What is a Migraine?
A migraine is a headache that could cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It is often followed by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks could last for hours to days, and the pain can be so severe that it interferes with your daily activities.
For some people, a warning symptom called an aura occurs before or with the headache. An aura could include visual disturbances, like flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
Medications could help prevent some migraines and make them less painful. The correct medicines, combined with self-help remedies and lifestyle changes, may help.
Migraines, which affect children and teenagers as well as adults, could progress through four stages: prodrome, aura, attack, and post-drome. Not everyone who has migraines goes through all the stages.
A day or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:
- Mood changes, from depression to euphoria
- Food cravings
- Neck stiffness
- Increased urination
- Fluid retention
- Frequent yawning
For some people, an aura may occur before or during migraines. Auras act as reversible symptoms of the nervous system. They are usually visual but could also include other disturbances. Each symptom usually begins slowly, builds up over several minutes, and can last up to sixty minutes.
Examples of migraine auras are:
- Visual phenomena, like seeing various shapes, bright spots, or flashes of light
- Vision loss
- Pins and needles sensations in an arm and leg
- Weakness or numbness of the face or on either side of the body
- Difficulty speaking
A migraine generally lasts for 4 to 72 hours if untreated. How often migraines occur differs from person to person. Migraines might happen rarely or strike several times a month.
During a migraine, you may have:
- Pain generally on one side of your head, but often on both sides
- Pain that throbs or pulses
- Sensitivity to light, sound, and at times smell and touch
- Nausea and vomiting
After a migraine attack, you may feel exhausted, confused, and washed out for up to a day. Some people report feeling thrilled. Sudden head movement may bring on the pain again briefly.
When should you see a doctor?
Migraines are usually undiagnosed and untreated. If you regularly experience signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then schedule an appointment with your doctor to discuss your headaches.
Even if you have a history of headaches, consult your doctor if the pattern changes 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 severe medical problem:
- An abrupt, severe headache such as a thunderclap
- Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which can be a sign of a stroke
- Headache after a head injury
- A chronic headache that is worse after coughing, exertion, straining, or an unexpected movement
- New headache pain after age fifty
Though migraine causes are not completely understood, genetics and environmental factors appear to play a role.
Changes in the brainstem and its interactions with the trigeminal nerve, an important pain pathway, may be involved. So, may imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.
Researchers are investigating the role serotonin has in migraines. Other neurotransmitters play a part in the pain of migraine, including calcitonin gene-related peptide (CGRP).
There are a few migraine triggers, including:
- Hormonal changes in women - Fluctuations in estrogen, like before or during menstrual periods, pregnancy, and menopause, seem to trigger headaches in many women.
Hormonal medications, like oral contraceptives, also can worsen migraines. Some women, however, find that their migraines happen less often when taking these medications.
- Drinks - These include alcohol, especially wine, and too much caffeine, like coffee.
- Stress - Stress at work or home could cause migraines.
- Sensory stimuli - Bright or flashing lights could induce migraines, as can loud sounds. Strong smells — like perfume, paint thinner, secondhand smoke, and others — trigger migraines in some people.
- Sleep changes - Missing sleep or getting too much sleep could trigger migraines in some people.
- Physical factors - Intense physical exertion, including sexual activity, may provoke migraines.
- Weather changes - A change of weather or barometric pressure could prompt a migraine.
- Medications - Oral contraceptives and vasodilators, like nitroglycerin, can aggravate migraines.
- Foods - Aged cheeses and salty and processed foods may trigger migraines. So may skipping meals.
- Food additives - These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in various foods.
Migraine Risk factors
Various factors make you more prone to having migraines, including:
- Family history - If you have a family member who has migraines, then you have a good chance of developing them too.
- Age - Migraines could begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s and slowly become less severe and less frequent in the following decades.
- Sex - Women are three times as likely as men to get migraines.
- Hormonal changes - For women who have migraines, headaches may begin just before or shortly after the onset of menstruation. They can also change in pregnancy and menopause. Migraines usually improve after menopause.
Taking painkillers too often can trigger severe medication-overuse headaches. The risk seems to be greatest with aspirin, acetaminophen, and caffeine combinations. Overuse headaches might also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than fourteen days a month or triptans, sumatriptan (Imitrex, Tosymra), or rizatriptan (Maxalt, Maxalt-MLT) for more than 9 days a month.
Medication-overuse headaches happen when medications stop relieving pain and start to cause headaches. You then use more pain medication, which keeps the cycle going.
If you have migraines or a family history of migraines, a doctor trained in treating headaches will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological exam.
If your condition is unusual, complex, or suddenly becomes severe, tests to rule out other causes for your pain may include:
- Magnetic resonance imaging (MRI) - An MRI scan uses a powerful magnetic field and radio waves to produce detailed pictures of the brain and blood vessels. MRI scans help doctors diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) problems.
- Computerized tomography (CT) scan - A CT scan uses a series of X-rays to create detailed cross-sectional pictures of the brain. This helps doctors diagnose tumors, infections, brain damage, bleeding in the brain, and other possible medical problems that might be causing headaches.
Migraine treatment is designed for stopping symptoms and preventing future attacks.
Many medications have been aimed to treat migraines. Medications used to combat migraines fall into 2 broad categories:
- Pain-relieving medications - Also called acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
- Preventive medications - These types of drugs are taken every day, often daily, to reduce the severity or frequency of migraines.
Your treatment choices depend upon the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
Medications for relief
Medications used to ease migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that could be used to treat it include:
- Pain relievers - These over-the-counter or prescription pain relievers are aspirin or ibuprofen (Advil, Motrin IB, and others). When taken too long, these may cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.
Migraine relief medications that combine caffeine, aspirin, and acetaminophen (Excedrin Migraine) might be helpful, but usually only against mild migraine pain.
- Triptans - Prescription drugs like sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots, or nasal sprays, they could relieve many symptoms of migraine. They may not be safe for those at risk of a stroke or heart attack.
- Dihydroergotamine (D.H.E. 45, Migranal) - Available as a nasal spray or injection, this drug is most effective when taken shortly after the beginning of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects could include worsening of migraine-related vomiting and nausea.
People with coronary artery disease, high blood pressure, or kidney or liver disease should stay away from dihydroergotamine.
- Lasmiditan (Reyvow) - This newer oral tablet is authorized for the treatment of migraine with or without aura. In the drug trials, lasmiditan significantly improved headache pain. Lasmiditan could have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours.
- Ubrogepant (Ubrelvy) - This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without the aura in adults. It is the first drug of this type approved for migraine treatment. In the drug trials, ubrogepant was more effective than placebo in relieving pain and other migraine symptoms like nausea and sensitivity to light and sound two hours after taking it. Common side effects are dry mouth, nausea, and excessive sleepiness. Ubrogepant shouldn’t be taken with strong CYP3A4 inhibitor drugs.
- CGRP antagonists - Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral CGRP antagonists recently approved for the treatment of acute migraine with or the without aura in adults. In the drug trials, drugs from this class were more effective than placebo in relieving pain and other migraine symptoms like nausea and sensitivity to light and sound two hours after taking it. Common side effects are dry mouth, nausea, and excessive sleepiness. Ubrogepant and rimegepant shouldn’t be taken with strong CYP3A4 inhibitor drugs.
- Opioid medications - For people who cannot take other migraine medications, narcotic opioid medications might help. Because they could be highly addictive, these are usually used only if no other treatments are effective.
- Anti-nausea drugs - These could help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs are chlorpromazine, metoclopramide (Reglan), or prochlorperazine (Compro). These are generally taken with pain medications.
Some of these medications aren’t safe to take during pregnancy. If you are pregnant or trying to get pregnant, do not use any of these medications without first talking with your doctor.
Medications could help prevent frequent migraines. Your doctor may recommend preventive medications if you have frequent, long-lasting, or severe headaches that do not respond well to treatment.
Preventive medication is aimed at reducing how often you get a migraine; how serious the attacks are and how long they last. Options are:
- Blood pressure-lowering medications - These include beta-blockers like propranolol (Inderal, InnoPran XL, others), and metoprolol tartrate (Lopressor). Calcium channel blockers like verapamil (Verelan) can be helpful in preventing migraines with aura.
- Antidepressants - A tricyclic antidepressant (amitriptyline) could prevent migraines. Because of the side effects of amitriptyline, like sleepiness, other antidepressants may be prescribed instead.
- Anti-seizure drugs - Valproate and topiramate (Topamax, Qudexy XR, others) may help if you have less frequent migraines but can cause side effects like dizziness, weight changes, nausea, and more. These medications aren’t recommended for pregnant women or women trying to get pregnant.
- Botox injections - Injections of onabotulinumtoxinA (Botox) about every twelve weeks help prevent migraines in some adults.
- CGRP monoclonal antibodies - Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti) are new drugs approved by the Food and Drug Administration to treat migraines. They are given monthly or quarterly by injection. The most common side effect is a reaction in the injection area.
Ask your doctor if these medications are correct for you. Some of these medications aren’t safe to take during pregnancy. If you are pregnant or trying to get pregnant, do not use any of these medications without first talking with your doctor.
If you or anyone you know is suffering from migraine, our expert providers at Vegas Health will take care of your health and help you recover.
Call us at (701)-551-5212 to book an appointment with our specialists.