Migraine is a headache disorder. They may happen many times a week or once every few years. Sensations called auras may come before a migraine headache.
Migraines can be so severe that they get in the way of daily activities.
The exact cause is not known. Genes may play a role. Some things that may trigger a migraine are:
- Things in the environment, such as odors and bright lights
- Some foods and drinks, such as alcohol
- Some medicines
- Changes in sleep patterns
- Changes in the body, such as menstruation and puberty
- Weather changes
Migraines are more common in people under 50 years of age. They are also more common in women.
Things that may raise the risk of migraines are:
- A family history of migraines
- Changes in hormones during menstruation
Migraines happen in these phases:
A warning may come before a migraine. A person may have these symptoms in the hours or days before a headache:
- Changes in mood, behavior, and activity level
- Tiredness and yawning
- Food cravings or lack of hunger
- Sensitivity to light
Auras often last about 15 to 30 minutes. Visual auras are the most common type. A person may have:
- Flashing lights, spots, or zig zag lines
- Partial loss of vision that lasts a short time
- Weakness in an arm or leg
- Numbness or tingling in the face and hands
- Problems speaking
Migraine pain may start within an hour of an aura ending. Problems may be:
- A headache on one or both sides that may feel:
- Moderate or severe
- Throbbing or pulsating
- More severe with bright light, loud sound, or movement
- Nausea or vomiting
Migraines usually last 4 to 72 hours. They often go away with sleep. After the headache, a person may have:
- Problems with focus
- Sore muscles
- Mood changes
The doctor will ask about symptoms and past health. A physical exam will be done. The diagnosis is often made based on symptoms. Tests may be done to rule out other problems.
The goal of treatment is to ease headaches to help with quality of life. Using cold compresses and trying to sleep in a dark, quiet room may help.
Other options are:
The doctor may advise these medicines to ease migraine pain:
- Over the counter pain medicine, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Dopamine antagonists
- Ergotamine tartrate
- Calcitonin gene-related peptide (CGRP) inhibitors
Regular use of some over the counter medicines may cause a rebound headache.
The doctor may advise these medicines to prevent migraines in people who get them a lot:
- Calcium channel blockers
- Anti-seizure medicine
- Tricyclic antidepressants
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)
- Calcitonin gene-related peptide (CGRP) inhibitors
Therapy may be used to reduce the length and frequency of headaches. Methods may be cognitive behavioral therapy, biofeedback, or relaxation methods.
Procedures that may be done are:
- Botulinum toxin injections may be used to prevent migraines. They may also reduce headache pain and duration.
- Transcranial magnetic stimulation may also be used by people with migraine with aura who have not been helped by other treatments.
Some people may have surgery when other methods do not help. Some migraines are triggered when a nerve in the head is stimulated. Surgery can be done to find the nerve and turn it off. This may make the headaches go away or make them happen less often.
It is not clear how to prevent migraines from ever happening. Migraine events may be prevented by:
- Using relaxation methods
- Eating a healthful diet and drinking plenty of water
- Exercising regularly, such as doing yoga
- Avoiding known migraine triggers
- Getting enough sleep
- Taking prescription medicine to prevent migraines
- Migraine in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/migraine-in-adults.
- Migraine information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page.
- Migraine prophylaxis in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/migraine-prophylaxis-in-adults.
- Reese, O., Lukas, R.V., et al. Challenge case report: increasing frequency of migraine. Practical Neurology, 2020. Available at: https://practicalneurology.com/articles/2020-jan/challenge-case-report-increasing-frequency-of-migraine/pdf.
- Silberstein, S.D., Holland, S., et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology, 2012; 78 (17): 1337-1345.
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