Migraines – all you need to know

1.What are migraines?
2.Causes and Triggers
4.Stages of migraine symptoms
5.Common types of migraine
6.Other types of migraine
7.When to see a doctor
8.Lifestyle remedies and prevention strategies
9.Acute Migraine Medications
10.Preventive migraine medications

What are migraines?

Migraineis more than just a nasty headache. It’s a neurological disorder that causes severe and recurring pain. The pain is characterized by moderate-to-intense pulsing or throbbing, typically on only one side of the head.

A migraine may last up to three days, and the pain could be so severe that it interferes with your daily activities. Along with the headache pain, you may experience other symptoms, including heightened sensitivity to light and sound.

You can prevent a full-blown migraine attack by recognizing and acting upon the onset of symptoms.

Causes and Triggers

Migraines are typically triggered by the same factors each time. Recognizing the pattern is vital to avoiding migraines.

Abnormal brain activity

A migraine begins when the overactive nerve cells send signals that activate the trigeminal nerve (i.e., the nerve that supplies sensation to your head and face). That, in return, stimulates the release of neurotransmitters (e.g., serotonin), which irritate blood vessels and trigger the pain response. When these neurotransmitter signals keep firing for an extended period, your nerves become hypersensitive.

Family history

Migraine seems to run in families. 80% of people with migraines have other family members who have them. Furthermore, if one parent has a history of migraines, their child has a 50% chance of inheriting them, and if both parents have migraines, the risk increases to 75%.

Trigger foods and drinks

Certain foods and drinks can trigger a migraine.

Caffeinated drinks

Drinking too much or withdrawing from caffeine can trigger migraine headaches. Hence, you should limit your caffeine intake to one or two beverages daily (or 200 mg caffeine).


Wine, beer, and other alcoholic drinks contain ethanol, which can trigger migraine headaches (hangovers) by widening the blood vessels. You can alleviate hangovers by drinking plenty of water.

Food additives

Food additives like nitrates and monosodium glutamate (MSG) account for up to 30% of migraine triggers.


Another migraine trigger is tyramine, whichis found naturally in some foods, such as:

  • Aged cheeses
  • Smoked fish
  • Cured meats
  • Some types of beer

Also, protein-rich foods may contain high levels of tyramine if:

  • They have been sorted for a long time
  • They haven’t been kept for long enough

Eating habits

Migraine attacks may be triggered by:

  • Skipped meal or irregular mealtimes
  • Unhealthy snacks
  • Dehydration
  • Abrupt caffeine withdrawal

Sensory stimuli

Extreme sensory stimuli can trigger migraines. This include:

  • Flickering or bright lights (e.g., glare from a TV screen, sun glare)
  • Pungent smells (e.g., perfume, secondhand smoke, paint thinner)
  • Loud noises
  • Stuffy rooms
  • Extreme changes in temperature, humidity, or barometric pressure

Hormonal changes

Women are more likely than men to develop migraines due to fluctuating estrogen hormone levels. Hormonal migraines may occur before or during menstrual periods, pregnancy, and menopause. This generally improves after menopause.

Emotional triggers

Migraine headaches may precede the onset of emotional triggers or mental disorders, including:

  • Stress
  • Generalized anxiety disorder (GAD)
  • Major depression
  • Dysthymia
  • Bipolar disorder
  • Panic attacks
  • Panic disorder
  • Substance abuse disorders
  • Agoraphobia
  • Simple phobia

When you are in distress, your body releases “fight or flight” chemicals, which tenses your muscles and constrict blood vessels, both of which cause migraines.

Sleep disruption

The lack of sleep caused by insomnia could also cause migraines. Too little sleep, getting too much sleep or jet lag can trigger migraines in some people.

Physical factors

Physical triggers of migraine include:

  • Tiredness
  • Shoulder or neck tension
  • Intense physical overexertion (e.g., sexual intercourse)
  • Poor posture
  • Low blood glucose


Some hormone replacement therapy (HRT) medications, oral contraceptive pill, vasodilators, and sleeping pills have all been named as possible migraine triggers.


Migraine attacks may present as moderate-to-severe headaches on one side of the head in addition to other symptoms, including nausea and vomiting.

Migraine headaches

Migraine pain is usually on one side of the head, but it may occur on both sides or shift. The migraine pain typically starts in your temple around the forehead area.

Characteristics of the migraine pain include:

  • Throbbing
  • Pulsating
  • Pounding
  • Perforating
  • Debilitating

Most migraines persist for approximately 4 hours.

Vertigo and dizziness

Vertigo and dizziness may happen before or at the same time as the migraine headache. You may feel unsteady or lightheaded – the room seems like its spinning. This symptom may not begin until several years after the migraine headache episodes begin.

Vision problems

About 25% of people who suffer from migraine will experience an aura, which often includes visual symptoms, such as:

  • Flashing lights
  • Spots of light
  • Blind spots
  • Wavy lines

Vision problems typically start 20 minutes to an hour before the headache.

Allodynia (sensitivity to touch)

Migraine can cause your nerves to be hypersensitive to touch (allodynia). Allodynia occurs in 80% of migraine attacks.

Other symptoms

There are other symptoms to watch out for:

  • Sweating or cold hands
  • Increased appetite
  • Restlessness
  • Pale facial color
  • Drowsiness or depression
  • Excessive yawning
  • Surge of energy

Keep a diary of your migraine symptoms. Take it with you when you see your doctor so that you get proper treatment.

Stages of migraine symptoms

Migraine symptoms occur in a step-wise manner. The phases are:

  • Prodromal phase
  • Aura phase
  • Attack phase
  • Postdrome phase

Sometimes, a phase is skipped.

Prodromal phase (before the migraine): Early warning signs

Hours before the migraine onset – and sometimes even the day prior – you may experience some warning signs, including:

  • Hyperactivity
  • Irritability
  • Moodiness
  • Anxiety
  • Decreased appetite
  • Food cravings
  • Constipation
  • Fatigue or low energy
  • A brief period of depression
  • Frequent yawning
  • Neck stiffness
  • Thirsty and increased urination

Aura stage: strange feelings start

Approximately 30% of people with migraines experience an “aura” that begins before or during a headache episode. Auras may not happen with every headache, though.

An aura can include:

Changes in vision

  • A flickering, jagging arc of light. It may have a complicated shape. It typically appears on either side of your vision. After a few minutes, it might enlarge.
  • A blind spot in your field of vision. This problem – combined with the flickering lights – can make it difficult to drive or focus your eyes on small objects.
  • Hallucinations or “see” images from the past.

These symptoms may continue to worsen over the next several minutes.

Skin sensations

  • You may feel tingling or “pins and needles” in your body during an aura. It might also cause numbness. These sensations often affect the face and hands, but they could spread out across the body. They might continue to expand over the next few minutes.

Language problems

You might have a difficult time communicating with others. Symptoms include:

  • Trouble understanding written or spoken words
  • Trouble expressing thoughts when you write or speak
  • Confusion
  • Trouble concentrating

Attack phase: the headache begins

The attack phase is the most severe or acute of the migraine phases, during which the headache pain begins. In some people, this may overlap or occur during an aura. This phase may last anywhere from hours to days.

Symptoms during the attack phase include:

  • Pain on one side of the head or one eye
  • Pulsing and throbbing head pain above the eyes
  • Increased sensitivity to light, sounds, and smells
  • Nausea and vomiting
  • Lightheadedness and fainting

The attack phase of a migraine may persist from several hours to days. During this phase, you should rest quietly and refrain from normal activities.

Postdromal phase (after the migraine): after it stops

After the most severe phase of the migraine, you might feel unwell for up to a day.

Symptoms of post-migraine phase include:

  • Sluggishness
  • Extreme tiredness
  • Headache during physical activity
  • Confusion and dizziness
  • Moodiness

Your migraine symptoms, frequency, and intensity may change over time.

Common types of migraine

There are two primary forms of migraine – “migraine with aura” and “migraine without aura.” This classification depends on whether you experience any auras leading up to a migraine. Some people have both types.

Migraine with aura

Migraine with aura is a recurring headache pain that strikes during or after sensory disturbances, termed “aura.” This type of migraine occurs in 25% of people who have migraines.

Migraine aura typically occurs within an hour before head pain begins and usually persists for less than an hour. For many people with migraines, the auras act as an unmistakable warning sign before the onset of a severe headache. Auras can have positive or negative symptoms.

Positive symptoms

Migraine aura often begins with positive symptoms. Positive symptoms are triggered by the activation of the central nervous system.

Examples of positive symptoms include:

  • Visual disturbances like zig-zag lines, flashing spots, shimmering spots
  • Auditory problems like tinnitus or noises
  • Somatosensory symptoms such as pain
  • Motor abnormalities like repetitive or jerking movements

Negative symptoms

After the onset of positive symptoms, you may subsequently experience negative symptoms. Negative symptoms are manifested as:

  • Scotoma (i.e., blind spots) which may be outlined by simple geometric designs
  • Tunnel vision, blurry vision, or temporary vision loss
  • Numbness, pins and needles, muscle weakness, or temporary paralysis
  • Loss of hearing
  • Speech or language difficulty

Migraine without aura

More commonly, you may experience a migraine without aura, which accounts for approximately 75% of all migraine types. This type of migraine occurs without any sensory disturbance leading up to the attack.

Common symptoms of a migraine without aura include:

  • Pulsing or throbbing on one side of the head
  • Photophobia
  • Phonophobia
  • Pain that worsens with physical activity
  • Nausea and vomiting

Other types of migraine

Chronic migraine

Chronic migraine attacks occur more than 15 days a month for more than three months. The symptoms are experienced at least eight days per month.

During the initial onset of chronic migraine, you may notice that your headaches are less severe but happen more often. Most days feel like typical migraine, but there could be significant variability in the severity of the symptoms in any given day.

Chronic migraines are characterized by:

  • Severe headaches
  • Another type of chronic pain, like arthritis
  • Depression
  • Severe disability
  • Other comorbidities (serious health problems), like high blood pressure
  • Previous head or neck injuries

Acute migraine (episodic migraine)

Acute migraine (also known as episodic migraine) is a term for migraine headaches that occur up to 14 days a month. Thus, people with acute migraines have fewer headache episodes a month compared to those with chronic migraines.

Migraine with brainstem aura

Migrainewith brainstem aura are headaches that begin at the lower part of the brain, termed the brainstem. Hormonal changes in young women typically trigger this type of migraine.

Symptoms of migraine with brainstem aura include:

  • Headache pain
  • Double vision or graying vision
  • Dizziness or confusion
  • Nausea and vomiting
  • Loss of balance
  • Ringing in the ears
  • Trouble hearing
  • Trouble speaking or slurred speech
  • Tingling sensation
  • Loss of consciousness
  • Sensitivity to light and sound
  • Cold hands or feet

The symptoms may begin suddenly.

Cyclic migraines

As the name suggests, cyclic migraines are migraines that occur in cycles. Cyclic migraines may happen daily or several times a week for 1-6 weeks, with low-grade headaches in between. An average attack lasts about 6 hours and is followed by an “off” cycle that may last up to months. They’re different from cluster headaches.

Symptoms include:

  • Headache pain
  • Aura
  • Fatigue
  • Poor concentration
  • Depression
  • Stiff neck
  • Nausea and vomiting
  • Sensitivity to light and sound

Ocular migraine

An ocular migraine is a rare type of migraine characterized by temporary loss of vision in one eye. It is triggered by reduced blood flow or spasms of blood vessels within the retina or behind the eye.

The symptoms of ocular migraine include:

  • A partial loss of vision or blind spot (scotomata)
  • Flashes of light (scintillations)
  • Temporary loss of vision in one eye
  • Impaired motor skills
  • Slurred speech
  • Sensitivity to light and sound
  • Numbness or tingling on one side of the body
  • Nausea and vomiting
  • Intense headache pain, which might pulsate or throb, in one or both sides of the head

The visual disturbances usually occur within an hour of the head pain. The symptoms usually dissipate on their own within an hour. 

Retinal migraine

Retinal migraine is a rare eye condition that causes you to lose vision in one eye temporarily. It occurs when the blood vessels to the eye suddenly constrict, reducing the blood flow to the eye. Afterward, the blood vessels relax, blood flow resumes, and vision is restored. The frequency of retinal migraines vary, but many people who experience them will have one episode every few months.

The symptoms of retinal migraine include:

  • Temporary partial or total loss of vision in an eye – this usually persists 10-20 minutes before vision gradually returns
  • Scintillations – seeing twinkling lights or flashing lights
  • Scotomas – the pattern of black spots that eventually become bigger
  • Headache – this might happen before, during or after the vision disturbance

Fortunately, these symptoms typically dissipate without any permanent vision loss.

Visual migraine

Visual migraine usually affects both eyes, unlike ocular migraines. If you’re experiencing visual disturbance and you’re unsure if it’s ocular migraine or a visual migraine, then cover one eye at a time. If it affects both eyes, it might be a visual migraine.

Possible symptoms of visual migraine include:

  • A flickering blind-spot in the center of your field of vision
  • A wavy or zig-zag ring of colored light surrounding a central blind spot
  • A blind spot that gradually migrates across your visual field

Vestibular migraine (migraine-associated vertigo)

Vestibular migraine is a nervous system disorder. Unlike common migraines, you might not always experience a headache.

Vestibular symptoms include:

  • Dizziness (vertigo) that comes and goes
  • Nausea and vomiting
  • Loss of balance
  • Sensitivity to sound
  • Extreme motion sensitivity – feeling dizzy or sick when you move your head, eyes, or body
  • Feeling disorientated or confused
  • Feeling unsteady, like you’re in a rocking boat

Silent migraine (acephalgic migraine)

Silent migraine refers to a type of migraine without any headache. Visual aura symptoms are most common.

A silent migraine can affect your body in numerous ways, including:

  • Upset stomach or vomiting
  • Hot flashes and chills
  • Stuffy or runny nose
  • Dizziness or vertigo
  • Sore neck or jaw
  • Sensitivity to light, sounds, smells, touch, or motion
  • Confusion

Menstrual migraine

Menstrual migraine occurs in a pattern associated with the menstrual cycle, as a result of a fluctuation in estrogen levels. Approximately 60% of women with migraines also experience menstrual migraines. They may occur before, during, or after menstruation or during ovulation.

Symptoms of menstrual migraine include:

  • Aura before the headache
  • Throbbing pain on one side of your head
  • Nausea and vomiting
  • Sensitivity to light and sound

Hemiplegic migraine

Hemiplegic migraine briefly causes weakness on one side of the body. This may involve the face, leg, or arm, and may be accompanied by temporary numbness or tingling sensation. It can mimic the symptoms of a stroke.

Symptoms of hemiplegic migraine include:

  • Severe, throbbing pain, often on one side of your head
  • A pins-and-needles sensation, often from your hand to arm
  • Numbness on one side of your body, which can include your arm, leg, and half of your face
  • Weakness or paralysis on one side of your body
  • Seeing zig-zag lines, double vision or blind spots
  • Extreme sensitivity to light, sound, and smell
  • Speech difficulties such as slurring, mixing words or trouble remembering a word
  • Loss of balance and coordination
  • Dizziness or vertigo
  • Nausea and vomiting
  • Confusion

Status migrainosus

Status migrainosus refers to amigraine that persists for more than 72 hours. This severe and rare type of migraine could cause intense symptoms.

A typical migraine may transform into status migrainosus if:

  • You don’t get treatment early enough after the onset of a migraine attack
  • You don’t get proper treatment
  • You overuse headache medicine

Also, because status migrainous persists for at least three days, you may be at risk of dehydration and insomnia due to prolonged pain and vomiting.

When to see a doctor

See a doctor if:

  • You’re suffering from migraines more than five times a month
  • You have abrupt, severe headaches
  • The migraines are beginning to affect your quality of life
  • Headaches start when you are physically active, coughing, straining, or having sex
  • Your headaches start for the first time after the age of 50
  • You lose weight unintentionally
  • You develop a fever or stiff neck
  • You lost consciousness

Doctors may prescribe you medications and also rule out serious conditions, such as stroke.

Lifestyle remedies and prevention strategies

You can take proactive steps to reduce the risk of having a migraine. Controlling triggers can confer substantial relief.

Keep a migraine diary

To help identify a migraine, you should keep a diary noting the details, including:

  • Symptom severity, duration, and frequency
  • Any associated symptoms
  • Potential triggers
  • Medications that relieve symptoms

Continue recording in your migraine diary after you consult your doctor. It can help you learn about your migraine triggers and what treatment is most effective.

Dim the lights

Flickering or bright light may cause migraine headaches.

Ways to minimize light exposure include:

  • Wear sunglasses outdoors
  • Cover windows with blackout curtains during the daytime
  • Use anti-glare computer screens
  • Use daylight-spectrum fluorescent bulbs in light fixtures


If you are in the middle of a migraine attack, you should retreat to a quiet, darkened room. Close your eyes and rest. Relieve the tension in your shoulders, neck, and back. Sleep if you can and try to minimize exposure to migraine triggers.


Biofeedback can help teach you ways to deal with stress-induced migraines. This relaxation technique uses specialized equipment to help you monitor and control certain physiological responses associated with stress, like muscle tension. It can prevent a full-blown migraine attack.

Cognitive-behavioral therapy

Cognitive-behavioral therapy could benefit some people with migraines. This type of psychotherapy educates you on how behaviors and thoughts affect perceived pain.

Cold compress

Place a cold compress or ice pack on your forehead or at the back of your neck. It can help constrict the blood vessels and reduce inflammation within the area, thereby relieving migraine pain. Apply the cold compress or ice pack for 15 minutes, and then take a break for 15 minutes before resuming.

Exercise regularly

Regular aerobic exercise can help prevent migraines by relaxing your muscles. Aerobic activities that may help include walking, swimming, and cycling. Warm-up slowly, however, because intense exercise can trigger migraines.

Avoid strong smells

Strong odors may trigger migraines. If you think you might be hypersensitive to strong-smelling chemicals, you should avoid cigarette smoke, perfumes, and strongly-scented foods.

Essential oils

Essential oils can help relieve acute migraine symptoms. We recommend lavender and peppermint essential oil. You can apply it topically on your forehead or inhale it.

Try a herbal remedy

Herbal remedies of migraine include:

  • Feverfew extract (50-100 mg)
  • Magnesium supplements
  • Ginger tea
  • Vitamin B complex
  • Vitamin E (for menstrual migraines)


Caffeine can help mitigate migraine symptoms by relaxing the blood vessels and reducing inflammation. It can also boost the effectiveness of pain relievers. However, be careful not to take too much caffeine as it could paradoxically trigger migraines when taken in excessive amounts.

Try an elimination diet

Avoid trigger foods, including:

  • Aged cheese, chocolate, coffee, alcohol, and citrus fruits
  • Foods that contain gluten (try a gluten-free diet instead)
  • Foods high in histamine
  • Alcohol

Acute Migraine Medications

Consider seeking medical treatment if lifestyle changes don’t relieve the frequency and symptoms of migraines. Acute migraine treatments are taken at the onset of migraine symptoms to relieve the symptoms. However, taking any of these medications too frequently can trigger a rebound headache (also known as medication-overuse headaches).

OTC Painkillers

If you feel an onset of a migraine, consider taking a non-prescription pain reliever. Otherwise known as an acute or abortive treatment, these pain relievers are designed to halt symptoms.

Over-the-counter (OTC) medications that are effective include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Acetaminophen (Excedrin, Tylenol)
  • Diclofenac (Cataflam)
    Ketorolac (Toradol)
  • Aspirin
  • Excedrin Migraine (a combination of aspirin, caffeine, and acetaminophen)

Be cautious when you take too many OTC painkillers because they can trigger rebound headaches (medication-overuse headaches).


Ergotaminesare a class of drugs that can contract blood vessels in the brain. It may relieve a migraine within several minutes.

Some ergotamines include:

  • Dihydroergotamine (DHE-45, Migranal)
  • Ergotamine (Ergomar)
  • Ergotamine and caffeine (Cafatine, Cafergot, Cafetrate, Migergot, Ercaf)
  • Methylergonovine (Methergine)
  • Methysergide (Sansert)

Ergotamines are available as tablets, pills, suppositories, nasal sprays, and injections. They’re typically taken at the first sign of migraine symptoms.


For difficult-to-treat migraines, doctors may prescribe triptans. It increases serotonin levels in the brain, thereby constricting blood vessels and reducing inflammation.

Popular options of triptans include:

  • Sumatriptan (Imitrex, Tosymra)
  • Rizatriptan (Maxalt)

They come in the form of pills, shots, nasal sprays, and injections.

Drugs that treat nausea

Anti-nausea drugs can reduce nausea and vomiting that accompany severe migraines.

Some include:

  • Metoclopramide (Reglan)
  • Dimenhydrinate (Gravol)
  • Prochlorperazine (Compazine)
  • Promethazine (Phenergan)
  • Trimethobenzamide (Tigan)

They’re typically taken with a painkiller, as they don’t reduce pan.


Ifmigraine pain fails to respond to other medications, your doctor may prescribe opioids.

Opioids include:

  • Morphine
  • Codeine
  • Oxycodone (OxyContin)
  • Meperidine (Demerol)

Opioid posses a high-risk fo addiction, so they are prescribed sparingly. They are only used if no other migraine medications are effective.

Preventive migraine medications

Preventive migraine medications can mitigate the frequency and severity of migraines when taken regularly. Your doctor might prescribe preventive medications if your migraines are frequent, chronic, or severe, and don’t respond well to treatment.


Commonly prescribed for high blood pressure, beta-blockers reduce the effects of stress hormones on your blood vessels and heart. It can also help to reduce both the frequency and intensity of migraines.

Examples of beta-blockers include:

  • Atenolol (Tenormin)
  • Metoprolol (Toprol XL)
  • Propranolol (Inderal)
  • Nadolol (Corgard)
  • Timolol (Blocadren)

These drugs are a mainstay for preventing episodic migraines.

Calcium channel blockers

Calcium channel blockers are blood pressure medications that moderate the dilation and constriction of your blood vessels.

Some calcium channel blockers include:

  • Diltazem (Cardizem, Cartia XT, Dilacor, Tiazac)
  • Verapamil (Calan, Verelan, Covera, Isoptin)
  • Nimopidine (Nimotop)

Anticonvulsants (Anti-seizure drugs)

Anticonvulsants prevent seizures and may also alleviate migraine symptoms by calming the overactive nerves in your brain.

Some anticonvulsants include:

  • Gabapentin (Neurontin)
  • Divalproex (Depakote)
  • Pregabalin (Lyrica)
  • Tiagabine (Gabitril)
  • Valproate (Depakene)
  • Topiramate (Topamax)
  • Zonisamide (Zonegran)
  • Levetiracetam (Keppra)


Antidepressants can help increase the levels of serotonin in the brain, which in return may reduce inflammation and constrict blood vessels.

Some antidepressants used to treat migraines are:

  • Fluoxetine (Prozac, Sarafem)
  • Amitriptyline (Elavil, Endep)
  • Paroxetine (Paxil, Pexeva)
  • Venlafaxine (Effexor)
  • Sertraline (Zoloft)
    Imipramine (Tofranil)
  • Nortriptyline (Aventyl, Pamelor)

CGRP antagonists

Calcium gene-related peptide (CGRP)antagonists are the newest class of medications approved for the prevention of migraines. They target the CGRP protein found in the brain.

Examples of CGRP antagonists include:

  • Erenumab (Aimovig)
  • Fremanezumab (Ajovy)

Botulinum toxin

Botox (OnabotulinumtoxinA) can be injected into your forehead or neck muscles if you have chronic migraines. The injections are typically repeated every three months. It could be a viable option if you don’t experience relief from conventional migraine treatments.


There are a few surgical procedures that are utilized to treat migraines, including neurostimulation procedures and migraine trigger site decompression surgery (MTSDS).

Neurostimulation surgeries

Duringneurostimulation surgery, electrodes are inserted under your skin. The electrodes transmit electrical stimulation to the affected nerves.

Several types of stimulators are used, including:

  • Deep brain stimulators
  • Occipital nerve stimulators
  • Sphenopalatine ganglion stimulators
  • Vagal nerve stimulators


Migraine trigger site decompression surgery (MTSDS) is a surgery that involves releasing the nerves around the head and face, which are potential trigger sites for chronic migraines. The surgeon uses Botox injections to identify the trigger point nerves, and then subsequently decompress or deactivate the isolated nerves.


Migraine is a neurological disorder that causes severe and debilitating headaches. The most common type of migraine is those with aura or those without aura. Understanding the type and triggers of your migraines may help you identify ways to reduce their frequency.

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