Migraine

A migraine is a very common, but very particular, type of headache. Most people who get migraines have repeated attacks of headaches that occur over many years. The typical migraine headache is throbbing or pulsating, and often is associated with nausea and changes in vision. While many migraines are severe, not all severe headaches are migraines, and some migraines can be quite mild.

Up to 20% of people in the United States will experience migraine headaches at some point in life. Two-thirds of people who get migraines are women, probably because of the influence of hormones. Migraines also tend to run in families.

Despite years of research, scientists do not know exactly why migraines occur. The pain of migraines is associated with swelling in blood vessels and irritation of nerves that surround the brain. The brain chemical serotonin appears to play an important role in this process as it does in other conditions, including depression and eating disorders.

Symptoms

A migraine usually is a throbbing headache that occurs on one or both sides of the head. The headache typically is accompanied by nausea, vomiting or loss of appetite. Activity, bright light or loud noises can make the headache worse, so someone having a migraine often seeks out a cool, dark, quiet place. Most migraines last from 4 to 12 hours, although they can be shorter or much longer. One unique feature of migraines is an unusual sensation that a migraine is about to occur. This sensation is called a prodrome. Prodrome symptoms can include fatigue, hunger and nervousness. Migraines also have typical aftereffects, such as a feeling of exhaustion that lasts a day or two after a severe migraine headache has faded. Not all people who get migraines have prodromes or aftereffects.

Migraines can be triggered by certain activities, foods, smells or emotions. Some people are more likely to experience migraines when they are under stress, while others develop migraines when stress is relieved (for example, the day after exams or an important meeting). Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods.

Another unique feature of migraines is an aura. In a typical aura, a person suddenly will develop blurry or distorted vision or will see pulsating lights. These changes in vision will come and go over 15 to 30 minutes and alert someone that a headache is about to begin. Sometimes, auras affect the sense of hearing, smell or taste. Only some people who get migraines have auras, and they don't accompany every headache. An aura also can occur without being followed by a headache. Rarely, migraines can cause unusual neurological symptoms such as dizziness, loss of vision, passing out, numbness, weakness or tingling.

Diagnosis

A doctor usually will diagnose migraine based on your history and symptoms. In most cases, a physical and neurological examination will be entirely normal.  

There are no special tests to diagnose migraines. For example, a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain usually will be normal. However, your doctor may recommend additional testing if your headaches have features that are not typical for migraines, or you develop other worrisome symptoms. If there is any doubt about your diagnosis, your doctor also may recommend a consultation with a neurologist, a doctor specializing in illnesses of the nerves and brain.

Expected Duration

Migraine headaches can last from a few hours to a few days. A typical migraine sufferer will have several headaches each month. However, some people have only one attack in a lifetime, while others have more than three attacks per week.

Prevention

Not all migraine headaches can be prevented. However, identifying your headache triggers can help to reduce the frequency and severity of migraine attacks. Common migraine triggers include:

• Caffeine (either using too much or cutting back on regular use)
• Certain foods and beverages, including those that contain tyramine (aged cheeses and meats, fermented beverages), sulfites (preserved foods, wines) and monosodium glutamate (MSG), a common flavor enhancer).
• Stress or relief from stress
• Hormone levels (menstrual cycles, hormone-containing medication such as birth control pills or estrogen)
• Lack of sleep or disrupted sleep patterns
• Travel or changes in weather or altitude
• Overuse of pain-relieving medications

  Treatment

  How your migraines are treated will depend on the frequency and severity of attacks. People who have a headache several times per year often respond well to non-prescription pain relievers. However, other therapies should be considered when headaches are disabling enough to interfere with usual activities and pain relievers don't work well.

  There are two types of medications to treat migraines — drugs that are taken when a headache starts (called abortive medications) and drugs that are taken every day to prevent migraines (called preventive medications). The decision of whether to take a daily preventive medication or abortive medications is a personal choice. 

  Even if you avoid all possible triggers, you are still likely to experience a migraine occasionally. And many people who get migraines have frequent and severe headaches no matter how well they avoid triggers. 

  Other methods some people have used to decrease their migraine attacks include biofeedback, yoga, acupuncture, massage and regular exercise.