Migraine: Causes, Symptoms, Types & Tests

Migraine is a common yet often misunderstood neurological disorder. Characterized by intense, throbbing headaches often on one side of the head, migraines can last for hours or even days. Alongside pain, people with migraines may experience nausea, vomiting, and sensitivity to light and sound. Some people also experience visual disturbances known as aura before or during a migraine attack. Although migraines are widely prevalent affecting an estimated one in seven people globally they are still under diagnosed and sometimes inadequately managed. Understanding migraines better is essential to recognizing symptoms early and seeking appropriate care.

What is Migraine?

Migraine is defined as a neurological disorder characterized by recurrent episodes of severe headaches, often accompanied by sensory disturbances. Unlike ordinary headaches, migraines typically cause moderate to severe pain, which may interfere with work, daily activities, and social life.

Migraines usually fall into two main patterns:

• With aura: Neurological symptoms (like visual flashes or tingling) that precede or accompany the headache.
• Without aura: The most common type, with headache attacks but no preceding aura.

Migraines can begin in childhood or adulthood and are more common in women than men, largely due to hormonal factors.

Causes of Migraine

The exact cause of migraines isn’t fully understood, but several contributing factors and triggers have been identified:

• Genetics: Family history is one of the strongest risk factors. If a parent has migraines, their child is significantly more likely to develop them.
• Brain activity: Changes in the brainstem and its interactions with the trigeminal nerve a major pain pathway may be involved.
• Neurotransmitters: Fluctuations in brain chemicals like serotonin play a role.
• Hormonal changes: Especially in women, fluctuations in estrogen (e.g., during menstruation, pregnancy, or menopause) can trigger migraines.
• Environmental triggers: Bright lights, loud noises, or strong smells can provoke an attack.
• Dietary factors: Certain foods and drinks like aged cheese, alcohol (especially red wine), chocolate, and processed meats containing nitrates.
• Stress: Emotional stress is a well-known trigger.
• Sleep changes: Too little, too much, or disrupted sleep patterns.
• Weather changes: Shifts in barometric pressure or extreme weather conditions.
• Medications: Certain drugs, like oral contraceptives or vasodilators.

It’s often a combination of factors rather than a single cause that leads to migraine attacks.

Symptoms of Migraine

Migraines can present differently from person to person, but common symptoms include:

• Intense headache: Often throbbing or pulsating, usually on one side of the head but can affect both.
• Aura (in some cases): Visual disturbances (flashing lights, blind spots), sensory changes (tingling in face or hands), or speech difficulties.
• Nausea and vomiting: Common during the headache phase.
• Sensitivity to light, sound, or smells: Bright lights, loud noises, or certain odors may worsen symptoms.
• Visual disturbances: Blurred vision or seeing zigzag patterns.
• Fatigue: After the headache subsides, many people feel drained or exhausted.

Migraines typically progress through four stages, though not everyone experiences all stages:

1. Prodrome: Subtle warning signs like mood changes, food cravings, or neck stiffness, hours or days before the attack.
2. Aura: Lasts 20-60 minutes, occurs in about 25% of people with migraine.
3. Headache: Can last 4-72 hours if untreated.
4. Postdrome: “Migraine hangover” with tiredness, confusion, or mood changes.

Types of Migraine

Migraines are categorized based on patterns, associated symptoms, and duration:

1. Migraine without aura:

• Most common type.
• Characterized by headache attacks lasting 4–72 hours.
• No preceding neurological symptoms.

2. Migraine with aura:

• Headache preceded by temporary neurological disturbances.
• Symptoms can include visual changes, speech difficulties, or tingling.

3. Chronic migraine:

• Occurs on 15 or more days each month, for more than three months.
• At least eight days each month must meet criteria for migraine.

4. Hemiplegic migraine:

• Includes temporary paralysis or weakness on one side of the body.

5. Vestibular migraine:

• Prominent dizziness or balance problems during migraine attacks.

6. Menstrual migraine:

• Related to hormonal changes and usually occurs around menstruation.

7. Retinal migraine:

• Causes temporary vision loss or disturbances in one eye.

Identifying the specific type is important, as treatment strategies may differ.

Tests Used to Diagnose Migraine

Migraine is largely diagnosed clinically based on medical history and symptoms. However, certain tests can help rule out other conditions:

• Neurological examination: Doctors check reflexes, muscle strength, coordination, and sensation.
• MRI scan: Helps detect brain tumors, infections, or structural abnormalities if headaches are new, severe, or changing.
• CT scan: Useful for identifying bleeding, stroke, or skull abnormalities.
• Electroencephalogram (EEG): Rarely used but may help if seizures are suspected.
• Blood tests: To check for infections, inflammation, or other underlying issues.

Keeping a headache diary noting timing, symptoms, potential triggers, and response to treatment can greatly assist doctors in diagnosis.

Treatment and Management

Migraine treatment aims to relieve symptoms during attacks and prevent future attacks:

• Acute treatments: Over-the-counter pain relievers (e.g., ibuprofen, aspirin), prescription medications like triptans (e.g., sumatriptan), anti-nausea drugs.
• Preventive treatments: For frequent or severe migraines. These include beta-blockers, antidepressants, anticonvulsants, and CGRP inhibitors.
• Lifestyle changes: Regular sleep, balanced diet, hydration, stress management techniques like yoga or mindfulness.
• Avoiding triggers: Identifying and minimizing exposure to known triggers.
• Alternative therapies: Acupuncture, biofeedback, and cognitive behavioral therapy may help some people.

Treatment should be tailored to individual needs, often combining medication with lifestyle adjustments.

Living with Migraine

Migraines can disrupt work, school, and social life. Having a treatment plan, support from family and doctors, and understanding personal triggers can significantly improve quality of life.

Tracking migraines and discussing changes with a doctor help ensure treatments remain effective as symptoms evolve.

Conclusion

Migraine is more than “just a headache” it’s a complex neurological disorder that can significantly affect quality of life. Understanding causes, symptoms, and treatment options empowers individuals to manage the condition more effectively. With proper diagnosis, tailored treatment, and lifestyle adjustments, many people can find relief and continue to lead active, fulfilling lives.

Frequently Asked Questions (FAQ’s)

What is migraine?
Migraine is a neurological disorder characterized by recurrent, often severe headaches, sometimes accompanied by aura and other symptoms.

What triggers migraine attacks?
Common triggers include stress, hormonal changes, certain foods, lack of sleep, and environmental factors like bright lights.

How long do migraine attacks last?
They can last from 4 to 72 hours if untreated.

Can children have migraines?
Yes, migraines can affect children as well as adults.

Is migraine hereditary?
Yes, a family history of migraine increases the likelihood of developing the condition.

What is an aura in migraine?
Aura refers to temporary neurological symptoms like visual disturbances or tingling that may occur before or during the headache.

Are there treatments to prevent migraines?
Yes, preventive medications and lifestyle changes can reduce frequency and severity of attacks.

Can migraines be cured?
There is no cure, but effective treatments and trigger management can help many people control their migraines.

Do migraines damage the brain?
Current research shows migraines don’t typically cause brain damage, but frequent attacks can impact daily life.

When should I see a doctor for migraine?
If headaches are severe, new, changing, or affect daily life, it’s important to consult a healthcare professional.