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Neurosciences and Behavioral Health Center

Migraine

Migraine is a type of recurring headache that involves nerves and brain chemicals.

Two types of migraines can occur:

  • With an aura (formerly called "classic")
  • Without an aura (formerly called "common")

Auras cause a perceptual disturbance, lights or smells, before a migraine or seizure.

Migraine may happen several times a week or once every couple of years. Their severity can interfere with your ability to work and carry on normal activities.

Potential Causes of Migraines

While the precise cause is not known, many triggers have been identified, including:

  • Environment (e.g., odors, bright lights)
  • Dietary  (e.g., alcohol)
  • Certain medicines
  • Changes in sleep patterns
  • Stress
  • Physiologic changes (e.g., menstruation, puberty)
  • Weather changes

Risk

Factors that increase your chance for migraines may include:

  • Gender: more common in adult females
  • Age: most migraines occur by age 40
  • Family history of migraines
  • Menstruation
  • Obesity

Migraine Symptoms

Migraines occur in phases.

Warning

In the hours or days before the headache, warning symptoms may include:

  • Changes in mood, behavior and/or activity level
  • Fatigue
  • Yawning
  • Food craving or decreased appetite
  • Nausea, diarrhea
  • Sensitivity to light

Aura

The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:

  • Flashing lights, spots or zig zag lines
  • Temporary, partial loss of vision
  • Speech difficulties
  • Weakness in an arm or leg
  • Numbness or tingling in the face and hands
  • Confusion
  • Dizziness, lightheadedness
  • Speech disturbances
  • Cognitive dysfunction

Headache

Migraine pain starts within an hour of the aura ending. Symptoms include:

  • A headache (usually on one side but may involve both sides) that often feels:
    • Moderate to severe in intensity
    • Throbbing or pulsating
    • More severe with bright light, loud sound or movement
  • Nausea or vomiting
  • Diarrhea
  • Lightheadedness or dizziness

Post-Headache Period

Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:

  • Trouble concentrating
  • Fatigue
  • Sore muscles
  • Irritability
  • Mood changes

You should seek medical attention to make sure these symptoms aren’t due to a more serious cause like stroke or seizure. CT, MRI and/or blood tests can help diagnose your migraine.

Therapy for a Migraine Headache

Migraine therapy aims to:

  • Prevent headaches
  • Reduce headache severity and frequency
  • Restore your ability to function
  • Improve quality of life

Medications

Pain medicines are often needed to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.

Warning: Regular use of some over-the-counter medicines may cause a rebound headache.

Some prescription medicines act directly to stop the cause of the migraine headache. These include drugs that:

  • Quiet nerve pathways
  • Reduce inflammation
  • Bind receptors for serotonin, a brain chemical

Medicines that can help stop a migraine once it has begun include:

  • Triptans
  • Steroids
  • Acetaminophen (Tylenol)
  • Non-steroidal anti-inflammatory drugs (NSAIDS) 
  • Medicines for nausea
  • Ergots
  • Combination medicine that contains caffeine

Other drugs can help prevent migraines for people with frequent migraines. Taken every day, these preventative medicines include:

  • Beta-blockers
  • Calcium channel blockers
  • Tricyclic antidepressants
  • Anticonvulsants
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)

Procedures

Botulinum Toxin Injections

Botulinum toxin injections may be used as a way to prevent migraines and to reduce the duration and intensity of the headaches in people who have headaches often.

Surgery

In some people, the stimulation of certain brain nerves trigger migraines. With surgery, a doctor finds the nerve trigger point in the head and deactivates it. This surgery may reduce the number of migraines or completely eliminate them in sufferers who do not respond to conventional treatments. Most migraines are not treated with surgery.

Self-Care During the Migraine

  • Apply cold compresses to painful areas of your head.
  • Lie in a dark, quiet room.
  • Try to fall asleep.

Lifestyle Changes

  • Keep a diary. It will help identify what triggers migraines and what helps relieve them.
  • Learn stress management and relaxation techniques.
  • Consider counseling to learn new coping skills and relaxation techniques.
  • Exercise regularly.
  • If you are a smoker, quit. Smoking may worsen a migraine.
  • Avoid foods that trigger migraines.
  • Eat regular meals.
  • Maintain your regular sleep pattern even during the weekend or on vacation.

You can also try mind-body therapies such as:

  • Biofeedback
  • Cognitive behavioral therapy
  • Guided imagery (may improve pain coping)
  • Massage therapy

Foods suspected to trigger migraines include:

  • Nuts and peanut butter
  • Beans (e.g., lima, navy, pinto and others)
  • Aged or cured meats
  • Aged cheese
  • Processed or canned meat
  • Caffeine (intake or withdrawal)
  • Canned soup
  • Buttermilk or sour cream
  • Meat tenderizer
  • Brewer's yeast
  • Avocados
  • Onions
  • Pickles
  • Red plums
  • Sauerkraut
  • Snow peas
  • Soy sauce
  • Anything with MSG (monosodium glutamate), tyramine or nitrates

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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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