Migraines are a common neurological condition that impact over a billion people worldwide (1). It’s most common among younger adults and females (2). Depending on the severity, migraines may impact daily life of those who are affected.

What are Migraines?

Migraines are a health condition that in most cases resemble a headache followed by more severe symptoms. They usually unfold in different stages and can last for days at a time (3). In many situations, migraines are known to impact a person’s daily functioning and their ability to perform well at work and school.

The way symptoms of migraines unfold may differ from person to person. These differences are seen in the severity levels, triggers, symptoms and frequency. Some people may experience migraines rarely, while others may even experience them as frequently as multiple times a week (2).

Types of Migraines

There exist different types of migraines based on the different severity levels and symptoms, with the most common forms of migraines being migraines with Aura and migraines without Aura.

Migraine with Aura

Migraines with aura are also known as classical migraines. They get created along with sensory disturbances such as:

Visual alterations such as seeing sparks of flashing lights, blind spots, blank patches and zig-zag lines
Feelings of confusion
Weakness in the neck, shoulders and limbs
Hallucinations such as seeing strings or blurry transparent objects

The closest comparison to these disturbances are similar to a bright camera flash that may last a couple of minutes to an hour (4). It’s advised to talk to your doctor if you start experiencing these symptoms for the very first time to rule out any serious conditions such as stroke or brain tumors.

Migraine without Aura

Migraine without aura is also known as common migraine. It happens without sensory disturbances in around 75% of cases (5). These types of migraines usually start off as headaches and become more severe with symptoms such as sensitivity to light and sound, throbbing head pain, feeling nauseous and vomiting (3).

By understanding the different types of migraines, you can effectively cooperate with your doctor to accurately diagnose your case and improve your overall quality of life.

Other types of Migraines

There are other types of migraines which are less common. Here is a list to help you understand them better:

Silent Migraine: Also known as the acephalgic migraine, this type has similar aura symptoms but without the headache. It usually lasts around 30 minutes or less and sufferers have also expressed experiencing nausea throughout it.
Menstrual Migraine: Some women experience migraines right before or during their menstrual cycle. It’s mostly common for these migraines to appear 2 days before the period begins and may last anywhere from a couple of hours up to 5 days. These migraines are usually without aura (6).
Vestibular Migraine: People with vestibular migraines may experience balance issues, vertigo, nausea and vomiting without a headache (7).
Ocular Migraines: Also known as ophthalmic or retinal migraine, people with this type of migraine often experience headaches with a dull pain behind the eyes and sometimes a temporary loss of vision in one eye. It’s important to contact emergency services if you experience vision changes without a diagnosis.
Abdominal Migraines: This form is more common among children and is often followed by symptoms such as stomach pain, nausea and vomiting. This type of migraine is not yet fully understood by experts and more research is needed to be done to see why it happens (8).
Migraine with Brainstem Aura: Mostly impacts young females (AFAB) due to hormonal fluctuations. It’s accompanied by pre-headache symptoms such as feeling dizzy or throbbing pain behind the back of the head.
Hemiplegic Migraine: This type is usually followed by weakness, numbness, dizziness, vision alternations and in more serious cases, paralysis. If you experience such symptoms, seek immediate medical attention to rule out the possibility of experiencing a stroke (9).
Status Migrainosus: This is a severe headache that lasts more than 72 hours. People affected by it often require hospitalization due to the severe pain they experience (10).
Ophthalmoplegic Migraine: People with this migraine experience pain and paralysis around the eye. It requires a medical emergency intervention due to a high risk of nerve pressure around the eye area. Other symptoms of ophthalmoplegic migraines include droopy eyelids or having double vision (11).

It’s important to seek medical help if you experience any of these types of migraines. Neurological conditions may sometimes worsen in time if nothing is done to help ease symptoms.

Symptoms of Migraines

Migraines usually develop gradually. So, in most cases that you are experiencing a migraine, symptoms may have started to develop hours before:

Before the Migraine – Prodrome Phase Symptoms

According to studies, 32.9% of people develop warning symptoms hours or even days before a migraine hits them (12). These early stages are known as the “prodrome” and may involve a shift in mood and even feelings of unexplained sadness or irritability.

The Prodrome phase symptoms may include (13, 14, 15):

low energy or fatigue
food cravings
frequent yawning
depression
neck stiffness
hyperactivity
irritability

Aura Phase Symptoms

For people who have migraine with aura, symptoms appear after the prodrome phase and may include (16, 17):

Feeling a tingling sensation in your face, arms, or legs
Difficulty speaking
Temporary lose of vision
Seeing shapes or bright spots

During the Migraine – Attack Phase Symptoms

During this phase, sufferers may experience a number of symptoms that range from mild to severe. This depends on the type of migraine the individual is experiencing.

The Attack phase symptoms may include (3):

dizziness
increased sensitivity to light and sound
vomiting
nausea
dizziness or feeling faint
throbbing head pain

After the Migraine – Postdrome Phase Symptoms

After more serious symptoms have subsided, it’s common to feel drained and it is often referred to as having a “migraine hangover”.

The Postdrome symptoms may include (18, 19):

Extreme tiredness
Fatigue
Irritability
Sluggishness
Confusion
Impaired concentration
Mild head pain that worsens when you move

If you or your loved one is showing signs and symptoms of experiencing migraines, seeking help from a medical expert is advised to create tailored treatment plans to ease symptoms.

Causes of Migraines

Migraines are not fully understood by doctors since the precise cause to why it happens remains unknown. However, it’s believed that it might be due to genetics and alterations between brain activity. Studies have also found that people who have one or more family members suffering from migraines are more at risk to suffer from migraines themselves (20).

It used to be believed that the reason for migraines was changes of blood flow inside the brain. Even though this was proven to not be the true cause, blood flow might play a role in worsening the pain experienced during a migraine.

Some research suggests that migraine pain may be caused by hyperactive nerve cells emitting signals that activate the trigeminal nerve (3).

These nerves are responsible for feeling sensation around the head area. When these nerve cells become active, it releases serotonin and calcitonin gene-related peptides (CGRP). CGRP, is known for causing swelling in the blood vessels that surround the brain’s lining. Neurotransmitters, on the other hand, are believed to be the leading cause of inflammation and pain that contribute to a migraine (21).

Risk Factors of Migraines

Migraines affect more than 38 million people in the United States (2). There are many risk factors that might increase the likelihood of experiencing a migraine:

Family History: One of the risk factors of migraines is linked to family history. According to some studies, around 4 out of 5 people with one or more family members that experience migraines end up having migraines. If one parent suffers from migraines, their offspring is at 50% risk of having them as well. If both parents are sufferers, that risk goes up to 75% (5), 22).
Sex: Biological females are three times more likely to experience migraines than biological males (2).
Age: Migraines typically happen to people ages 10 to 40. Many people that suffer from migraines between these ages often see an improvement or complete cessation of migraines after reaching their 50s (23).
Other medical conditions: People that experience depression, anxiety, sleeping disorders or bipolar disorder are at higher risk of experiencing migraines (24).

Understanding these risk factors can help rule out other possible medical conditions and even help sufferers prevent or manage their symptoms at an early stage of the condition.

Migraine Triggers

There are many triggers that are known to increase the risk of experiencing a migraine. Knowing what they are can help in treating the migraine as soon as the first warning signs appear. Some triggers of migraines include:

Stress: Higher stress levels can alter the different types of chemicals that are released in the brain. Some chemicals, when released in high amounts, may cause blood vessels and lead to migraines (25).
Hormonal changes: Birth control pills, menopause or pregnancy can lead to a higher risk of experiencing migraines due to the hormonal changes that happen in the body (26).
Dietary factors: Some foods like alcohol, aged cheese, and foods containing nitrates or MSG are known to increase the risk of experiencing a migraine (27).
Caffeine: Drinking too much coffee (more than 2-3 cups a day) can lead to migraines. Sudden caffeine withdrawal also causes migraines that can last for days (28).
Sensory stimuli: Another migraine trigger may be due to loud noises, bright lights and strong odors (29).
Skipping meals: Eating meals at random times of day, or even skipping meals often can trigger migraines (30).
Weather changes: Storms, strong winds and barometric pressure variations can lead to migraines (31).
Physical activity: Too much exercise may trigger migraines in some cases (32).
Medications: Some medications such as vasodilators may widen blood vessels and lead to migraines.
Tobacco: Smoking in excess has been known to cause migraines in some cases (33).
Sleeping patterns: A bad sleep hygiene such as oversleeping, sleeping too little or sleeping without a schedule may lead to more frequent migraines (34).

If you experience migraines frequently, keeping a journal helps to see what may be triggering your migraines in the first place. You can note details such as timing, symptoms and frequencies to keep up and predict when a migraine episode is more at risk of happening. There are also smartphone apps to help with keeping up with migraines (35).

Diagnosis of Migraines

When setting up a doctor’s appointment for migraines, your doctor may ask you for your medical history and family’s medical history. You will also be questioned on the type of symptoms you have been experiencing during your migraine episodes. To be prepared for a doctor’s appointment, you can keep a diary noting:

Symptoms you have been experiencing
The frequency of your migraines
How long they last
Who else is experiencing migraines in your family
A list of medications you are taking or have taken in the past

To rule out other conditions your doctor might require you to take some additional tests such as:

Blood tests
Imaging testings (MRI/CT scans)
Electroencephalogram (EEG)

By following these steps and being open with your doctor, you can reach a proper diagnosis. Your doctor will then help make a proper treatment plan to help you manage symptoms when experiencing a migraine (36).

Treatment Options for Migraines

Migraines can be painful and interfere with daily life. However, there are many strategies and treatment options out there to improve overall quality of life.

Medication

Experts still haven’t found a definite cure for migraines, but there are many medications you can take to find relief. These medications include:

Prescription medication: A medical expert can prescribe specific medications to ease symptoms of migraines. These may include triptans, ditans, gepants, or NSAIDs like celecoxib (Celebrex, Elyxyb) (37). These medications can stop the body from producing hormones that are responsible for experiencing pain throughout the body. These treatments are often taken orally, but there are also types that can be taken via injections or nasally. Your doctor can even prescribe newer options like rimegepant (Nurtec) or ubrogepant (Ubrelvy) if other options don’t work for you.
Other Medications: Medications such as anti-nausea drugs, lasmiditan (Reyvow), and ergotamine (Cafergot, Ergomar, Migergot), can also be prescribed by your doctor depending on the type of symptoms you have.
Over-the-counter (OTC) Pain Relief: These medications usually include ingredients such as aspirin, acetaminophen, caffeine, and ibuprofen, which are known to provide relief when experiencing a migraine. It’s advisable to be cautious with this type of medications for those that are at a younger age, as they tend to require smaller doses. Overuse of these medications may cause side effects (38) and in some cases even dependency. If you use OTC medications more than twice a week, talk to your doctor for a more effective treatment plan.
Preventive Medications: If you suffer more severe or frequent migraines, your doctor might also prescribe preventative medication. These can be seizure medications, beta-blockers, calcium channel blockers and antidepressants. CGRP antagonists like atogepant (Qulipta), fremanezumab (Ajovy), and galcanezumab (Emgality), eptinezumab (Vyepti), erenumab (Aimovig), are also effective treatment options for severe migraines (39).

Home Remedies

Lifestyle changes can also help in reducing the frequency and symptoms of migraines. This can help reduce the overconsumption and sole reliance on medications. Some lifestyle changes that might be effective are:

Practice Relaxation Techniques: Yoga, deep breathing techniques, and meditation help in reducing stress, promote relaxation and can help ease symptoms of migraines (40).
Cool Compress or Ice Pack: Using a cool compress around your head, neck and shoulder area can help numb migraine pain and also reduce inflammation of that area.
Rest in a Dark, Quiet Room: Lying down in a cool dark room and closing your eyes can be effective if you are experiencing intense pain.

Alternative therapies

Alternative therapies can also help you have a more positive outlook on life and change the way you respond to migraines. Some alternative treatments include:

Cognitive Behavioral Therapy (CBT): Working with a therapist might help make you more aware of how you respond to pain and understand your actions that might trigger a migraine. This can empower you to treat migraines more effectively (41).
Biofeedback: This type of therapy helps you become more aware of triggers that lead to migraines and ways to handle them to prevent a migraine from becoming severe.
Body Work: Chiropractic adjustments, massage therapy, acupressure, acupuncture, and craniosacral therapy are all great options to relax the body and reduce stress, muscle tension, and improve blood flow.
Supplements: Certain vitamins, minerals, and herbs like riboflavin, coenzyme Q10, and melatonin have been shown effective in treating migraines in some cases. It’s important to talk to a medical expert if you’re also taking other medications (42).

Pregnancy and Medication

If you’re pregnant or are trying to conceive, there are certain medications that can interfere with your pregnancy. That’s why it’s important to discuss your options with your doctor.

When to Avoid Medications: Many medications out there are not advised to be taken while pregnant as they can increase the risk of the fetus not developing properly. There are more safer options such as acetaminophen, to help reduce migraine pain (43).

It’s important to talk to your doctor before making any changes in your treatment plan. If you have other medical conditions and are going through a pregnancy, exploring life modifications and alternative therapies are both great options to help manage migraines.

Prevention of Migraines

If you are diagnosed with migraines, there is no known way to eliminate them completely from your life. However, there are some ways to prevent symptoms of escalating such as:

Staying hydrated: Dehydration can worsen symptoms and cause further symptoms during a headache such as dizziness (44).
Identify Triggers: By being aware of what causes your migraines you can help come up with a treatment plan for early intervention (35).
Quality Sleep: Having good sleep hygiene can prevent symptoms of migraines from getting worse. Sleep and wake up at the same hours, have a bedtime routine such as dimming the lights or reading a book, and sleeping for 7 to 8 hours a day to help with migraine prevention (34).
Quit Smoking: If you see that smoking triggers your migraines, it’s best to consider quitting it with the help of your doctor (33).
Eating regular meals: Eating enough calories throughout the day not only gives you the energy you need throughout the day but can also prevent migraines. Eating in similar hours throughout the day can also help with this (45).
Relaxation Techniques: Practicing yoga or meditation for 10 to 20 minutes a day can help reduce stress and reduce tension buildup throughout the body. This can reduce the chances of experiencing a migraine attack (40).
Stress Reduction: Chronic stress can cause many complications including migraines. Try to keep stress at bay by finding different coping techniques such as walking, spending time in nature, hobbies and socializing (25).
Regular Exercise: Exercising for around 150 minutes a week can help lower stress and boost dopamine levels, making you feel better and relieved (40).

By trying out these preventative measures you can help manage symptoms and even prevent migraine attacks in some cases.

Conclusion

Even though headaches are common, migraines are more severe and can even impact our daily functioning. They can be an overwhelming and painful experience if left without any form of treatment.

The good news is that there are many treatment options available out there that can help soothe the symptoms of a migraine and prevent it from interfering with everyday life. Always talk to a healthcare provider to come up with an effective plan to treat migraines.

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