Migraine is one of the most common neurological disorders where patients experience episodes of one or more moderate-to-severe headaches over a period of 4 to 72 hours.1 These headaches are commonly felt on one side of the head and generally have four distinguishable phases.
Although migraines often happen for no discernable reason, many people who have migraines have triggers for these headaches, such as strong lights or loud noises. A migraine’s repetitive, intense headaches can absolutely stall or derail your day, affecting your professional and personal lives.
However, learning more about migraines, your personal triggers, and effective medication for them can give you the tools you need to better manage your symptoms.
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What Is the Difference Between a Headache and a Migraine?
While headaches and migraines share similarities, there are several key differences. The key difference between a headache and a migraine is that migraines are a complex condition that includes headaches as a symptom.2 Headaches generally can happen with or without any accompanying disorder and manifest in different forms, like tension headaches and cluster headaches.3,4
Compared to regular headaches, migraines are much more painful and debilitating (though some headaches, such as cluster headaches, tend to be as painful as migraines and are often confused with them). Regular headaches are also less likely to be sharply localized to one side of the head, like migraines. While noise and light can exacerbate a regular headache, people experiencing a migraine are much more likely to experience this sensitivity.
Symptoms of a Migraine
While pain is the first thing that comes to mind when thinking about migraines, there are several other key symptoms.1,2 Not all people who live with migraines experience all of them, as there are several subtypes of migraines, each with its own distinct set of symptoms. In addition, symptoms change during the phases of a migraine episode.
Symptoms of a migraine include:
- Throbbing moderate-to-severe head pain that lasts between 4 and 72 hours
- Pain that is often focused on one part or side of the head
- Visual or sensory disturbances called auras
- Nausea and vomiting
- Light and sound sensitivity
- Motor weakness
- Impaired consciousness
Phases of a Migraine
If you experience migraines, you may have noticed that your symptoms change throughout the course of the migraine episode.5 Migraine sessions can be divided into four main phases: prodrome, aura, headache, and postdrome.
Prodrome: The prodrome phase is the first stage of a migraine episode — almost serving as a warning sign. Most — but not all — people living with migraines experience a prodromal phase before their headache that can last up to 48 hours. During the prodrome phase, you may experience mood or energy changes, yawning, sensitivity to light, neck pain or stiffness, food cravings, or constipation.
Aura: Some forms of migraine come with auras — sensory phenomena that happen before or during the headache. Visual auras often look like areas of vision that blur out and are often surrounded by a bright jagged border. Some people also experience other kinds of sensory auras, like sound or smell. In addition, many patients feel tingling sensations called paresthesia that usually occur on one side of the face or body.
Headache: The headache phase is the most painful phase of the migraine and is characterized by throbbing or pulsing pain that usually affects one side or area of the head. The pain usually escalates in the first few hours and can sometimes last for days. The headache phase is often accompanied by nausea and vomiting. Symptoms are usually exacerbated by bright lights and loud noises. Accordingly, people experiencing this phase of a migraine generally seek out dark, quiet environments to ride out their headache phases when possible.
Postdrome: The postdrome phase begins when the headache subsides. In this immediate post-headache period, some pain in the area may persist when moving the head. During the postdrome phase, patients often feel exhausted and have a hard time focusing on things. Some people feel dizziness, while others feel elation.
What Are the Different Kinds of Migraines?
Migraines are a complex set of disorders that can be divided into two categories — resistant and refractory.5 Learn more about the different ways in which migraines are categorized.
Resistant Migraines
Resistant migraines don’t respond to three or more classes of migraine drugs. Patients with resistant migraines experience at least eight days with moderate-to-severe headaches per month for three months in a row.
Refractory Migraines
Refractory migraines do not improve when treated with all major classes of migraine medications. Patients with refractory migraines suffer from at least eight headache days per month for at least six months in a row.
Within these broad divisions are several different subtypes of migraines.1,2 Each is defined by its particular set of symptoms, the frequency of these symptoms, and their severity.
Migraine without aura: Exhibit all of the phases of a migraine but lack the aura phase. Migraines without auras otherwise follow the same symptoms of migraines with auras.
Migraine with aura: Have all the phases of migraines without auras, except in addition, they include auras that manifest as visual, sensory, and sometimes motor disturbances.
Chronic migraine: Migraine where a person has headaches 15 days out of the month. These must persist for at least three months. Out of these 15 days per month, the full spectrum of migraine symptoms must be present for eight days per month.
Complications of migraine: Conditions resulting from or caused by migraines. These include status migrainosus, seizures, stroke, and transient ischemic attack.
Probable migraine: When a person has many, but not all, of the key symptoms of migraines. Importantly, these symptoms must not be able to be associated with another class of headaches.
Episodic syndromes that may be associated with migraine: There are several syndromes that occur in recurrent episodes alongside migraines. These include gastrointestinal issues, vertigo, or paroxysmal torticollis, a condition where a person’s head consistently tilts to one side.
What Causes Migraines?
The root cause of migraines is not entirely understood and varies from person to person and subtype to subtype.1,2,7 However, research has identified changes in the brain that are tied to migraines. Cells in the brain communicate through electrical signals that are very tightly regulated. During a migraine, these signals change and become irregular, spreading throughout the brain.
A key chemical in the brain that is tied to these changes is serotonin, often associated with moods.8 Amid this altered activity, the blood vessels in the brain dilate, or expand. This can trigger inflammation and act on nerves that transmit pain to the brain. Migraines can also be caused by increased pressure inside the skull, either as a symptom of conditions like hypertension or on its own.9
Are Migraines Genetic?
While not all people living with migraines have a family history of the disorder, migraines are highly inheritable.10 People with a relative who has migraines are three times more likely to experience them themselves. However, there are many genes related to migraines, so predicting whether a given person will develop migraines based on their relatives is difficult.
Can Other Conditions Cause Migraines?
Several other conditions can cause symptoms of migraines.1,2 These include diseases such as meningitis, encephalitis, and intracranial hemorrhage. Some of these conditions can be life-threatening, so it’s important to have your migraines diagnosed by a medical professional.
Migraine Triggers
Although migraines can happen out of nowhere, they are often triggered by certain external and internal factors.1,2,5 There are several things that can trigger a migraine, which vary widely from person to person. By identifying one’s triggers, a person with migraines can make lifestyle changes to reduce the incidence of their headaches.
Common triggers for migraines include:
Hormones: Hormonal changes are a frequent trigger for migraines, particularly those tied to a person’s menstrual cycle. Migraines related to the menstrual cycle usually begin in the first 2 to 3 days before or after the start of a period.
Emotions: Strong emotions can trigger a migraine episode, whether they are positive or negative. For example, stress, anxiety, anger, depression, and tension are tied to migraines. Conversely, excitement and stark positive mood swings are triggers for some people.
Physical activity: Migraines can be triggered by changes in physical activity. Intense exercise or hard physical labor are potent triggers, but some people experience migraines after they have a period of reduced physical activity.
Sleep: Poor sleep is strongly tied to migraines. Accordingly, they are often triggered by sleep issues caused by shift work and insomnia.
Diet: A person’s diet can greatly impact their migraine episodes. For example, missing meals or extreme dieting can initiate a migraine in some people. This often happens as a result of low blood sugar.
Intake of specific foods and substances also affects migraine frequency and intensity. For example, some people’s symptoms are worsened by alcohol and caffeine, while others find that foods with the amino acid tyramine trigger their episodes. Tyramine is predominantly found in cured foods like bacon, salami, smoked or pickled fish, and certain kinds of sausage. In addition, specific kinds of cheeses are high in tyramine and can cause migraines for some people.
Strong smells: Many people with migraines find that particularly strong smells can trigger an episode. While any strong smell can do it, many find that a particular smell is a trigger.
Bright lights: In addition to worsening migraine headaches while they happen, bright lights frequently kick off episodes for some people.
Loud noises: Much like bright lights, loud noises both worsen and trigger migraine episodes.
Temperature and humidity changes: Some patients find that changes in the weather can cause migraines, particularly changes in temperature or humidity.
Smoking: Smoking, both firsthand and secondhand, causes migraines for some people.
Medications: Certain medications can trigger migraine episodes, such as sleeping pills and other drugs that affect female reproductive hormones. In particular, birth control and hormone replacement therapy are common causes for many people.
Prevalence of Migraines
Research indicates that approximately 1.1 billion people worldwide suffer from various forms of migraines, making it a very common disorder.
Migraines tend to concentrate within certain groups. For example, women are roughly 3 times more likely to be affected by migraine than men, likely because of the role of hormonal changes as a trigger. In addition, though people of any age may develop migraines, they tend to develop in individuals before age 45.5
There are geographical differences in migraine rates as well.6 In 2019, Belgium and Italy ranked highest for proportion of people living with migraines, while Djibouti and Ethiopia had the fewest percentage of people with migraines.
Diagnosing Migraines
Migraines are diagnosed with a medical history.1,2 Your doctor will ask you several questions related to your symptoms, the timeline of your symptoms, and what events precede them.
Sometimes, migraines can indicate the presence of other disorders. If your doctor suspects other conditions, they will use imaging techniques like magnetic resonance imaging (MRI) and computerized tomography (CT) scans to check for changes in the brain.
Migraine Treatments
There are several different treatments for migraines that fall into one of two major classes: acute (abortive) or prophylactic (preventive).5,11,12 Acute treatments are intended to stop a current migraine or prevent it from worsening in severity. In contrast, preventive treatments help reduce how often migraines occur and lessen their overall impact when they do.
Complications and Risks of Migraines
Migraines come with several complications and risks:1,2,5 A key complication is status migrainosus, a migraine that lasts for more than 72 hours. In addition, for people who have epilepsy, severe migraines can trigger seizures.7
Perhaps the most significant complication of migraines is how they affect your life. It is nearly impossible to get anything done in the midst of a throbbing, debilitating headache. Moreover, light and sound sensitivity issues make it hard to try to “brute-force” your way through the pain. As a result, migraines cause those who live with them to call in sick to work, miss events with friends and family, and struggle to do daily chores like cooking and cleaning.13,14
Because of these difficulties of carrying out activities of everyday life, people with migraines can be negatively affected, both financially and emotionally. Up to one-third of people with migraines report worrying about how their symptoms affect their family’s finances. In addition, people who live with migraines suffer higher rates of anxiety and depression that are linked to the intensity of their symptoms.15 One study of 2,981 patients found that nearly a third experienced depression or anxiety, and a quarter experienced both.
Most distressingly, migraine is associated with a higher risk for suicide, in large part related to the link between migraine and depression.5
Resources
If you or someone you love experiences migraines, there are resources available that can help you learn more about the condition and provide strategies to help manage the symptoms. With medical care and lifestyle adjustments, you may be able to reduce the frequency and severity of migraine episodes.
