Everything you need to know about migraine
Migraine is a medical condition that involves severe, recurring headaches, and other symptoms. Before the headache, there may be sensory changes that are known as an aura.
A migraine episode is different from a headache. It usually occurs in stages and can last for several days. It can affect a person’s daily life, including their ability to work or study.
How migraine affects people can also vary. Triggers, severity, symptoms, and frequency can all be different. 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 or a severe headache within the last 3 months.
Figures from 2015 found that migraine affects just over 19% of females and 9% of males. Episodes often occur from the ages of 18 to 44 years, but they can happen at any time, including in childhood.
Causes and triggers
Experts do not know what causes migraines.
Possible causes include changes in the brain that affect:
- the way nerves communicate
- the balance of chemicals
- the blood vessels
Genetic features may play a role as having a family history of migraine is a common risk factor.
Migraine triggers vary but include:
- Hormonal changes, for example, around menstruation.
- Emotional triggers, such as stress, depression, anxiety, excitement, and shock.
- Physical causes that can include tiredness, lack of sleep, shoulder or neck tension, poor posture, physical overexertion, low blood sugar, jet lag, irregular mealtimes, and dehydration.
- Dietary factors, including alcohol, caffeine, chocolate, cheese, citrus fruits, and foods containing the additive tyramine.
- 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, stuffy rooms, temperature changes, and bright lights.
A person may be more likely to experience migraine if they have:
- bipolar disorder
- irritable bowel syndrome (IBS)
- an overactive bladder
- sleep disorders
- obsessive-compulsive disorder
There is no cure for migraine, but treatment may reduce the frequency and severity of attacks and help relieve symptoms.
A migraine attack often occurs in response to a trigger. Identifying and avoiding triggers can help reduce the chances of an episode starting. Keeping a diary can help identify triggers.
Lifestyle changes that might help reduce the frequency of migraines include:
- getting enough sleep
- reducing stress
- drinking plenty of water
- avoiding certain foods
- regular physical exercise
If these changes do not relieve the severity or frequency of migraine episodes, a doctor may suggest medication or other options.
Pain relief and other types of medication can often help treat a migraine. Taking medication as soon as symptoms start may help prevent symptoms from becoming severe.
Over-the-counter (OTC) pain relief medications that may help include:
Other options include:
- triptans, such as sumatriptan, to help reverse the brain changes that cause migraine
- antiemetics to manage nausea and vomiting
- gepants that blocks the inflammatory factor CGRP
A medication overuse headache, or rebound headache, can occur after frequent use of as-needed medications.
Medication to prevent episodes
The following prescription drugs may help reduce migraine episodes in people with severe symptoms:
- topiramate, an antiseizure drug
- propanolol for treating high blood pressure
- antidepressant medications
- CGRP preventive treatments
It may take several weeks to see an improvement.
Treatment for children may be different from those for adults. A doctor can advise on the best option.
Home and natural remedies
Some home remedies that can help relieve the symptoms of migraine include:
- using flexible cold packs, hat, or mask for headache relief
- staying in a quiet, darkened room
- sleeping when necessary
The following supplements might help prevent migraine, although there is limited evidence that they work:
- herbal extracts, such as feverfew
- coenzyme 10
Other nondrug remedies may include acupuncture and neck exercises or physical therapy.
Before using any of these treatments, people should speak to a doctor. Research has not proven beyond doubt that these remedies work.
It is always sensible to find a qualified and experienced professional to provide alternative therapy.
Various products that may or may not help relieve migraine are available for purchase online.
What natural remedies are there for a headache?
There are various types of migraine. The main distinguishing factor is whether they involve an aura or not.
Migraine with aura
An aura is a disturbance of the senses in the early stages of an episode. The aura can act as a warning that a migraine headache is approaching.
An aura can involve:
- confusing thoughts or experiences
- the perception of strange, sparkling, or flashing lights
- zig-zagging lines in the visual field
- blind spots or blank patches in the vision
- pins and needles in an arm or leg
- difficulty speaking
- weakness in the shoulders, neck, or limbs
Visual disturbances can involve:
- seeing things that are not there, such as transparent strings of objects
- not seeing part of an object in clear view
- feeling as if part of the field of vision appears, disappears, and reappears
An aura may feel similar to the sensation that follows exposure to a very bright camera flash.
Migraine without aura
More commonly, a person will not experience any sensory disturbances before a migraine.
According to the Migraine Trust, 70–90% of migraines occur without an aura.
Other types of migraine relate to specific syndromes or triggers. They include:
- Chronic migraine: Any migraine that triggers attacks on more than 15 days of the month.
- Menstrual migraine: The attacks follow a pattern that appears to link to the menstrual cycle.
- Hemiplegic migraine: This type causes temporary weakness on one side of the body.
- Abdominal migraine: This syndrome connects migraine attacks to irregular function in the gut and abdomen. It mainly affects children under 14 years of age.
- Vestibular migraine: Vertigo is a symptom of this form of migraine.
- Basilar migraine: This rare type of migraine is now also known as migraine with brainstem aura and can affect neurological functions, such as a person’s speech.
A person can speak to a doctor if they experience headaches that appear to have a migraine pattern.
Symptoms of migraine tend to occur in stages:
Before the headache: According to older research, around 20–60% of people experience symptoms that start hours or possibly days before the headache. These include both physical and sensory symptoms, such as aura.
During the headache: Alongside a mild to severe throbbing or pulsing headache, symptoms may include nausea, vomiting, and nasal congestion.
Resolution: Tiredness and irritability may last another 2 days, sometimes called the “migraine hangover.”
Other common features are:
- head pain that worsens during physical activity or straining
- an inability to perform regular activities due to pain
- increased sensitivity to light and sound that lying quietly in a darkened room relieves
Other symptoms may include sweating, temperature changes, stomach ache, and diarrhea.
Migraine vs. headache
A migraine episode is different from a headache. The experience is different, and they have different causes.
A diary of symptoms can help identify a migraine. Keep the journal for at least 8 weeks, and record the following.
- the time of onset
- possible triggers, such as relations to stress or menstruation
- the nature of the headache
- any other symptoms
- how long specific symptoms last
- any noticeable signs or auras
- any medications used and the effect they had
The International Headache Society recommend the “5, 4, 3, 2, 1” criteria to diagnose migraine without aura.
This number series stands for:
- 5 or more attacks with a duration of 4 hours to 3 days.
- At least two of the following qualities: Occurring on one side of the head, a pulsating, moderate-to-severe pain aggravated by routine physical activity.
- At least one additional symptom, such as nausea, vomiting, sensitivity to light, or sensitivity to sound.
Keeping a diary can help a person explain their symptoms to their doctor.
The doctor may recommend imaging or other tests to exclude different causes of symptoms, such as a tumor.
Knowing how to distinguish a migraine from other types of headache can help people find suitable treatment.
When to see a doctor
A person should see a doctor if they experience:
- episodes after not having migraine before
- worsening or unusual symptoms
- severe symptoms affecting their ability to do regular tasks
If the following symptoms occur, the person should seek immediate medical help:
- an unusually severe headache
- visual disturbance
- loss of sensation
- difficulty speaking
These could indicate another condition that may need urgent attention, such as a stroke.
Migraine is a medical condition that involves a headache, but it is not only a headache. It can have a significant impact on an individual’s life, making it difficult to work or carry out regular tasks.
Identifying triggers can often help avoid or reduce the frequency of attacks, although it is not always possible to prevent them.
Medication and other treatments can help manage migraine and its symptoms. Anyone who has concerns about migraine symptoms should see a doctor.