Migraines are a type of primary headache disorder that affects more than 10 million adults in the U.S. alone. 

Migraines tend to be severe headaches that can cause significant disability; headache days can prevent people from functioning in work or school for as long as weeks at a time. Because of the intense pain — in addition to several other uncomfortable symptoms — migraines are associated with a lowered quality of life. 

This guide from HealthTap provides a comprehensive overview of everything to know about migraines, including their signs and symptoms, risk factors, diagnosis, and treatment options. 

What is a migraine?

Migraines are a type of severe headache with throbbing pain on one side of the head. They are often accompanied by other symptoms, such as nausea and vomiting, sensitivity to light and sound, and brain “fog.” Episodic migraines occur less than 15 days per month, while chronic migraines occur 15 days or more per month.

Because of the wide range of severe symptoms that migraines cause, they can lead to impaired performance in work or school. The World Health Organization even lists migraines as one of the top causes of disability in the world. 

Migraines are almost always set off by a trigger, which varies depending on the person. These triggers, such as exposure to loud sounds, generally don’t bother people without migraines. However, for those with the condition, triggers are enough to set off a series of migraine attacks that can disrupt someone’s entire day.

Migraine attacks can hit at any time of day. However, they are more common in the morning. 

What are the symptoms of a migraine?

It’s important to recognize the symptoms of a migraine headache because they are often misdiagnosed for another headache disorder. This can lead to delayed or inappropriate treatment. 

The symptoms of a migraine depend on which stage the headache is in. There are roughly three stages of a migraine: the premonitory phase, the migraine attack, and the postdrome. 

The premonitory phase 

This stage of the migraine headache occurs in response to a trigger. It can last several days before the migraine headache hits. 

Symptoms of this phase can include: 

• Visual changes.

• Sensitivity to external stimuli, like bright lights or loud sounds.

• Physical fatigue. 

• Muscle stiffness

• Mood changes, such as increased irritability. 

• Changes in appetite.

• Digestive issues. 

About 25% of those with migraines will also experience an aura before the migraine attack sets in. Auras mainly include visual changes, such as seeing flashing lights or black dots, and they typically start about 30 minutes before the headache begins.

The migraine attack

After the premonitory phase, the actual migraine attack begins, which typically lasts between 4-72 hours. The pain varies from person to person. Most often, it is described as severe throbbing pain that affects one side of the head. 

Depending on the individual, some additional symptoms of a migraine attack can include:

• Nausea.

• Vomiting.

• Dizziness.

• Sensitivity to light and sound.

• Irritability.

• Sadness.

• Fatigue.

• Nasal congestion.

In some cases, the pain can be so extreme that it is mistaken for a stroke or another life-threatening condition, which is just one reason it’s important to understand how headache symptoms differ from signs of something more serious. 

The postdrome

It can take days for a migraine attack to subside. Once this happens, many people experience the postdrome phase. 

This is often described as a physical and mental state that’s similar to a hangover and can include the following symptoms:

• Extreme fatigue.

• Brain “fog.”

• Depressed mood.

• Appetite changes.

• Sleep changes. 

What are the different types of migraines? 

There are several types of migraine headaches. 

The two most common types are migraines with aura and migraines without aura.

An aura is a series of symptoms that “warn” of an impending migraine attack. An aura usually includes visual changes, such as flashes of light, black dots, or blind spots. An aura lasts less than 30 minutes and is immediately followed by a migraine headache. 

An aura affects about 25% of all migraine sufferers. The remaining 75% do not experience an aura prior to their migraine attacks. 

What’s the difference between migraines and other types of headaches? 

Headaches can be grouped into two categories: primary and secondary.

Secondary headaches are a symptom of another health condition. Once this condition is treated, the headache should go away on its own. 

Secondary headaches can be caused by various conditions, which include: 

• Hangover.

• Allergies.

• Sinus infection.

• Tooth infection.

• Concussion. 

• Any other type of trauma to the head.

• Meningitis (inflammation of brain tissue).

• COVID-19.

• Stroke.

• Brain tumor. 

• Structural problems in the neck. 

• Low cerebrospinal fluid (which is one cause of positional headaches).  

There are some health conditions, such as high blood pressure, that can lead to headaches in rare cases. 

Unlike headaches caused by the above conditions, migraines are a type of primary headache disorder. This means that they aren’t caused by an underlying health condition. As such, they technically can’t be cured — only managed. 

Some other primary headache disorders include cluster headaches, tension headaches, and cough headaches. 

What causes migraines?

As with many types of headache disorders, there is no one underlying cause of migraines. 

Rather, there are dozens of potential causes of the condition, which can vary from individual to individual. In those who are genetically predisposed to migraines, these factors can cause the headaches to develop. 

Here are some of the most common culprits that can lead to migraines: 

Hormonal changes 

Women are much more likely than men to develop migraines. In addition, women report that their symptoms get worse around certain times of the menstrual cycle. This is likely because of an imbalance between the sex hormones estrogen and progesterone, which are thought to contribute to migraines.  

Food sensitivities 

Food sensitivities are different from food allergies because they don’t cause an immediate immune response. One way that food sensitivities can lead to migraines is by causing inflammation in the meninges, which are tissues that cover the brain and spinal cord. When the meninges become inflamed, pain can ensue. 

There are many foods that can trigger a sensitivity, the most common being gluten, dairy, eggs, and sugar. However, because everyone is unique, inflammation can be triggered by all kinds of foods. 

Smoking 

Cigarettes contain nicotine, which constricts blood vessels and reduces blood flow to the brain, which can contribute to migraine headaches. Studies show that as little as five cigarettes per day can more than double someone’s risk factor for getting migraines. 

What triggers migraines? 

A trigger is slightly different from a cause of migraines because it didn’t necessarily lead one to develop the condition. However, it can be enough to set off a migraine attack in those with the condition. 

Some common migraine triggers include: 

• Emotional stress.

• Sleep deprivation.

• Travel (especially to different time zones). 

• Weather changes.

• Foods high in a substance called tyramine, such as aged cheese.

• Alcohol consumption.

• Caffeine consumption. 

• Dehydration (on its own, this can also lead to a dehydration headache).

• Hormonal changes due to the menstrual cycle. 

There are potentially dozens of other migraine triggers, which are as unique as the individual who gets them. Keeping a migraine journal can be one way to identify migraine triggers and to avoid them as much as possible. 

How are migraines diagnosed?

A doctor will conduct a full medical evaluation in order to diagnose migraines. The symptoms of a migraine can overlap with those of more serious conditions, which is why seeing a healthcare provider can be so beneficial in finding relief. 

Sometimes, a doctor may conduct a brain imaging test, such as a CT scan or an MRI, in order to see if there are any abnormalities in the brain. If there are, then a neurology consultation may be necessary.

Once other medical conditions have been ruled out, a doctor may diagnose a patient with a migraine headache disorder if they meet the following criteria, as laid out by the International Headache Society:

• Each migraine attack lasts between 4-72 hours.

• At least five attacks occur in a given time period.

• The headache has at least two of the following characteristics: one-sided location, throbbing quality, moderate to severe pain, and aggravation by physical activity. 

• The headache is accompanied by nausea, vomiting, sensitivity to light, or sensitivity to sound.

• It cannot be explained by another headache disorder. 

Medication for treating migraines

Once a patient is diagnosed with a migraine headache disorder, they can be prescribed migraine medications (including antidepressants) for migraine management or even prevention.

Below are the most popular options for treating migraine attacks:

• Over-the-counter painkillers
  Some popular OTC pain relievers include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Acetaminophen (or Tylenol) is another popular option, especially when combined with a small dose of caffeine. It’s important not to overuse painkillers as doing so can lead to a condition known as medication overuse headache. 

• Beta blockers
  Some studies suggest that prescribing beta-blockers and calcium channel blockers (both types of medication that can lower blood pressure) can help decrease the severity of a migraine. These include propranolol (Inderal, InnoPran XL, and others) as well as metoprolol tartrate (Lopressor).

• Anti-seizure medication
  Valproate sodium and topiramate (like Topamax and Qudexy XR) are generally prescribed for people who have seizures, but may help those with less frequent migraine headaches.

• Triptans
  These medications shrink blood vessels in the brain, which can take some pressure off the surrounding nerves. Some popular triptans include sumatriptan, eletriptan, rizatriptan, and zolmitriptan. Triptans come in several forms, which include pills, intramuscular shots, and nasal sprays. Triptans are not recommended for people with hemiplegic migraine.

• Gepant
  This oral medication is a CGRP (calcitonin gene-related peptide) receptor antagonist, and is used for acute migraine treatment. Gepants include galcanezumab, eptinezumab, and fremanezumab.

• Lasmiditan
  This is the first medication approved by the Food and Drug Administration (FDA) that specifically targets migraines. It is used for the acute treatment of migraines and is taken at the first signs of a headache to stop it in its tracks. 

• Anti-nausea medication
  This class of medications is known as antiemetics, which includes metoclopramide (Reglan), can be used to treat nausea and vomiting, which are common symptoms of migraines. 

Though analgesic opioids like codeine, tramadol, and butorphanol can be effective for relieving pain, they are generally not used to treat migraines due to their high addiction potential. 

Alternative treatments for migraines

Medications for migraines come with a fair share of side effects, which is why some people may want to avoid them. Alternative therapies can be used in their place or in addition to them to provide migraine relief. These are some popular alternative treatments options that can be a part of an effective plan of care for headaches. 

1. Yoga

Yoga is an ancient mind-body practice that combines deep breathing, meditation, and physical movement. Because it is a slow and gentle practice, it will not aggravate migraines. 

Yoga can improve circulation while reducing psychological stress, thus helping to reduce migraine pain. Clinical trials show that adding yoga to the conventional treatment of migraines can produce much better outcomes than using medication alone. 

Yoga can be practiced at home using a video tutorial, though it may be better for novices to attend an in-person class with a certified yoga instructor. Talking to the instructor about suffering from migraines prior to class can prompt them to prepare modifications that put less pressure on the head and neck. Another benefit of practicing with an instructor is that they can offer feedback on poses and help adjust form as needed. 

2. Acupuncture

This is a therapy from traditional Chinese medicine (TCM) that is based on the idea of energy flow, or chi. According to TCM, energy in the body travels along certain points, also known as meridians. If one of the points is blocked, the energy can stagnate in the body. To get the energy moving, TCM practitioners apply needles to strategic points in the body. 

Current research shows that acupuncture is helpful with pain relief and can be used for pain management in some pain-related conditions. This is likely because acupuncture can release chemicals produced by the body that block the pain response, such as endorphins and dopamine. It can generally be safely used as an addition to conventional migraine treatments. 

3. Acupressure

Acupressure is also based on the TCM theory of energy flow. However, instead of needles, it applies pressure to certain points in the body. While TCM practitioners claim that acupressure “releases” stagnant energy, research shows that it can also help with muscle relaxation and emotional stress relief. 

When used as an adjunctive therapy, acupressure can improve migraine outcomes. This is likely because stress is a significant migraine trigger, which acupressure can effectively help reduce. 

The best part about acupressure is that it does not require a practitioner and can be done at home by anyone. People who suffer from migraines can find key acupressure points and manually apply pressure to them for at-home relief. This therapy is not associated with any negative side effects.

4. Head and neck exercises 

Some head and neck exercises can help with headaches by improving poor posture while relaxing tense muscles — both of which can contribute to headache pain. These exercises can be done on a regular basis to prevent headaches or during a migraine attack to get relief. 

5. Biofeedback

This therapy uses electrodes (which are small metal sensors attached to the skin) to relay information about muscle tension, skin temperature, and other physiological signs of stress. Seeing what triggers stress in them can help a person to consciously control their physical response. Because stress is a major migraine trigger, using biofeedback to lower stress can prevent some migraines from occurring. 

6. Botox 

Although it’s well-known for its use in cosmetic surgery, Botox can also be used to treat chronic migraines. When Botox is injected into the muscles, it may block the pain signals that cause migraine headaches.

To treat migraines, Botox can be injected into the forehead, temples, back of the head, or other surrounding structures that can cause headache pain signals. It usually needs to be re-injected about every three months to maintain results.

7. Supplements

Some people turn to supplements to aid in migraine relief. Some supplements, like riboflavin (vitamin B2) and coenzyme Q10 (CoQ10) may also help with migraine prevention. Low magnesium levels are thought to contribute to pain, so some doctors recommend magnesium supplements as a first step.

How do you prevent migraines?

Even though the right treatment approach can effectively stop migraine attacks, it’s much better to prevent them from happening in the first place. This can help patients avoid some of the negative side effects of medications while improving their overall health. 

The following are four migraine prevention strategies that can be part of an effective headache prevention plan. 

1. Get to the root cause 

Even though migraines are not caused by an underlying disease, they still have causes that are unique to each person. 

It is important to meet with a doctor for a full medical evaluation in order to determine what could be the root cause of migraines. A doctor can run a series of blood or other tests to find a potential abnormality that could be causing migraines. 

In addition, a doctor should ask about all lifestyle factors that could be causing migraines. If something is “off,” it can be viewed as a potential cause. 

2. Make lifestyle changes 

After discussing lifestyle factors with a doctor, patients can begin to make gradual lifestyle changes. For instance, if they sleep poorly, then improving sleep habits may help to improve migraine symptoms. Or if their medical exam indicates a food sensitivity, they may try an elimination diet to see if their symptoms improve. 

As a rule of thumb, any lifestyle changes that improve general health can also improve migraine symptoms. 

3. Balance hormones 

Some hormone disorders may worsen or lead to more frequent migraines. In these cases, a visit to the endocrinologist (a specialist in hormones) might be helpful to prevent migraines. 

However, some patients may experience migraines due to the menstrual cycle. In this case, it might be better to visit an OB-GYN doctor.

Last, a hormonal imbalance can stem from a poor diet, such as one that is high in sugar. Making dietary changes can help with restoring healthy hormonal function that may help prevent future migraine attacks. 

4. Reduce stress 

There is a strong association between emotional stress and migraines. In many cases, one day of excessive worry is enough to trigger a migraine attack. 

For those who feel consistent emotional stress, removing even a few stressors can be helpful in preventing migraines. If that’s not possible, then practicing stress reduction and management techniques, such as meditation and breathwork, can also be helpful in preventing migraine attacks. 

Takeaways

Migraines are a debilitating chronic health condition that affect millions of adults in the United States alone. Because of the severe pain that they cause — in addition to various other symptoms — migraines are viewed as a disability that can affect someone’s school, work, or personal life.

If you suffer from migraines, know that help is possible. Meeting with the right healthcare provider can help you put together a preventive treatment plan while recognizing and avoiding your triggers.

HealthTap can connect you with a low-cost doctor to help diagnose and treat your migraines. 

Make your virtual appointment today to get the relief you need and deserve.