Migraine: Symptoms, Diagnosis, Causes & Treatment

Last modified on January 2022
With inputs from Dr. Sreelekha Daruvuri

What are Migraine headaches?

A migraine, although a headache, is much more severe than a typical one. Migraine headaches vary in intensity and severity. They are most commonly described to be “throbbing” headaches that are focused on a particular area of the skull or head. They are most commonly associated with discomforting symptoms such as nausea and light and sound sensitivity.

There are various triggers to migraines such as foods, and hormonal changes. Identifying these triggers can help control the frequency and severity of migraines. Different types of migraines are accompanied by distinguishable symptoms. Once diagnosed, the treatment of migraines includes preventative and pain-relieving medications.

Last modified on January 2022
With inputs from Dr. Sreelekha Daruvuri

What are Migraine headaches?

A migraine, although a headache, is much more severe than a typical one. Migraine headaches vary in intensity and severity. They are most commonly described to be “throbbing” headaches that are focused on a particular area of the skull or head. They are most commonly associated with discomforting symptoms such as nausea and light and sound sensitivity.

There are various triggers to migraines such as foods, and hormonal changes. Identifying these triggers can help control the frequency and severity of migraines. Different types of migraines are accompanied by distinguishable symptoms. Once diagnosed, the treatment of migraines includes preventative and pain-relieving medications.

Chapter 1: Triggers and Causes of Migraines

Triggers and Causes of Migraines 

The accurate cause of migraines has not yet been fully understood. Although, research has proven that a headache results from the nerves in blood vessels sending pain signals to the brain. This results in the release of inflammatory factors into blood vessels in the head. However, when it comes to migraines, causes are most commonly referred to as triggers . Following are the possible triggers of migraines attacks:

(1) Unhealthy meal patterns: Skipping meals, or extreme dieting causes hypoglycemia – a drop in your blood sugar levels. Those diagnosed with migraines most commonly find that this drop triggers a migraine.
(2) Certain foods and drinks : Some people are sensitive to certain types of foods and drinks that can bring on a migraine headache. These include alcoholic beverages, chocolate, nitrates found in junk food such as hot dogs, fermented or pickled foods, and some types of cheese.
(3) Stress : This is one of the most common triggers of migraines. Stress causes the release of chemicals in the brain to help the body with the fight or flight response. A migraine is a result of this chemical release accompanied by other stressful emotions such as anxiety. It’s a treacherous cycle that not only continues to trigger migraines but can worsen their severity and frequency.
(4) Excessive self-medication: People often medicate themselves with pain killers without realizing the possible complications. Overuse of pain medications – even to control headaches – causes cause a rebound headache or medication overuse headache.
(5) Light sensitivity: vision is formed through visual pathways after the eye’s retina allows light to travel to the brain. During this process, the melanopsin system senses the light causing brightness. This system is further linked to the trigeminal system of the brain which can cause flashing lights, fluorescent lights, sunlight, and lights from technical devices to trigger a migraine.
(6) Caffeine : It has already been proven that excessive caffeine and sometimes caffeine withdrawal can cause serious headaches. This occurs because caffeine can cause sensitivity issues with blood vessels – as in, if they don’t get their fix, it causes a headache.
(7) Dehydration : the brain contracts from the loss of fluid when the body is dehydrated resulting in it pulling itself away from the skull. This results in dehydration headaches that can be alleviated through appropriate hydration.
(8) Hormonal fluctuations: As per research , women suffer from migraines three times as often as men. Hormonal changes in women – especially during menstruation or periods – are one of the major triggers for migraines because, during menstruation, estrogen levels drop abruptly. Women suffer more severe and frequent migraines between the years of puberty and menopause. If hormones are the cause behind migraines, women suffer from less frequent ones after they reach menopause.

Other possible triggers for migraines include weather changes, physical factors such as excessive physical exertion, medications such as oral contraceptives and vasodilators, and unhealthy sleep patterns.

Chapter 2: Symptoms of Migraines

Symptoms of Migraines

The main symptom of a migraine is a “throbbing” or “stabbing” pain in the head/skull. This headache commonly starts as a dull ache that further develops into a pain that can vary in intensity – mild, moderate, or severe. The location of the migraine headache pain is commonly localized to one part of the skull but can shift to other parts affecting the front and back of the head or can be present in multiple parts. This pain can also defer to the eyes, temple, sinuses, jaw, and neck.

 

Migraine symptoms occur in the following phases :

Prodrome (pre headache) symptoms
This phase of a migraine lasts from a few hours to days.
– Increased thirst and urination
– Increased sensitivity to light
– Increased sensitivity to sound
– Food cravings

– Constipation or diarrhea
– Depression
– Concentration issues
– Increased fatigue or tiredness
– Muscle cramps and/or stiffness
– Nausea
– Disturbed sleep patterns.


Aura symptoms
An aura is not present with all types of migraines. This phase of a migraine lasts from 5 minutes to one hour.
– Visual disturbances: these are most commonly associated with migraine and include seeing spots, having blind spots (scotomas) flashes of light, and/or light lines in the visual field
– Vision deterioration or loss
– Numbness or tingling of body parts
– Speech difficulty
– Muscle weakness


Migraine attack symptoms
This phase of a migraine lasts from 4 to 72 hours.
– Throbbing, pulsing, or stabbing pain in the head
– Nausea and vomiting
– Dizzines
– Insomnia
– Sinus congestion
– Depression and/or anxiety
– Light, smell, and sound sensitivity
– Neck pain and stiffness

Postdrome symptoms: also called a migraine hangover
This phase of a migraine lasts for one to two days.
– Lack of difficulty in concentration

– Tired or washed out feeling
– Increased fatigue
– Depressed or (at times) euphoric moods
– Comprehension difficulty

 

Not everyone experiencing migraines will experience all the above symptoms during the four phases. Migraines vary in intensity and severity, so symptoms are parallel to that.

 

Diagnosing Migraines
Migraine diagnoses are done through the patient’s medical history and the signs and symptoms they experience. Some of these include asking patients the following:
– Description of headache symptoms: severity, frequency, and intensity
– Triggers of migraines
– Location and type of pain
– Symptoms before, during, and after a migraine attack

 

In some severe cases, a general physician will recommend blood tests, imaging tests such as an MRI or a CT scan, and an EEG. These are recommended to rule out other medical conditions such as seizures.

Chapter 3: Types of Migraines

Types of Migraines
There are different types of migraine based on the symptoms and causes.

(1) Migraine with an aura
This type of migraine is accompanied by an aura, which is a warning that a migraine attack is about to ensue. This type of migraine is associated with aura symptoms (mentioned above). There are three subtypes of migraines that have an aura:
Migraines with brainstem aura
This is a rare type of migraine that used to be known as basilar-type migraine. The cause of migraine with brainstem aura, as per experts, is Cortical spreading depression (CSD), a brain mechanism. It is accompanied by at least two of the following symptoms.
– Dysarthria (slurred speech)
– Vertigo (moving sensation)
– Diplopia (doubly vision)
– Tinnitus (ear ringing)
– Ataxia (unsteady walking)
– Syncope (decreased consciousness)
– Numbing of body parts especially limps
– Visual disturbances.
Ocular or retinal migraine
This rare type of migraine is caused by an eye condition leading to attacks of partial or total blindness or visual disturbances. This type of migraine attack is discomforting but is medically harmless and symptoms are temporary and reversible. A retinal migraine is diagnosed by a general physician or an optometrist that will find evidence of decreased blood flow to the eye.

This type of migraine is more common in women, those under the age of 40, those with family history, and individuals diagnosed with medical conditions such as lupus, sickle cell, giant cell arteritis, antiphospholipid syndrome, and epilepsy. Symptoms of ocular or retinal migraines include
– Partial or total vision loss in one eye lasting from 10-20 minutes
– Headaches that occur pre, during, and post a vision disturbance attack
Hemiplegic migraine
This is a rare type of migraine that most commonly causes weakness on one side of the body. The definition of hemiplegia is the paralysis of one side of the body. Those who experience hemiplegic migraines complain of temporary weakness on one side of the body during their migraine attack. Along with one-sided body weakness, a hemiplegic migraine is accompanied by visual disturbances, speech difficulties, vertigo, tinnitus, and confusion. There are two types of hemiplegic migraines: Familial hemiplegic migraine and Sporadic hemiplegic migraine

(2) Migraine without an aura
This is the most common type of migraine that is not accompanied by an aura or warning sign. Migraine without aura is also called common migraine or hemicrania simplex. If this type of migraine is untreated it can last from 4 hours to three days. Symptoms of migraine without an aura include:
– Throbbing headache
– Nausea and vomiting
– Photophobia (sensitivity to light)
– Hyperosmia (sensitivity to smells)
– Phonophobia (sensitivity to sound)

(3) Chronic migraines
This is a type of migraine that causes debilitating symptoms and is diagnosed with individuals that have a migraine for 15 or more days per month. Symptoms of chronic migraines are similar to the symptoms mentioned above, but its distinguishable factors are frequency and severity.

(4) Vestibular migraine
This type of migraine is distinguishable in its symptoms – it is also called migrainous vertigo, migraine-related dizziness, vestibular migraine, or migraine with prominent vertigo. This is because those diagnosed with vestibular migraine experience a combination of the following symptoms:
– Vertigo
– Dizziness
– Balance difficulty.

A vestibular is diagnosed based on the following criteria:
– 5 or more episodes of migraine attacks
– History of migraine headaches
– Vestibular symptoms such as vertigo that last 5 minutes to 3 days
– Accompanied by other migraine common migraine symptoms

(5) Ophthalmoplegic migraine
This type of migraine also called neuralgia causes pain and weakness near the area of the eye. Some symptoms of this type of migraine include:
– Droopy eyelid
– Diplopia (double vision)
– Other visual disturbances are caused by eye changes.
Since these symptoms may indicate an emergency, immediate medical attention needs to be sought to rule out any dangerous conditions.

(6) Abdominal migraine
This type of migraine commonly affects children but can affect adults as well. There is not much that is medically known about an abdominal migraine – it is an idiopathic disorder. However, it is associated with the following symptoms:
– Stomach pain attacks lasting 2 hours to 3 days
– Nausea and vomiting
– No headache during attacks.

(7) Menstrual migraine
Women are more prone to experiencing migraine headaches than men – this is due to the link between migraines and hormonal fluctuations. A menstrual migraine occurs during a women’s period and is more severe and less commonly responsive to treatment. They also tend to have longer durations than most other types of migraines.

(8) Medication overuse migraine
This type of migraine occurs due to the frequent overuse of painkillers. These medications include NSAIDs, paracetamol, triptans, and opiates. This type of headache is commonly experienced by those that have a family history of migraines or have been diagnosed it a primary headache disorder. The medications further result in rebound headaches.

(9) Silent migraine
This type of migraine occurs with no actual headache. However, there is an aura or warning sign that can result in nausea and other common migraine symptoms. Silent migraines usually last about 20-30 minutes.

Chapter 4: (10) Status Migrainosus

(10) Status Migrainosus
This type of migraine is associated with pain that lasts for more than 3 days. It is most commonly caused by medications or their withdrawal. Severe cases of this type of migraine results in pain and nausea that require hospitalization.

Migraine Treatment
Migraine treatment involves the prescribed medications that help in relieving pain which includes Naproxen, Ibuprofen, and Acetaminophen. However, there are other medications used to help with pain such as:
– Triptans that help reverse brain changes during a migraine episode
– Antiemetics to alleviate symptoms of nausea and vomiting
– Ditans that help with sensory nerves and blood vessels

Chapter 5: Home remedies for migraines

Home remedies for migraines
– Cold packs for pain relief
– Reduced light exposure aka a dark room
– Increased rest
– Yoga to help with the reduction of stress and other mental health associated symptoms

Chapter 6: Diet supplements for migraines

Diet supplements for migraines
– Magnesium
– Coenzyme 10
– Riboflavin

Other non-conservative treatments for migraines
– Acupressure
– Physical therapy
– Botox

Migraine Prevention
It is not always possible to prevent a migraine headache or attack. There are however ways to help reduce the frequency of migraines and their severity.

To help reduce severe migraines episodes, the following medications/procedures are prescribed
– Antidepressant medications
– Propanol to reduce blood pressure
– Anti-seizure drugs such as Topiramate

Tracking and avoiding migraine triggers is one of the best ways to prevent migraines. These include:
– Timely meals to avoid a sudden blood sugar level drop and activation of the nervous system
– Reducing stress through yoga and meditation
– Limiting physical overexertion through exercise
– Avoiding migraine causing trigger goods such as MSG

To help reduce the frequency of migraine attacks, the following can help:
– Adequate rest and sleep
– Adequate hydration
– Avoid caffeine and alcohol
– Adequate physical exercise

Chapter 7: Migraine Risk Factors and Complications

Migraine Risk Factors and Complications 

Risk factors 

– Age: Migraines are more prominent during puberty and for women, between puberty and menopause. It is said to peak at its frequency in those that are between 30-40 years of age.
– Sex: Women are three times more likely to experience migraine episodes than men.
– Hormonal fluctuations: This is for women who experience migraines during hormonal functions that occur during menstruation, pregnancy, and menopause. Migraines are said to improve after menopause.
– Family history: migraines have a very strong genetic component

Complications

As previously mentioned, overuse of painkillers to treat migraine headaches can result in a higher frequency of migraine headaches or medication-overuse headaches. As per studies, the risk increases with medications such as:
– Actiminophine
– Aspirin
– Caffeine (this is sometimes used as a treatment because caffeine withdrawal can cause a migraine episode)

 

Migraines increase the risk of stroke and mental health problems like depression and bipolar disorder. They can also be associated or due to underlying medical conditions. Therefore, if left untreated can worsen existing symptoms and/or cause more severe symptoms.

Chapter 8: FAQ

FAQ’s
Q. What is the difference between Migraines and headaches?
A headache typically causes pain in the head that can radiate to the face or upper neck and can be on both sides. Migraine headaches, however, are much more severe and result in symptoms that can be delibating.

  1. Is there a genetic predisposition to migraines?
    The exact cause of migraines is unknown but it is said to be a result of abnormal brain activity. However, genetics have been linked to migraines – certain genes make individuals more prone to or sensitive to migraines and triggers that cause them.
  2. Can migraines cause strokes?
    No, migraines do not cause strokes. However, migraines can increase the risk of having a small stroke. A stroke is a medical emergency that results due to a blocked, leaking, or burst blood vessel.
  3. Do migraine damage the brain?
    No, migraines do not cause any brain damage even if there are severe and/or frequent.

Q. Do migraines affect children?
Yes, migraines can affect children but are often undiagnosed. Children as young as 12 can experience their first migraine attack.

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