A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.
Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, usually vision disturbances, that serve as a warning sign that a bad headache is coming. Most people, however, do not have such warning signs.
A lot of people get migraines -- about 11 out of 100. The headaches tend to first appear between the ages of 10 and 46. Occasionally, migraines may occur later in life in a person with no history of such headaches. Migraines occur more often in women than men, and may run in families. Women may have fewer migraines when they are pregnant. Most women with such headaches have fewer attacks during the last two trimesters of pregnancy.
A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. However, the exact chain of events remains unclear.
Scientists used to believe that migraines were due to changes in blood vessels within the brain. Today, most medical experts believe the attack actually begins in the brain itself, where it involves various nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.
Migraine attacks may be triggered by:
Alcohol
Allergic reactions
Bright lights
Certain odors or perfumes
Changes in hormone levels (which can occur during a woman's menstrual cycle or with the use of birth control pills)
Changes in sleep patterns
Exercise
Loud noises
Missed meals
Physical or emotional stress
Smoking or exposure to smoke
Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include:
Any processed, fermented, pickled, or marinated foods
Baked goods
Chocolate
Dairy products
Foods containing monosodium glutamate (MSG)
Foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans
Fruits (avocado, banana, citrus fruit)
Meats containing nitrates (bacon, hot dogs, salami, cured meats)
Nuts
Onions
Peanut butter
This list may not be all-inclusive.
True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.
Symptoms:
Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any of all of the following:
A temporary blind spot
Blurred vision
Eye pain
Seeing stars or zigzag lines
Tunnel vision
Not every person with migraines has an aura. Those who do usually develop one about 10-15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand.
Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:
Feel throbbing, pounding, or pulsating
Are worse on one side of the head
Start as a dull ache and gets worse within minutes to hours
Last 6 to 48 hours
Other symptoms that may occur with the headache include:
Chills
Increased urination
Fatigue
Loss of appetite
Nausea and vomiting
Numbness, tingling, or weakness
Problems concentrating, trouble finding words
Sensitivity to light or sound
Sweating
Symptoms that may linger even after the migraine has gone away include:
Feeling mentally dull, like your thinking is not clear or sharp
Increased need for sleep
Neck pain
Signs and tests:
Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines, and by monitoring how you respond to treatment. A complete physical exam will be done to make sure that your headaches are not due to muscle tension, sinus problems, or a more serious underlying brain disorder.
Tests are usually not needed if you have typical signs and symptoms of migraines. However, your doctor may order a brain MRI or CT scan to rule out other causes.
If you have a migraine with unusual symptoms such as weakness, memory problems, or loss of alertness, an EEG may be needed to rule out seizures. Rarely, a lumbar puncture (spinal tap) might be done.
Treatment:
There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.
A good way to identify triggers is to keep a headache diary. Write down:
When your headaches occur
How severe they are
What you've eaten
How much sleep you had
Other symptoms
Other possible factors (women should note where they are in their menstrual cycle)
For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.
When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:
Drink water to avoid dehydration, especially if you have vomited
Rest in a quiet, darkened room
Place a cool cloth on your head
Many different medications are available for people with migraines. Medicines are used to:
Reduce the number of attacks
Stop the migraine once early symptoms occur
Treat the pain and other symptoms
REDUCING ATTACKS
If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:
Antidepressants such as amitriptyline
Blood pressure medicines such as betablockers (propanolol) or calcium channel blockers (verapamil)
Seizure medication such as valproic acid and topiramate
Serotonin reuptake inhibitors (SSRIs) such as venlafaxine
STOPPING AN ATTACK
Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.
Your doctor can select from several different types of medications, including:
Triptans -- the most frequently prescribed medicines for stopping migraine attacks -- such as almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
Ergots such as dihydroergotamine or ergotamine with caffeine (Cafergot)
Isometheptene (Midrin)
These medications come different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray or injection instead of pills.
Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your healthcare provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.
TREATING SYMPTOMS
Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:
Nausea medicines such as prochlorperazine
Over-the-counter pain relieves such as acetaminophen (Tylenol)
Sedatives such as butalbital
Narcotic pain relievers such as meperidine
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.
Every person responds differently to treatment. Some people have rare headaches that require little to no treatment. Others require the use of several medications or even occasional hospitalization.
Complications:
Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.
Calling your health care provider:
Call 911 if:
You are experiencing "the worst headache of your life"
You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before
Your headaches are more severe when lying down
The headache starts very suddenly
Such headaches may be the result of stroke, bleeding in the brain, aneurysm, or other serious condition and require the immediate attention of a health care provider.
Depending on the history of the headache, a CT scan or MRI may be done to rule out any of the above conditions.
You are pregnant or could become pregnant -- some medications should not be taken when pregnant
Prevention:
Understanding your headache triggers can help you avoid foods and situations that cause your migraines. Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches.
Other tips for preventing migraines include:
Avoid smoking
Avoid alcohol
Avoid artificial sweeteners and other known food-related triggers
Get regular exercise
Get plenty of sleep each night
Learn to relax and reduce stress -- some patients have found that biofeedback and self-hypnosis helps reduce the number of migraine attacks
References:
Wilson JF. In the clinic. Migraine. Ann Intern Med. 2007: 147(9): ITC11-1-ITC11-16.
Ebell MH. Diagnosis of migraine headache. Am Fam Physician. 2006: 74(12): 2087-8.
Detsky ME, McDonald DR, et al. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006: 296(10): 1274-83.
Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. Classification of primary headaches. Neurology. 2004;63(3):427-35.
Silberstein SD, Young WB. Headache and Facial Pain. In: Goetz, CG. Textbook of Clinical Neurology. 3nd ed. St. Louis, Mo: WB Saunders; 2007: chap. 53.
Review Date: 7/27/2008 Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
