What is migraine?
Migraine is an inherited neurological disorder known for “migraine attacks” it causes, which are characterized by intense, throbbing headaches that worsen with movement. Sensitivity to light is the next most common symptom—with as many as 90% of people reporting it as a problem—followed by sensitivity to sound, nausea, and vomiting. For about 60% of people, the pain is confined to one side of the head and can switch from one side to the other from one migraine attack to the next. Attacks may be preceded by a visual aura (seeing flashing lights or squiggly lines or blind spots) or other neurological symptoms, like numbness, tingling, or weakness on one side of the body, mood changes, nausea, excessive yawning, or a variety of other possible symptoms. Despite headache being the most prominently recognized feature of migraine attacks, it is possible to have a migraine with no headache at all. 90% of people report being disabled during a migraine attack.
Because migraine attacks involve hyperreactivity in the brain, symptoms can affect any system in the body. In addition to the most well-known symptoms, migraine can also cause fatigue, brain fog, increased urination, ear or tooth pain, sweating, and a whole host of other, often unexpected, symptoms.
What causes migraine?
Migraine is caused by a genetic neurological disorder. Individual migraine attacks can be triggered by many different things, such as weather changes, menstruation, fluorescent lights, bright or artificial lights, certain foods, disruptions in sleep patterns, skipping meals, or drinking alcohol. What is a trigger for one person may not be a trigger for another. Someone who is sensitive to a particular trigger may not always have a migraine attack when exposed to that trigger. It is possible to have a migraine attack without exposure to any known triggers.
How does a migraine differ from a headache?
The run-of-the-mill headaches that most people experience typically have mild to moderate pain and feel like a dull pressure in the head. They are not typically accompanied by other symptoms of migraine, like sensitivity to light, sensitivity to sound, nausea, vomiting, and aura.
Are there different types of migraines?
The two primary categories of migraine are migraine with aura and migraine without aura. In migraine with aura (also called classic migraine, an outdated term), the pain is preceded by some warning sign, most commonly visual changes. In migraine without aura (once known as common migraine, which is no longer used) attacks begin without that telltale warning sign.
Forms of migraine that occur less frequently include hemiplegic migraine, basilar migraine, vestibular migraine (also known as migraine-associated vertigo or sometimes migrainous vertigo), abdominal migraine, acephalgic (headacheless) migraine and retinal migraine (also called ocular or ophthalmic migraine). Other types of migraine you may have heard before include complicated migraine and sinus migraine, but they are not officially recognized in the International Classification of Headache Disorders (ICHD) and may better reflect one of the aforementioned migraine types. Even so, we continue to learn more about the differences between migraine variants, and the ICHD is regularly updated to reflect these new insights.
What is the biggest misconception about migraine?
There are many misconceptions about migraine, but the one that has the farthest reaching impact is that there’s no effective treatment and a person just has to live with it. There is a widespread belief that any head pain is “just a headache” that can be taken care of with an over-the-counter painkiller. This makes some people believe their migraines aren’t a serious medical condition or that a doctor cannot help them. Also, because migraine is genetic, many people grew up seeing their parents or grandparents suffer through migraines without treatment and assume this is how it has to be for them as well, even though today’s medications are more effective than those available even a few years ago.
What causes a migraine attack?
Migraine is caused by a hereditary neurological disorder that causes hyperreactivity in the brain. A person who does not have this underlying disorder cannot have a migraine attack. Individual migraine attacks have many potential triggers, including weather changes, fluorescent lights, bright or artificial light (including LEDs), device and TV screens, inadequate sleep, too much sleep, foods, odors, excessive exercise, and even sex.
How do you treat migraine?
There are many different treatment options for migraine. Medications, supplements, and devices are classified into three categories, acute (or abortive), rescue and preventive.
Migraine abortives are taken at the time of a migraine attack and are most effective at the earliest possible stage of the migraine. The three main classes of abortive medications are triptans, ditans, and gepants. Triptans have been available since the 1990s, while ditans and gepants received their FDA approvals in late 2019. Older abortive medications include Migranal, DHE-45, and Midrin (which is currently only available from compounding pharmacies). Noninvasive devices first received FDA approval for abortive migraine treatment in 2013. There are multiple types with different modes of action; your doctor can help you choose the best one for you.
Rescue meds are taken when a person has an unrelenting migraine that hasn’t responded to abortives. These are often non-steroidal anti-inflammatories (NSAID), like naproxen or Toradol, and very occasionally narcotic painkillers. Antihistamines and anti-nausea or anti-anxiety medications are also sometimes used as rescue meds as they can provide pain relief for some people.
Preventive treatments aren’t taken at the time of a migraine attack, but are taken daily to keep attacks from happening at all. There are more than 100 options for preventives, including prescription medications, supplements, herbal treatments, and devices. Preventives are recommended for a variety of reasons, including for people who have: more than two migraine attacks a month; feel like their migraine attacks cause significant disruptions to their lives; use acute (abortive) treatments more than twice a week; cannot use abortive therapies for other health reasons; have an uncommon type of migraine; or want to take a preventive medication.
In 2018, the first medications developed specifically for migraine prevention became available, giving new optimism to patients worldwide. They target the protein called calcitonin gene-related peptide—or CGRP for short. Since then, abortive therapies that also target CGRP have become available.
There are numerous other migraine treatments in addition to medication, including TheraSpecs, acupuncture, massage, physical therapy, biofeedback, yoga and meditation. Lifestyle changes, like diet modification, regular aerobic exercise, sticking to a daily routine and stress management can also be of enormous benefit.
Do medications work for migraine treatment?
Yes, for most people medication can be tremendously effective in treating migraine attacks both as they occur and to keep them from happening in the first place. Some patients find success with the first medication they take, while others need to try a variety of medications before finding the right one.
When should I seek professional help for my migraines?
If you have not received an official migraine diagnosis, you should see a health care professional. This will help you find the most effective treatment and rule out any other causes for your symptoms.
If you have been diagnosed and would like to discuss options for migraine prevention, you should also see a health care professional. The best treatment for migraine is to keep it from happening in the first place, so it’s imperative to find the preventive therapies—whether medication, supplements, lifestyle changes, or devices—that are most effective for you.
You should also see a health care professional whenever you notice a change in the frequency, severity, or duration of your migraine attacks or if your symptoms change. This is to check for another disorder unrelated to migraine and also to adjust your medication appropriately.
Is there any way to prevent a migraine?
Prevention is by far the most effective approach to treating migraine and there are a variety of ways to prevent migraine attacks. Lifestyle modification is the first recommended approach to migraine prevention. This can include diet modification, regular aerobic exercise, sticking to a daily routine, yoga, meditation, and stress management.
There are also more than 100 different possible migraine preventive medications, several non-invasive devices, and a wide range of non-pharmaceutical treatments (like magnesium, butterbur and riboflavin). In addition, TheraSpecs precision-tinted eyewear can prevent light-triggered migraines, especially for those sensitive to fluorescent lighting, bright lights, device and TV screens, sunshine or glare.
What should I do once I have a migraine?
As soon as you know a migraine is coming on, you should take your abortive medication immediately. Early in the migraine attack is when it is most effective. You should get to a safe place—don’t drive if you have a visual aura—and then do whatever you need to do to take care of yourself. Most people prefer to be in a dark, quiet room during a migraine and usually try to sleep. If a dark room isn’t an option, TheraSpecs can help with the light sensitivity while a pair of earplugs help with noise. Some find relief from putting an ice pack on their foreheads and others benefit from taking a hot shower.
Does migraine affect people at a certain age? Do men or women have them more frequently?
Migraine is most common in adults between the ages of 25 and 55. However, it can still affect children and teenagers as well as older individuals. In America, about 18% of women and 6% of men have migraine.
Are there alternative treatments for migraine?
There are numerous alternative treatments for migraine. In clinical trials, acupuncture and biofeedback have both shown to be effective treatments, and the benefits of yoga and meditation are also supported by research. Massage, craniosacral therapy (a specific type of massage), aromatherapy and dietary changes can also be effective. Studies show that precision-tinted TheraSpecs are effective for preventing light-triggered and soothing light-aggravated migraines. Supplements, such as magnesium, riboflavin and butterbur, are also beneficial for some people with migraine. Read more about some of these natural migraine remedies here.
Will I outgrow migraine?
Some people do outgrow migraine, others do not. After menopause, about a third of women experience a drastic reduction of their migraines and some women’s migraines stop altogether. However, research shows that migraine attacks tend to worsen in perimenopause and menopause. Men in their 50s and 60s also often have a decrease in or cessation of their migraines. Researchers hypothesize that for both sexes, the reduction in hormone fluctuation associated with aging are responsible for the decrease in migraines.
What are some migraine triggers?
There are many different possible migraine triggers and they vary from person to person. Someone who is sensitive to a particular trigger may not always have a migraine attack when exposed to that trigger. It is also possible to have a migraine attack without exposure to any known triggers.
Food triggers get the most attention in the media, but many people can identify no food triggers at all. More common food-related triggers include skipping meals or drinking alcohol. Fluorescent lights, bright lights, sunlight and glare can also be triggers. Getting too much or too little sleep, or going to sleep too early or too late can trigger migraine attacks. Scents, like perfume, fabric softener, or even cooking odors, are potential triggers. Weather changes, being in temperatures that are too hot or too cold, hormonal fluctuations, loud sounds, and stress can all be triggers.
Rather than look at a list of possible triggers and try to avoid all of them, many people with migraine find more success in keeping a migraine diary in which they record things that could have preceded each migraine attack. Over time, a pattern often emerges, helping the person identify which triggers are problematic for them.
How does light impact migraine?
Light and light sensitivity play a prominent role in migraine. Not only is sensitivity to light a common symptom of migraine attacks (affecting upwards of 90% of people with migraine, regardless of migraine type), but bright and/or artificial light is a frequent trigger as well. While the specific causes of photophobia are not well known, there is evidence that certain cells in our eyes are sensitive to wavelengths of blue light and trigger pain sensations and other dysfunction within the migraine brain. To learn more about how light sensitivity impacts specific migraine types, click on the links below:
- Vestibular migraine and light sensitivity
- Hemiplegic migraine and light sensitivity
- Migraine with vs without aura and light sensitivity
What is an aura?
A migraine aura occurs before the onset of pain for some people with migraine and is a helpful prompt to take a migraine abortive medication. The most commonly recognized aura is a visual disturbance in which a person sees flashing lights or squiggly lines or has a blind spot. Other presentations of auras can include numbness, tingling or weakness on one side of your body, auditory or olfactory hallucinations, and a variety of other possible symptoms. It is helpful to reflect on how you feel before migraine attacks hit and discuss this with your health care professional. You could have a warning sign that would help you treat your migraine attacks early.
Where can I learn more about migraine?
There are some incredible organizations that with which patients can connect to learn more about migraine, from the American Migraine Foundation to the National Headache Foundation. In addition, advocacy organizations (Coalition for Headache and Migraine Patients, Association of Migraine Disorders) and support communities (migraine.com, Migraine Again) are great resources as well.
Last updated August 28, 2020
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