Description

A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last anywhere from hours to days, and the pain can be so severe that it interferes with their daily activities.

For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disorders, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

Medicines can help prevent migraines and make them less painful. The right medicines, combined with measures and lifestyle changes, it might be of help.

Symptoms

Migraines, which affect children and adolescents as well as adults, can progress through four stages: prodrome, aura, attack, and post-drome. Not everyone who has migraines passes through all the stages.

Prodrome

One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:

  • The constipation.
  • Mood changes, from depression to euphoria.
  • The food cravings.
  • Stiffness in the neck.
  • Increased urination.
  • The retention of fluids.
  • Frequent yawning.

Aura

For some people, an aura may occur before or during migraines. Auras are reversible symptoms of the nervous system. They are usually visual, but can also include other disturbances. Each of the symptoms usually begins gradually, builds up over several minutes and can last up to 60 minutes.

Examples of the aura of migraine headaches include:

  • Visual phenomena, such as seeing various shapes, spots or flashes of light.
  • The loss of vision.
  • Pins and needles sensations in an arm or a leg.
  • Weakness or numbness in the face or one side of the body.
  • Difficulty speaking.

Attack

A migraine usually lasts from 4 to 72 hours if not treated. What frequency of migraine headaches occur varies from person to person. Migraine headaches can occur rarely or hit it several times a month.

During a migraine, you may have:

  • The pain usually on one side of your head, but often on both sides.
  • The pain that throbs or pulses.
  • The sensitivity to light, sound, and sometimes the smell and touch.
  • Nausea and vomiting.

Post-drome

After a migraine attack, you might feel drained, confused, and dragged up to a day. Some people say they feel euphoric. Sudden movement of the head can cause the pain again briefly.

When to see a doctor

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine headaches, keep a record of your attacks and how they are treated. Then, make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your health care provider if changes in the pattern or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

  • An abrupt, severe headache like a thunderclap.
  • Headache with fever, stiff neck, confusion, seizures, double vision, weakness or numbness in any part of the body, which could be a sign of a stroke.
  • Headache after a head injury.
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement.
  • New headache after age 50.

Causes

Even though migraine causes are not fully understood, genetics and environmental factors seem to play a role.

The changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. You can, therefore, imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are a number of migraine triggers, including:

  • Hormonal changes in women.Fluctuations in levels of estrogen, such as before or during menstrual periods, pregnancy, and menopause, seem to trigger headaches in many women. Hormonal medications, such as oral contraceptives, also may worsen migraines. However, some women find that their migraines occur less often when taking these medications.
  • Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
  • Stress. Stress at work or home can cause migraines.
  • The sensory stimuli. Bright or flashing lights can induce migraines, as loud sounds. Strong odors such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
  • Changes in sleep. Lack of sleep or too much sleep can trigger migraines in some people.
  • The physical effort. Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes of climate. A change of weather or barometric pressure can cause a migraine.
  • Drugs. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
  • Food. Cheeses and salty and processed foods may trigger migraines. Therefore, you can skip the meals.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), which is found in many foods.

Hormonal changes in women. Fluctuations in levels of estrogen, such as before or during menstrual periods, pregnancy, and menopause, seem to trigger headaches in many women.

Hormonal medications, such as oral contraceptives, also may worsen migraines. However, some women find that their migraines occur less often when taking these medications.

Risk factors

There are several factors that make it more likely to have migraines, including:

  • The history of the family. If you have a family member with migraines, then you have a good chance of developing them as well.
  • Age. Migraines can begin at any age, although the first, often occurs during adolescence. Migraines tend to peak during the 30 years, and gradually become less severe and less frequent in the following decades.
  • Sex. Women are three times more likely than men to have migraines.
  • The hormonal changes. For women who suffer from migraines, headaches may begin just before or shortly after the onset of menstruation. You can also change during pregnancy or menopause. Migraines usually improve after the menopause.

Complications

Taking painkillers too often can trigger severe medication-overuse headaches. The risk appears to be greater with aspirin, acetaminophen (Tylenol, others), and caffeine combinations. Excessive use of the headaches can also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days per month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt) for more than nine days a month.

Medication-overuse headaches, occur when the drugs stop relieve the pain and begin to cause headaches. Then, use more medication for the pain, which continues the cycle.

Diagnosis

If you have migraines or a family history of migraine, a specialist trained in the treatment of headaches, known as a neurologist, it is likely diagnose migraines based on your medical history, symptoms and a physical and neurological examination.

If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes of pain may include:

  • AnMRIscan. A magnetic resonance imaging (MRI) uses a powerful magnetic field and radio waves to produce detailed images of blood vessels, and brain. MRI scans help diagnose tumors, strokes, brain hemorrhages, infections, and other brain and nervous system, known as neurological conditions.
  • ACTscan. A computed tomography (CT) scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps to diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that can cause headaches.

Treatment

Migraine treatment is aimed at stopping symptoms and preventing future attacks.

Many drugs have been designed for the treatment of migraine headaches. The medications used to combat migraines fall into two broad categories:

  • Medications to ease the pain. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop the symptoms.
  • Preventive medications. These types of medications are taken regularly, often daily, to reduce the severity or frequency of migraines.

Your treatment options depend on the frequency and severity of your headaches, if you have nausea and vomiting with their headaches, disabling headaches, and other medical conditions that you have.

Medicines for the relief of the

Medications used to relieve the pain of migraine, they work better when taken at the first sign of an oncoming migraine as soon as the symptoms of a migraine starting. The medications that can be used to treat it include:

  • Pain relievers.These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When it takes too long, can cause medication-overuse headaches, and, possibly, ulcers and bleeding in the gastrointestinal tract. Relief of migraine medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild pain of the migraine.
  • The triptans. Prescription drugs, such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) is used to treat migraine headaches, because they block pain pathways in the brain. As pills, injections or nasal sprays can relieve many of the symptoms of migraine headaches. They may not be safe for people at risk of a stroke or heart attack.
  • Dihydroergotamine (Migranal, Trudhesa).Available as a nasal spray or injection, this drug is most effective when taken shortly after the onset of the symptoms of migraine headaches to migraines, which tend to last for more than 24 hours. Side effects may include worsening of migraine-related nausea and vomiting. People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamine.
  • Lasmiditan (Reyvow). This new oral tablet is approved for the treatment of migraine headaches with or without aura. In drug trials, lasmiditan significantly improved the headache. Lasmiditan may have a sedative effect and cause dizziness, so that the people who take it, it is recommended not to drive or operate machinery for at least eight hours.
  • Oral calcitonin gene-related peptide antagonists, known as gepants. Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral gepants approved for the treatment of migraine in adults. In drug trials, the drugs of this class were more effective than placebo in relieving the pain two hours after taking it. They were also effective in the treatment of the symptoms of migraine, such as nausea and sensitivity to light and sound. Common side effects include dry mouth, nausea, and excessive drowsiness. Ubrogepant and rimegepant should not be taken with a strong inhibitor of CYP3A4 medications such as some medicines used to treat cancer.
  • Intranasal zavegepant (Zavzpret).The Food and Drug Administration recently approved this nasal spray for the treatment of migraine headaches. Zavegepant is a gepant and the only medicine for migraine that comes as a nasal spray. Brings migraine pain relief within 15 minutes to 2 hours after taking a single dose. The medicine continues to work for up to 48 hours. You can also improve other symptoms related to migraine, such as nausea and sensitivity to light and sound. The common side effects of zavegepant include a change in the sense of taste, nasal discomfort, and irritation of the throat.
  • The opioid drugs. For the people who cannot take other medications for migraine, narcotic opioid medication can help. Because it can be highly addictive, these are usually used only if other treatments are not effective.
  • Anti-nausea drugs. These can help if your aura with migraine headache is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Gimoti, Reglan) or prochlorperazine (Compro, Compazine). These tend to take drugs for the pain.

Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When it takes too long, can cause medication-overuse headaches, and, possibly, ulcers and bleeding in the gastrointestinal tract.

Relief of migraine medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild pain of the migraine.

Dihydroergotamine (Migranal, Trudhesa). Available as a nasal spray or injection, this drug is most effective when taken shortly after the onset of the symptoms of migraine headaches to migraines, which tend to last for more than 24 hours. Side effects may include worsening of migraine-related nausea and vomiting.

People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamine.

Intranasal zavegepant (Zavzpret). The Food and Drug Administration recently approved this nasal spray for the treatment of migraine headaches. Zavegepant is a gepant and the only medicine for migraine that comes as a nasal spray. Brings migraine pain relief within 15 minutes to 2 hours after taking a single dose. The medicine continues to work for up to 48 hours. You can also improve other symptoms related to migraine, such as nausea and sensitivity to light and sound.

The common side effects of zavegepant include a change in the sense of taste, nasal discomfort, and irritation of the throat.

Some of these medications are not safe to take during pregnancy. If you are pregnant or trying to become pregnant, do not use any of these medicines without first talking with your health care provider.

Preventive medications

Medicines can help prevent frequent migraines. Your health care provider may recommend preventive medications if you have frequent, long-lasting or severe headaches that do not respond well to treatment.

Preventive medication is intended to reduce the frequency with which you have a migraine headache, the severity of the attacks are and how long they last. The options include:

  • Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, InnoPran), Hemangeol) and metoprolol (Lopressor). Calcium channel blockers such as verapamil (Verelan, Calan) may be useful in the prevention of migraines with aura.
  • Antidepressants. A tricyclic antidepressant, amitriptyline, can prevent migraine headaches. Due to the side effects of amitriptyline, such as sleepiness, other antidepressants may be prescribed in its place.
  • Anti-seizure drugs. Valproate and topiramate (Topamax, Qudexy, others) may help if you have a less frequent migraines, but they can cause side effects such as dizziness, weight changes, nausea, and more. These medications are not recommended for women who are pregnant or trying to become pregnant.
  • Injections of Botox. Injection of onabotulinumtoxinA (Botox) every 12 weeks to help prevent migraines in some adults.
  • Calcitonin gene-related peptides (CGRP) monoclonal antibodies. Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti) are the new drugs approved by the Food and Drug Administration to treat migraine headaches. It gives them a monthly or quarterly basis by injection. The most common side effect is a reaction at the site of the injection.
  • Atogepant (Qulipta). This medication is a gepant which helps to prevent migraines. It is a tablet that is taken orally on a daily basis. The possible side effects of the medicine include nausea, constipation and fatigue.
  • Rimegepant (Nurtec ODT). This medicine is unique in that it is a gepant which helps to prevent migraines, in addition to the treatment of migraine headaches, as needed.

Ask your doctor if these medications are right for you. Some of these medications are not safe to take during pregnancy. If you are pregnant or trying to become pregnant, do not use any of these medicines without first talking with your provider.

Lifestyle and home remedies

When the symptoms of migraine headaches start, try going to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cold cloth or an ice bag wrapped in a towel or cloth on the forehead and drink a lot of water.

These practices can also relieve the pain of migraine headaches:

  • Try relaxation techniques. Biofeedback and other forms of relaxation training to teach you ways to deal with situations of stress, which can help to reduce the number of migraines you have.
  • Develop a sleep and feeding routine. Do not sleep too much or too little. Establish and follow a consistent sleep and wake schedules on a daily basis. Try to eat at the same time each day.
  • Drink plenty of fluids. Stay hydrated, especially with the water, it could help.
  • Keep a pain diary. The recording of their symptoms in a headache diary will help you learn more about what triggers your migraines and what treatment is most effective. It will also help your doctor to diagnose your condition and follow your progress between visits.
  • Exercise regularly.Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose an aerobic activity that you enjoy, such as walking, swimming, and biking. Hot little by little, however, due to the sudden, intense exercise can cause headaches. Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is considered to be a factor in migraines.

Exercise regularly. Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose an aerobic activity that you enjoy, such as walking, swimming, and biking. Hot little by little, however, due to the sudden, intense exercise can cause headaches.

Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is considered to be a factor in migraines.

Alternative medicine

Non-traditional therapies can help with the pain of chronic migraine.

  • Acupuncture. Clinical trials have found that acupuncture may be useful for headache. In this treatment, a doctor inserts thin disposable needles into different areas of the skin at defined points.
  • Biofeedback. Biofeedback appears to be effective in the relief of migraine pain. This relaxation technique uses special equipment to teach how to monitor and control certain physical responses related to stress, such as muscle tension.
  • Cognitive-behavioral therapy. Cognitive-behavioral therapy may benefit some people with migraine. This type of psychotherapy teaches you how to the behaviors and thoughts affect how pain is perceived.
  • Meditation and yoga. Meditation can relieve stress, which is a trigger of migraine headaches. Done on a regular basis, yoga can reduce the frequency and duration of migraines.
  • Herbs, vitamins, and minerals.There is some evidence that the herbs feverfew and butterbur can prevent migraine headaches or reduce their severity, despite the fact that the results of the study are mixed. The butterbur, is not recommended due to safety concerns. A high dose of riboflavin (vitamin B-2) can reduce the frequency and severity of headaches. Coenzyme Q10 supplements may decrease the frequency of migraines, but larger studies are needed. Magnesium supplements have been used for the treatment of migraine headaches, but with mixed results.

Herbs, vitamins, and minerals. There is some evidence that the herbs feverfew and butterbur can prevent migraine headaches or reduce their severity, despite the fact that the results of the study are mixed. The butterbur, is not recommended due to safety concerns.

A high dose of riboflavin (vitamin B-2) can reduce the frequency and severity of headaches. Coenzyme Q10 supplements may decrease the frequency of migraines, but larger studies are needed.

Magnesium supplements have been used for the treatment of migraine headaches, but with mixed results.

Ask your health care provider if these treatments are right for you. If you are pregnant, do not use any of these treatments without consulting first with your doctor.

Preparing for your appointment

Probably first see a primary care provider, who may refer you to a provider trained in the evaluation and treatment of headache, called a neurologist.

Here's some information to help you prepare for your appointment.

What you can do

  • Keep track of your symptoms. Keep a pain diary, a written description of each one of the incidents of visual disturbances or unusual sensations, including when they occurred, how long they lasted and what caused them. A headache diary can help diagnose your condition.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you take, including over-dose. It is particularly important to make a list of all medicines that you have used to treat their headaches.
  • Write questions to ask their health care provider.

Have a friend or family member, if possible, to help you remember the information that you receive.

For migraines, questions to ask your care provider include:

  • What is likely causing my migraines?
  • There are other possible causes of my symptoms of migraine headaches?
  • What tests do I need?
  • Are my migraines likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • What changes in lifestyle or diet do you suggest to do?
  • I have these other health conditions. How can I best manage them together?
  • There are printed materials that you can give me? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask a series of questions, including:

  • What is the frequency of your headaches occur?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does anyone else in your family suffer from migraines?
Symptoms and treatment of Migraine