraine should consult a healthcare professional.

Diagnosis

The International Headache Society recommends the “5, 4, 3, 2, 1” criteria to diagnose migraine without aura. These numbers stand for:

• having 5 or more episodes, each lasting 4 hours to 3 days
• having a headache with at least 2 of the following qualities:
  – occurring on one side
  – pulsating
  – causing moderate-to-severe pain aggravated by activity
• having at least 1 additional symptom, such as:
  – nausea
  – vomiting
  – sensitivity to light
  – sensitivity to sound

The doctor may recommend imaging or other tests to exclude other causes of the symptoms, such as a tumor, meningitis, or a stroke.

A person should consult a healthcare professional if they experience:

• what seems like a first migraine episode
• worsening or unusual migraine symptoms
• severe symptoms

If any of the following occur, seek immediate medical help:

• an unusually severe headache
• visual disturbances
• a loss of sensation
• difficulty speaking

These could indicate another condition that may need urgent attention, such as a stroke.

When is it sensible to worry about a headache?

Migraine is a medical condition that involves a headache and other symptoms. It is not just a bad headache, and it can have a significant impact on daily life, making it difficult to work and do everyday activities.

Identifying and avoiding triggers can often help reduce the frequency or severity of episodes, though it is not always possible to prevent them.

Medication and other treatments can help manage migraine symptoms. Anyone who has concerns should contact a healthcare professional.

Read the article in Spanish.