The Causes and Treatments of Migraine Headaches
Physical Health
A migraine is more than a painful inconvenience. Migraine headaches are a disabling neurological disease that can impact your ability to function.
Continue reading to learn more about migraines, what can trigger them, and how they’re treated.
What Is a Migraine Headache?
A migraine headache is a neurological disorder characterized by recurrent, throbbing head pain, often accompanied by symptoms like nausea, sensitivity to light or sound, and, in some cases, visual disturbances known as aura. Migraine headaches can last from a few hours to a few days and result from abnormal brain activity that triggers a cascade of events that lead to blood vessel changes and chemical imbalances.
The frequency of migraine headaches differs from person to person. Some people will get a migraine once a year, while others experience a migraine once a week. It’s most common to experience 2 to 4 migraines per month.
Migraine headaches differ from other types of headaches in the severity and type of pain they cause. Head pain is just one symptom of a migraine.
What Are the Symptoms of a Migraine Headache?
The symptoms of a migraine headache may differ from person to person. However, migraines typically progress through four stages — prodrome, aura, migraine attack, and postdrome.
Prodrome
Prodrome refers to the early signs and symptoms of a disease. In the prodrome stage of a migraine, you may notice symptoms that warn you a migraine headache is coming in the next 1 to 2 days, such as:
- Changes in your mood
- Constipation (less frequent or difficult bowel movements)
- Stiffness in your neck
- Retaining fluid
- Increased urination
- Yawning
- Food cravings
The symptoms in the prodrome stage can be different for everyone. You should be familiar with the symptoms that come in the prodrome stage of your migraine so you can take action.
Aura
An aura is a symptom caused by your nervous system that occurs before or during a migraine headache. The aura phase usually lasts a few minutes to an hour. Most people experience symptoms that affect their vision, but other senses may also be affected. A migraine aura may look or feel different from person to person. Examples of aura symptoms include:
- Seeing shapes or bright spots in your vision
- Seeing flashes of light
- Vision loss
- Tingling or pins and needles sensation in your arms or legs
- Feeling weak or numb on one side of your face or body
- Difficulty speaking
Migraine Attack
For most people, migraines start off as a dull pain that gradually gets worse over a few minutes or hours. Migraines can last between 4 hours and 72 hours. During a migraine attack, you may experience pain that is:
- Throbbing, pounding, or pulsing
- Worse on one side of your head
- Behind your eyes
- In the back of your head or neck
Additional symptoms during a migraine attack may include:
- Sensitivity to lights, sounds, and smells
- Nausea and vomiting
- Decreased appetite
- Sweating
- Chills
- Tiredness
- Dizziness
- Blurred vision
Postdrome
The postdrome phase occurs during the day or two after your migraine headache. The postdrome phase is also referred to as a migraine hangover.
During the postdrome phase, you may feel:
- Fatigue (extreme tiredness)
- Confusion
- Head pain with quick movements
- Depressed or euphoric
- Difficulty concentrating
Who Gets Migraine Headaches?
About 16% of adults experience migraine headaches. Migraines are more common in women than men. About 21% of women and 11% of men are affected by migraines.
Some people are more likely to experience migraines. Risk factors for migraines include:
- Family history — Migraines often run in families. About 80% of people who get migraines also have a parent or sibling with migraines.
- Female sex — People assigned female at birth are more likely to experience migraines, likely due to the influence of hormones.
- Age — Migraines can start at any age, but they commonly begin in adolescence.
- Hormone changes — The hormonal changes that occur before or after menstruation and during pregnancy can make migraine headaches more likely.
- High stress — Stress is a common migraine trigger.
- Smoking — People who smoke tobacco products may have an increased risk of migraines.
What Happens During a Migraine Headache?
Researchers don’t fully understand what causes your pain and other symptoms during a migraine headache. The pain you feel during a headache is caused by inflammatory substances released into the nerves and blood vessels of your head. Pain signals sent by nerves in certain blood vessels can send signals to your brain that result in the release of these inflammatory substances. However, it’s not clear why your nerves send this signal.
Imbalances in certain neurotransmitters (brain chemicals) — such as serotonin — may also be involved in migraine headaches.
What Are Migraine Triggers?
Migraine headaches often occur spontaneously — meaning nothing specific caused the headache. However, some migraines have an identifiable cause called a trigger. A migraine trigger is a factor that may lead to a migraine headache. Everyone has different triggers. Common triggers are discussed below.
Hormonal Changes
Changes in estrogen levels — a female sex hormone — are linked to an increased likelihood of migraines. Women and other people assigned female at birth experience natural changes in estrogen throughout their lifetime. This may explain why migraine headaches are more common in women compared to men.
When the estrogen levels fluctuate (rise and fall), blood vessels in your head may begin to contract, setting off pain signals in your nerves. Low levels of estrogen may also make the nerves in your face and scalp more sensitive to pain, triggering a migraine.
Foods and Drinks
The relationship between food and migraines is complex. Consuming certain foods and drinks has been linked to migraines. Some of the most common food and drink triggers include:
- Alcohol — especially red wine, strong beer, rum, and tequila
- Caffeinated drinks — including coffee, tea, caffeinated soft drinks, and energy drinks
- Chocolate
- Cheese
- Cured or processed meat — such as deli meat and salami
Missing or delaying a meal can also trigger a migraine in some people by causing low blood sugar. Some people may also get a migraine due to becoming dehydrated from not drinking enough fluids.
Stress
Stress is a common migraine trigger for many people. The chemicals released in your brain during a stressful event can cause a migraine. Emotional or physical stress can cause the release of stress chemicals.
Some people are able to cope with a stressful event without any migraine symptoms. However, when a stressful event (such as a work deadline or a big life event like a wedding) is over, a migraine can strike.
Physical stress may be caused by several factors, such as:
- Exercise
- Illness
- Neck or back pain
Change in Routine
A change in your regular routine may increase your chances of triggering a migraine. Some people experience migraines on the weekends when their routine differs from the work week. The changes in your routine caused by travel are also associated with migraines.
For example, changes in your sleep patterns may result in a migraine. Changes in sleep may include getting more or less sleep than usual. Migraines can be triggered in shift workers during times when their shift time is changed.
Changes in your caffeine intake can also trigger a migraine. If you regularly drink caffeine but suddenly stop (such as on a weekend), you may trigger a migraine caused by caffeine withdrawal.
Sensory Stimuli
Some people may experience migraines after being exposed to sensory stimuli, such as:
- Flashing lights
- Light from screens (including television, phones, and computers)
- Strong smells
- Loud noises
Medication
Some medications are associated with causing or worsening headaches and migraines, such as:
- Immunosuppressant drugs used to treat autoimmune conditions or cancer
- Vasodilators used to treat heart and blood vessel diseases
- Antiviral medications used to treat hepatitis C or human immunodeficiency virus (HIV)
You can also trigger a migraine by taking pain medications too often — called a medication-overuse headache. If you find yourself using over-the-counter (OTC) pain medications like ibuprofen (sold as Advil, Motrin, and other brand names) more than 14 days per month, talk to your doctor.
How Are Migraine Headaches Diagnosed?
Your healthcare provider can diagnose migraines based on your symptoms, personal history, family history, and medical tests. Depending on your symptoms, you may need to visit a neurologist — a doctor who specializes in treating diseases of the brain, spinal cord, and nerves.
Your doctor may ask you questions about your symptoms and triggers. Before your appointment, it may help to keep a headache diary — a detailed record of what happens before, during, and after your headaches.
Your healthcare provider may perform a neurological exam to see how well your nervous system works. During this exam, your healthcare provider will evaluate the following:
- Your mental status
- Your motor function and balance
- Your sense of touch, taste, and smell
- Your hearing
- Your vision and ability to move your eyes
- Your reflexes
- Your coordination
If your symptoms are severe, unusual, or complex, your healthcare provider may recommend additional tests to rule out other causes of your headaches, such as a magnetic resonance imaging (MRI) scan, a computerized tomography (CT) scan, or an electroencephalogram (EEG).
How Are Migraine Headaches Treated?
There are two approaches to treating migraine headaches — acute and preventative treatments. The goal of acute treatment is to reduce your migraine symptoms during a migraine. Preventative treatments may help decrease the frequency and severity of your migraines.
Acute Treatment
Treatments that relieve your migraine symptoms work best when they’re taken at the first sign of a migraine headache. This type of migraine treatment is sometimes called abortive treatment because it can stop a migraine from getting worse once it starts.
Talk to your doctor about the best treatment for you. Some acute migraine treatments shouldn’t be used if you’re pregnant or trying to become pregnant.
Home Remedies
Home remedies are treatments you can perform at home to help improve your migraine symptoms. Home remedies for migraine headaches may include:
- Resting in a cool, dark, and quiet space
- Cool compress on your forehead or back of your neck
- Scalp massage
- Circular massage to your temples
- Meditation
- Yoga
Pain Relievers
Pain relievers are medications you can take during a migraine headache to reduce your pain. Many pain relievers are available OTC, such as:
- Ibuprofen (Motrin, Advil, and other brand names)
- Naproxen (Aleve)
- Aspirin
- Acetaminophen (Tylenol)
- Combination of aspirin, caffeine, and acetaminophen (sold as Excedrin Migraine)
Opioid pain relievers may be an option for people who can’t take other types of migraine medications. However, these medications can be addictive, so they are typically only used when other medications don’t work.
Triptans
Triptans are a class of medications that block pain pathways in your brain. Triptans can also affect your blood vessels. Triptans are available as a pill, nasal spray, and injection (shot). Triptan medications include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
Gepants
Gepants are a newer class of migraine medications that also block pain pathways in your brain. These medications block pain by blocking a protein called calcitonin gene-related peptide (CGRP), which can start the process of sending pain signals. Gepants include:
- Ubrogepant (Ubrelvy)
- Rimegepant (Nurtec ODT)
- Zavegepant (Zavzpret)
Ditans
Ditans are another new class of migraine medications. These medications work in a similar way as triptans but don’t affect blood vessels. Lasmiditan (Reyvow) is currently the only ditan available.
Dihydroergotamine
Dihydroergotamine (sold as Migranal or Trudhesa) is an acute migraine treatment that works by constricting (tightening) the blood vessels in your brain and decreasing substances that cause swelling. It’s available as a nasal spray or an injection.
Anti-Nausea Medications
If you experience nausea or vomiting during a migraine headache, your doctor may prescribe anti-nausea medications. Your doctor may advise you to take these medications along with your pain medications. Examples of anti-nausea medication include:
- Chlorpromazine (Thorazine)
- Metoclopramide (Reglan)
- Prochlorperazine (Compazine)
Preventative Treatment
Preventative treatment can help reduce the frequency of migraines. There are several options for preventative medications, including:
- Blood pressure-lowering medications — such as propranolol (Inderal), metoprolol (Lopressor), and verapamil (Verelan)
- Antidepressants — such as amitriptyline (Elavil)
- Antiseizure medications — such as valproic acid (Depacon) and topiramate (Topamax)
- Injectable medications — such as erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti)
- Gepants — such as atogepant (Qulipta) and rimegepant (Nurtec ODT)
When Should I Contact My Doctor?
Migraine headaches are always unpleasant and often debilitating. You should be aware of warning signs that indicate you should seek medical treatment right away. These include the following:
- You have a headache that feels like the worst headache of your life
- You have symptoms you haven’t ever had before — such as difficulty speaking, balance problems, problems with your vision, confusion, seizures, or numbness
- Your headache occurs suddenly
- Your headache occurs after a head injury
Signs that you should schedule an appointment with your doctor to discuss your migraines include:
- Increased frequency or severity of your migraines
- Your acute or preventative medications aren’t working as well
- New or different side effects of your migraine treatment
