Migraine Headaches

What is a migraine headache?

This often severe, throbbing type of headache is different from other types of headaches. Symptoms other than pain can occur with a migraine headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual changes are common. A migraine headache may last from 4 to 72 hours.

Migraines are also unique in that they have distinct phases. But not all people have each phase. The phases of a migraine headache may include:

• Premonition phase. A change in mood or behavior may occur hours or days before the headache.

• Aura phase. About one-third of people who have migraine headaches describe having an unusual “feeling” or aura before the headache. The aura phase includes visual, sensory, or motor symptoms that occur just before the headache. Examples are hallucinations, numbness, changes in speech, visual changes, and muscle weakness. Migraine sufferers may or may not have an aura before the start of the headache.

• Headache phase. This is the period during the actual headache. Throbbing pain occurs on one or both sides of the head. Sensitivity to light and motion is common. So, too, are depression, fatigue, and anxiety.

• Headache resolution phase. Pain lessens during this phase. But it may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, while others do not.

Headaches are classified as with or without aura.

What causes migraine headaches?

Experts are not certain what causes a migraine headache. Many experts think an imbalance in brain chemicals, such as serotonin, and changes in nerve pathways are involved. Migraines may also run in families suggesting a genetic link. Several proteins called neuropeptides have recently been discovered to have a role in migraine. Newer medicines target the way these proteins cause headaches.

What are the symptoms of migraine headaches?

These are the most common symptoms of migraine headaches:

• Throbbing, severe headache pain with a specific location either on one side or both

• Nausea and vomiting

• Lightheadedness

• Sensitivity to light or sound

• Visual changes, such as a flashing light or even lack of sight, for a short period of time

• A change in mood or behavior hours or days before the headache

• Depression, fatigue, or anxiety

• Fatigue, irritability, and trouble concentrating as the headache goes away

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How are migraine headaches diagnosed?

Migraine headaches are diagnosed based on your symptoms and a physical exam.

Tracking and sharing information about your headache with your healthcare provider helps with the diagnosis. Write down the following:

• Time of day when your headaches occur

• Specific location of your headaches

• How your headaches feel

• How long your headaches last

• Any changes in behavior or personality

• Effect of changes in position or activities on the headache

• Effect of headaches on sleep patterns

• Level of stress in your life

• Details about any head trauma, either recently or in the past

Keeping a headache journal can help your healthcare provider form a treatment plan.

If you have unusual symptoms or the findings from your exam aren’t normal, your healthcare provider may want you to have other tests or procedures. These can rule out underlying diseases or health problems. These tests include:

• Blood tests. Various blood chemistry and other lab tests may be used to check for underlying health problems.

• Sinus X-rays. This X-ray checks for congestion or other problems linked to the headaches.

• MRI. This test uses a combination of large magnets, radio waves, and a computer to make detailed images of organs and structures.

• CT scan. This test uses X-rays and computer technology to make images of the body or head. CT scans show more detail than standard X-rays.

• Spinal tap (lumbar puncture). A special needle is placed into the lower back, into the spinal canal, which is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebrospinal fluid (CSF) can be removed and sent for testing to check if there is an infection or other problems. CSF is the fluid that surrounds the brain and spinal cord.

How are migraine headaches treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Certain medicines can help treat or prevent migraine headaches:

• Abortive medicines. These medicines are prescribed by your healthcare provider. They act on specific receptors in both the brain and the blood vessels in the head, stopping a headache once it has started.

• Rescue medicines. These are medicines purchased over-the-counter, such as pain relievers, to lessen or stop the headache.

• Preventive (prophylactic) medicines. These medicines are prescribed by your healthcare provider. They are taken regularly to stop the start of severe migraine headaches.

What are possible complications of migraine headaches?

Complications of migraine headaches may include:

• Severe headache pain, often in one part of your head, such as near one eye

• Potential nausea and vomiting

• Immobility and lack of activity because of severe pain

• Loss of work time and personal time

Can migraine headaches be prevented?

The goal of treatment is to prevent migraines from occurring. You can help do that by:

• Staying away from known triggers, such as certain foods and beverages like caffeine, lack of sleep, and fasting

• Changing eating habits

• Getting regular exercise

• Sticking to a regular sleep schedule

• Resting in a quiet, dark place

• Taking medicines, as advised by your healthcare provider

• Managing stress

• Getting therapeutic massage

• Taking prescribed medicine as directed

When should I call my healthcare provider?

Some headaches may need care right away, including going to the hospital for observation, and diagnostic testing. Call your healthcare provider right away if you have a migraine headache with:

• Stiff neck

• Fever

• Convulsion

• Shortness of breath

• Confusion

• Muscular weakness

• Double vision

• Change in level of consciousness

Key points about migraine headaches

• A migraine is a severe, throbbing type of headache.

• Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual disturbances are common migraine symptoms.

• A migraine headache may last from 4 to 72 hours.

• Preventing a migraine headache is often the most helpful approach for treatment.

• Migraine headaches can have a predictable pattern. It can help you notice and treat them appropriately.

• Many people have an aura before a migraine. Treatment may help at that time.

• Managing stress and getting regular exercise may help prevent or lessen the occurrence of migraine headaches.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.