Migraine

Migraine headaches affect an estimated 28 million people in the United States. Characterized by intense pain on one side of the head or behind an eye or ear, these headaches can be brought on by certain triggers, such as food, lack of sleep, or light. However, the exact causes are unknown. Treatment options for a migraine may include medications, lifestyle changes, and alternative treatments.

What Is a Migraine?

A migraine is a medical condition characterized by severe pain felt on one, and sometimes both, sides of the head. The pain is mostly in the front, around the temples, or behind one eye or ear. Besides having pain, people with a migraine may have nausea and vomiting, and be very sensitive to light and sound.
 
It is the second most common headache syndrome in the United States (behind tension headaches). It is estimated that nearly 28 million Americans have this type of headache and 157 million workdays each year are lost due to the headaches' severity. Nearly half of all the estimated migraine sufferers are either undiagnosed or untreated.
 
Although both men and women can get these headaches, about three out of every four people who have them are women (see Women and Migraines). Most often, they affect people between the ages of 15 and 55. They often improve as the person ages. However, at this time, there is no cure.
 

Types

There are actually several different types of migraines. The two most common types are migraine with aura and migraine without aura. During a migraine with aura, a person has visual symptoms (also called an "aura") 10 minutes to 30 minutes before an attack. During a migraine without aura, a person does not have an aura but does have the other symptoms.
 
Several other less-common types include:
 
  • Hemiplegic migraine
  • Opthalmoplegic migraine
  • Basilar artery migraine
  • Benign exertional headache
  • Status migrainosus
  • Migraine aura without headache
  • Abdominal migraine.
 
(Click Types of Migraines to learn more.)
  

Causes and Triggers

Researchers are unclear about the precise cause or causes of these headaches. There seems to be general agreement, however, that a key element is blood flow changes in the brain.
 
Other possible causes may include:
 
  • Imbalances of brain chemicals
  • Genetics.
     
(Click Migraine Causes for more information.)
 
Also, while the direct cause is unknown, there are often controllable and uncontrollable migraine triggers. The most common ones are stress (see Stress-Related Migraines), anxiety, hormones, not eating, and weather changes. Certain types of food may also play a role (see Migraine Food Triggers or Migraine Diet).
 

Symptoms of a Migraine

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. It is often accompanied by extreme sensitivity to light and sound, nausea and vomiting, or loss of appetite.
 
These symptoms are possible regardless of whether a person is experiencing classic or common migraines. However, a person with classic migraines also experiences an "aura" just before the headache begins. To simplify terminology, healthcare providers now refer to classic migraines as "migraines with aura" and common migraines as "migraines without aura."
 
Both classic and common symptoms can strike as often as several times a week or as rarely as once every few years. More than 50 percent of people experience no more than one headache per week. A migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days.
 
(Click Migraine Symptoms to learn more about possible symptoms, including aura symptoms.)
 

Making a Diagnosis

In order to diagnose migraines, your healthcare provider will ask a number of questions about the headache, such as how often you have headaches or where the pain is. He or she will also ask about other symptoms that you may experience. Your healthcare provider will also perform a physical exam, looking for signs of conditions known to cause headaches. If your healthcare provider is unsure of the diagnosis, he or she may also order tests to rule out other more serious causes of headaches.
 

Treatment Options

There are many different treatment options. They will vary based on the frequency, severity, and disabling qualities of your headaches. Some people with mild, infrequent migraine headaches may do fine with over-the-counter medications. Other people may need more powerful medicines to treat moderate-to-severe attacks. Finally, others may have migraines so frequently that preventive treatment is recommended.
 
In general, your healthcare provider may recommend one or more treatment options, including:
 

Tension Headache Versus Migraine

While migraine headaches affect millions of people, they are still less common than tension headaches. Tension headaches cause a more steady pain over the entire head rather than throbbing pain in just one spot.
 
Most of the time, migraine attacks happen occasionally. However, tension headaches can occur as often as every day. While fatigue and stress can bring on both types of headache, migraines can be triggered by certain foods, changes in the body's hormone levels, and even changes in the weather.
 
There are also differences in how these two types of headaches respond to treatment with medicines. While some over-the-counter drugs used to treat tension headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension headaches.
 

When to Seek Help for a Migraine

Nearly half of the people in the United States who have migraine headaches do not get diagnosed and treated. The National Headache Foundation suggests that you talk with your healthcare provider about your headaches if:
 
  • You have several headaches per month and each one lasts for several hours or days
  • Your headaches disrupt your home, work, or school life
  • You have nausea, vomiting, vision problems, or other sensory problems.
Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD
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