Migraine headache is a result of specific changes within the brain. It causes severe head pain that is often accompanied by sensitivity to light, sound, or smells.

• Common symptoms of migraine are:
  • Eye pain
  • Sensitivity to light or sound
  • Nausea
  • Vomiting
  • Severe pain, usually on one side of the head that some individuals describe as "pounding"
• Other types of headaches can also cause severe pain, and not all headaches are migraines. For example, some people describe the pain of cluster headaches as the worst pain they have experienced.
• The exact cause of migraines is not known. Changes in neurotransmitter levels within the brain are thought to play a role.
• Migraines are diagnosed by the typical clinical signs and symptoms.
• A number of factors can trigger migraines to include:
  • hormonal changes,
  • stress,
  • strong stimuli like loud noises, and
  • certain foods.
• Treatment of migraine involves over-the-counter (OTC) or prescription medications.
• Prescription medications used to relieve the pain of migraine include the triptans, for example,
  • sumatriptan (Imitrex, Alsuma, Imitrex STATdose System, Sumavel DosePro),
  • rizatriptan (Maxalt, Maxalt-MLT),
  • eletriptan (Relpax),
  • zolmitriptan (Zomig, Zomig-ZMT),
  • naratriptan Amerge),
  • almotriptan (Axert), and
  • frovatriptan (Frova).
• Lifestyle modifications such as diet and exercise may be useful to help migraine sufferers manage the triggers of their condition.
• Avoiding dietary triggers of migraines may be able to help some patients decrease the frequency of attacks.
• Some people find that exercises, such as yoga, that promote muscle relaxation are helpful in pain management.
• Most people with migraines find their condition to be manageable with a combination of medications and lifestyle modifications.
• Preventive medications of a variety of drug classes may be used in some patients to decrease the frequency of migraines.

What is a migraine?

Although many people use the term "migraine" to describe any severe headache, a migraine headache is the result of specific physiologic changes that occur within the brain and lead to the characteristic pain and associated symptoms of a migraine.

Migraine headaches are usually associated with sensitivity to light, sound, and smells. In addition, many patients experience nausea or vomiting. The headache of a migraine often involves only one side of the head but in some cases, patients may experience pain bilaterally or on both sides. The pain of a migraine is often described as throbbing or pounding and it may be made worse with physical exertion.

In some cases, patients with migraines experience specific warning symptoms, or an aura, prior to the onset of their headache. These warning symptoms can range from flashing lights or a blind spot in one eye to numbness or weakness involving one side of the body. The aura may last for several minutes, and then resolves as the head pain begins or may last until the headache resolves. For patients who have never experienced an aura, the symptoms can be frightening and can mimic the symptoms of a stroke.

Not all headaches represent migraines, and migraine is not the only condition that can cause severe and debilitating headaches. For example, cluster headaches are very severe headaches that affect one side of the head in a recurrent manner (occurring in a "cluster" over time). The pain is sometimes described as "drilling," and can be worse than migraine pain in some cases. Cluster headaches are less common than migraine.

Tension headaches are a more common cause of headache. Thee occur due to contraction of the muscles of the scalp, face, and neck.

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from Depression to euphoria
• Food cravings
• Neck stiffness
• Increased urination
• Fluid retention
• Frequent yawning

Aura

For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They're usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes.

Examples of migraine auras include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking

Attack

A migraine usually lasts from 4 to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

• Pain usually on one side of your head, but often on both sides
• Pain that throbs or pulses
• Sensitivity to light, sound, and sometimes smell and touch
• Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

Though migraine causes aren't fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are a number of migraine triggers, including:

• Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.

  Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.

• Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
• Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
• Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
• Weather changes. A change of weather or barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
• Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
• Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Migraine medications

The treatment of an acute migraine headache may vary from over-the-counter medicines (OTC), like acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin, etc.) to prescription medications.

Triptans

• Triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, naratriptan, almotriptan, and frovatriptan), may be extremely effective in treating migraines and may be prescribed to help the patient treat their migraine at home.
• Not every patient can take these medications, and there are specific limitations regarding how often these medications can be used.
• Other medication regimens may also be used to control migraine headache.
• Some medications are appropriate for home use and others require a visit to the health-care professional's office or emergency department.

Narcotics

Narcotic pain medications are not necessarily appropriate for the treatment of migraine headaches and are associated with the phenomenon of rebound headache, where the headache returns -- sometimes more intensely -- when the narcotics wear off. In all cases of migraine, the use of acute pain therapies must be watched closely so that a patient does not develop medication overuse headache.

Other medications

If an individual experiences frequent headaches, or if the headaches routinely last for several days, then preventive medications may be indicated. These may be prescribed on a daily basis in an effort to decrease the frequency, severity, and duration of migraine headaches. There are many different medications which have been shown to be effective in this role, including:

• blood pressure medications, for example, propranolol (Inderal), nadolol (Corgard), verapamil (Clan, Covera, Isoptin, Verelan), and flunarizine),
• anti-seizure medications, for example, divalproex sodium (Depakote and others), topiramate (Topamax), and gabapentin (Neurontin, Gralise),
• antidepressant medications (amitriptyline and venlafaxine) and
• other supplements (magnesium, butterbur, and riboflavin).

The specific medication which is selected for a patient is dependent on many other factors, including age, sex, blood pressure, and other pre-existing medical conditions.

Some patients who experience more than 15 headache days every month might benefit from Botox injections.

What self-care treatment and lifestyle changes work for migraines?

Individuals who experience migraines can play a significant role in managing their headache frequency and severity.

Keep track of when migraines occur by using a paper or digital headache diary or log to track pain levels, triggers, and symptoms. This can help identify patterns which precede a migraine, as well as help identify factors which contribute to the development of the headache. Once these contributing factors are known, lifestyle modifications can lessen their impact. These modifications may include:

• Maintain a regular schedule for eating and sleeping
• Avoid certain foods that might trigger a migraine
• Keep well hydrated since dehydration has been identified as a migraine trigger for some people
• Exercise regularly

Relaxation strategies and meditation also have been recognized as effective strategies to prevent migraines and decrease headache severity.

Exercise and migraine

Some people find that exercises that promote muscle relaxation can help manage the pain of migraines. Examples of types of mind-body exercises that can help encourage relaxation are:

• Meditation
• Progressive muscle relaxation
• Guided imagery
• Yoga

Diet and Migraine

There is no specific diet for people with migraine that helps with symptom relief. However, as mentioned previously, certain foods can be triggers for migraines in susceptible people. These foods include:

• red wines,
• aged cheeses,
• preservatives used in smoked meats (nitrates),
• monosodium glutamate,
• artificial sweeteners,
• chocolate, and
•  dairy products.

Alcoholic beverages can also trigger migraine in some people.

Understanding the particular triggers of your migraines and avoiding these dietary triggers may help some sufferers decrease the frequency of attacks.

How are migraines managed during pregnancy?

Many women find that their headaches stabilize or even resolve during pregnancy. This may be related to more consistent hormone levels that occur during pregnancy. To decrease the risk of birth defects, certain medications used to prevent migraines may need to be discontinued prior to a pregnancy.

There are limited studies of medications which are used to treat migraine headaches during pregnancy. Acetaminophen is relatively safe when used in recommended doses. If a patient is experiencing frequent headaches, there are some treatment alternatives that may be provided by the patient's health-care professional. Many migraine medications, including the triptans, are not well studied in pregnancy; the potential benefits to the patient need to be weighed against the risks to the fetus before these medications are prescribed.

Several factors make you more prone to having migraines, including:

• Family history. If you have a family member with migraines, then you have a good chance of developing them too.
• Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
• Sex. Women are three times more likely than men to have migraines.
• Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.