Overview of migraine

Migraine is a neurological condition that causes moderate to severe headaches. Symptoms often include sensitivity to light and sound and nausea. Migraines are generally not life-threatening, but they can be debilitating and painful.

Migraine symptoms often occur for no apparent reason. A migraine can last anywhere from 4 hours to 3 days, and during this time, you may have:

• Headache on one side of your head (either right or left)
• Nausea or vomiting
• Stomach upset
• Loss of appetite
• Pain or discomfort in the neck and shoulders
• Blurred vision or other visual changes (like seeing spots)

What is a migraine headache?

A migraine headache is a severe, throbbing pain on one or both sides of your head. About 12 million people in the United States experience migraines. They tend to run in families and may be triggered by certain foods, stress, or changes in your environment.

A migraine is typically intense but lasts for only a few hours, although some people experience ongoing symptoms (called an aura) before the headache itself begins. The pain is usually accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Migraines are more than just a bad headache — they’re debilitating. People with migraines often can’t function normally while they’re experiencing symptoms. Some people have warning signs before their headaches start; others don’t have any warning at all.

Types of migraine headaches

The most common types of migraines are classic migraines and common migraines.

Classic migraines (also called complicated migraines) start with a warning sign called an aura. These types of migraines are sometimes also called “migraines with aura.” The aura involves changes in the way you see. You may see flashing lights, colors, a pattern of lines, or shadows. You may temporarily lose some of your vision, such as your side vision.

You may also feel a strange prickly or burning sensation or have muscle weakness on one side of your body. You may have trouble speaking/communicating. You may also feel depressed, irritable, and restless.

Auras last about 15 to 30 minutes. Auras may occur before or after your head pain. Sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic migraines may occur on one side of your head or on both sides.

Common migraines don’t start with an aura. For this reason, these types of migraines are also called “migraines without aura.” Common migraines may start more slowly than classic migraines, last longer, and interfere more with daily activities. The pain of common migraines may be on only one side of your head. Most people who have migraines have common migraines (they don’t have an aura).

Migraines without head pain, sometimes called “silent migraines,” may cause you to feel other migraine symptoms, but not pain. This means you may not the usual migraine pain around your eyes and temples. This type of migraine may even include an aura phase. You may also feel the same sensitivity to light and sound as with a typical migraine.

Hemiplegic migraines cause one side of your body to become weak, similar to having a stroke. These symptoms are only temporary. They are a part of the migraine attack. Areas of the body affected by the weakness may include your face, arm, or leg. The weakness may last from an hour to even days. It most often goes away within 24 hours. For this type of migraine, the head pain can come before or after the weakness. This type of migraine is rare.

Retinal migraines (also called ocular migraines) cause changes in vision that are not related to aura vision changes. For retinal migraines, symptoms involve vision problems or even blindness in one eye. These symptoms do not last long. They can occur before or after head pain. If you experience this type of migraine, contact your doctor.

Icepick headaches are not migraine headaches. They produce a stabbing pain around your eyes and temples. These stabbing pains may occur repeatedly in the same place or jump around to different areas each time. This type of headache can occur at any time and without warning. If you are a person who has migraine headaches, you are more likely to get icepick headaches, too.

Cluster headaches are not migraine headaches. They are rare headaches that occur in patterns, known as cluster periods. These periods can mean having a headache at the same time every day for a week or even a month. Cluster headaches can be extremely painful. They usually cause pain on one side of your head. This pain can be so severe that it makes your eyelid droop and your nose get stuffy.

Cervicogenic headaches are not migraine headaches. They are headaches caused by another illness or physical condition, usually a problem in your neck. Many times, this type of headache can be brought on by a sudden movement of your neck. You might also get a cervicogenic headache after keeping your neck in the same position for too long. The pain can last for hours or days. It may be limited to one side of your head or face.

What does a migraine feel like?

A migraine is a very painful headache that can last from 4 to 72 hours. People describe migraines as throbbing or pulsing headaches, often on one side of the head. A migraine may be accompanied by nausea and vomiting, sensitivity to light and sound, and increased sensitivity to smells.

Migraines are often described as splitting headaches or tight band-like headaches. They can be moderate or severe in intensity, but most people say that they are moderate or severe.

Migraines usually cause pain on only one side of the head — although some people experience pain on both sides of the head. The pain can extend from the eye to the temple and around to behind the ear on the same side of the head as well as through top of head down into neck and shoulder area.

Symptoms of migraines

The most common migraine symptoms are described below. But keep in mind that each person may experience migraines differently.

Headache

Migraine headaches may be throbbing or pulsating and usually affect just one side of your head. They’re commonly accompanied by nausea and/or vomiting, and some people have visual disturbances (auras).

Aura

About 20 percent of migraineurs experience an aura — a strange, often visual warning sign that precedes a migraine attack by about an hour. Auras can include:

Sensory disturbances such as tingling, numbness or weakness in your face, hands or arms

Visual changes such as flashing lights or shapes that look like lines or zigzags

Speech problems such as trouble finding the right words to say

Nausea and vomiting

Some people with migraines report feeling nauseated before their headaches begin. Many of these individuals vomit during their attacks, too.

What causes migraines?

In the majority of cases, migraine causes are unknown. However, there are a number of risk factors that increase your chance of developing migraines. These include:

Family history. If someone in your family has had migraines, you have an increased risk of developing them yourself.

Age. Migraines tend to develop during puberty and adolescence and become more common as you age.

Gender. Women have three times the risk of developing migraines compared to men.

Race and ethnicity. Caucasian women are at highest risk for having migraines, but they can affect anyone regardless of race or ethnicity.

How are migraines diagnosed?

Migraines are diagnosed based on a person’s medical history, a physical examination and the results of tests that may be performed to rule out other conditions.

A doctor will ask about your symptoms and medical history. You may be asked if you have any family members with migraines.

You may undergo a series of tests to determine whether you have migraines. These tests include:

Visual field test. This test checks how much you can see in all directions at once (peripheral vision) and how well you see straight ahead when your eyes are moved from side to side (central vision). The test is done by having you follow an object with your eyes while wearing special glasses that shine lights into your eyes.

Electrocardiogram (EKG). This test records the electrical activity of your heart as it beats. It can help detect problems such as abnormal heart rhythms and problems with blood flow through the arteries in your neck that could indicate an underlying cause for migraine headaches.

Imaging tests. Various imaging techniques can be used to detect structural changes in the brain or other abnormalities, such as tumors or bleeding within the brain that may be causing migraine headaches. These include magnetic resonance imaging (MRI) scans and computed tomography.

Migraine treatment

Migraine treatment can vary from person to person, but some of the most common treatments include:

Pain relievers. Acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can help relieve migraine pain. If you get migraines with auras, avoid NSAIDs because they can increase the risk of stroke in people with a history of cardiovascular disease.

Ergotamine drugs. Ergotamine drugs such as dihydroergotamine (DHE) are used to treat moderate to severe migraines. These medications can cause serious side effects if not used correctly. They’re only available in injectable forms and must be injected into a muscle by a doctor or nurse practitioner.

Triptans. Triptans are oral medications that constrict blood vessels in the brain and relieve pain associated with migraines. Some triptans are available over-the-counter but most require a prescription from your doctor or nurse practitioner.