Behind the Brain

Introduction

Migraines aren’t just bad headaches. They are a neurological condition that affects around 12% of the world population – about 1 billion people. Migraine caused episodes can last multiple hours and even days, greatly disturbing regular life. In fact, the WHO rates migraines among the top 10 most disabling medical conditions.

In this article, we’ll explore what migraines really are, their various triggers, how to recognize symptoms, and the best treatment options. Whether you are a migraine sufferer or a concerned friend or family member, this article will give insights into everything to do with migraines.

Please note that this is not official advice. A doctor should be consulted before taking any treatment.

What Are Migraines?

Clinical Definition

Migraines are recurring, severe headaches that affect one side of the head. They are also accompanied by changes in brain activity and blood flow. These additional symptoms make migraines a neurological condition rather than a pain condition. During a migraine, brain chemicals, nerve signals, and blood vessels, change temporarily leading to inflammation and pain.

Types of Migraines:

• Migraine Without Aura: This type of migraine has throbbing pain without preceding visual disturbances.
• Migraine With Aura: This type of migraine has throbbing pain with preceding visual disturbances.These disturbances (aura) include flashing lights, temporary blind spots, and zigzag lines.
• Chronic Migraine: These migraines last 15 days a month, with migraines coming at least 8 out of those 15 days. This has to repeat for at least 3 months in a row to be considered chronic migraine.
• Vestibular Migraine: Vertigo and balance problems instead of headache pain.
• Hemiplegic Migraine: This type of migraine results in temporary paralysis or weakness on a certain side of the body.
• Retinal Migraine: Temporary vision loss in one eye is followed by a headache.
• Abdominal Migraine: Primarily affecting children, this type of migraine’s main symptom is stomach pain.

Risk Factors:

• Genetics: Having a first-degree relative with migraines increases your risk by 50%.
• Sex: Women are three times more likely than men to experience migraines.
• Age: Migraines typically begin during adolescence but peak during your 30s.
• Hormonal changes: Fluctuations in estrogen often trigger migraines in women.
• Underlying conditions: Depression, anxiety, epilepsy, and sleep disorders are associated with higher migraine risk.

Recognizing Migraine Symptoms

Migraines typically progress through four distinct phases. However, not every person with migraines experience all phases:

1. Prodrome Phase (1-2 days before): Up to 80% of migraine sufferers experience subtle warning signs:
   • Mood changes (depression, irritability, or unusual euphoria)
   • Food cravings
   • Neck stiffness
   • Increased thirst and urination
   • Frequent yawning
   • Constipation
   • Difficulty concentrating
2. Aura Phase (typically before headache): About 25-30% of migraine sufferers experience aura symptoms:
   • Visual disturbances (flashing lights, zigzag lines, blind spots)
   • Sensory changes (tingling or numbness in face or extremities)
   • Speech or language difficulties
   • Weakness in limbs (in hemiplegic migraine)
   • Auditory hallucinations or ringing in ears
   • These symptoms typically last 20-60 minutes
3. Headache Phase (4-72 hours): This is the main attack phase and typically includes:
   • Moderate to severe pain, often pulsating or throbbing
   • Unilateral pain (typically affecting one side of the head)
   • Pain that worsens with physical activity
   • Nausea and/or vomiting
   • Sensitivity to light (photophobia)
   • Sensitivity to sound (phonophobia)
   • Sensitivity to smells (osmophobia)
   • Dizziness or vertigo
   • Blurred vision
   • Dehydration (often from vomiting or reduced fluid intake)
4. Postdrome Phase (up to 24-48 hours after): Called the “migraine hangover”, this phase includes:
   • Fatigue and weakness
   • Cognitive difficulties or “brain fog”
   • Dizziness
   • Continued sensitivity to light and sound
   • Mood changes (depression or euphoria)
   • Neck pain or stiffness
   • Primary symptoms during an attack

Common Migraine Triggers

Identifying and managing triggers is very important for migraine prevention. The most common triggers include:

Environmental Triggers

• Weather changes: Pressure fluctuations, storms, high humidity
• Bright or flickering lights: Including fluorescent lighting, computer/phone screens
• Strong smells: Perfumes, cleaning products, paint, gasoline
• High altitude: Changes in oxygen levels and pressure
• Tobacco smoke: Air pollutants
• Excessive noise

Dietary Triggers

• Alcohol: Especially red wine, beer, and spirits
• Caffeine: Both excessive consumption and withdrawal
• Food additives: MSG, artificial sweeteners (aspartame), nitrates and nitrites (in processed meats)
• Tyramine-rich foods: Aged cheeses, cured meats, fermented foods
• Chocolate
• Citrus fruits
• Skipping meals or fasting

Lifestyle Triggers

• Stress: Both during stressful periods and after stress subsides (“weekend migraines”)
• Sleep disturbances: Both too little and too much sleep
• Physical exertion: Intense exercise, especially if not hydrated properly
• Dehydration
• Eye strain from prolonged screen time
• Poor posture causing neck and shoulder tension
• Travel and time zone changes

Hormonal Triggers

• Menstruation: Fluctuations in estrogen before and during periods
• Hormonal contraceptives: Birth control pills, patches, or rings
• Pregnancy: Some women experience relief during pregnancy, while others find their migraines worsen
• Perimenopause and menopause: Hormonal fluctuations during this transition
• Hormone replacement therapy

Treatment Options

Acute Treatments (Stopping)

• Over-the-counter medications:
  • NSAIDs: Ibuprofen (Advil, Motrin), naproxen sodium (Aleve), aspirin Acetaminophen (Tylenol)Combination medications: Excedrin Migraine (acetaminophen, aspirin, caffeine)
• Prescription treatments (abortive and preventive)
• New treatments and breakthroughs (CGRP inhibitors, etc.)
• Non-pharmaceutical approaches

Preventative Treatments

• Beta-blockers: Propranolol, metoprolol, timolol
• Antidepressants: Amitriptyline, venlafaxine
• Anticonvulsants: Topiramate (Topamax), valproate
• Calcium channel blockers: Flunarizine (not available in US)
• CGRP receptor antagonists: Atogepant (Qulipta)

Conclusions

Migraines remain a challenging condition, but significant advances in understanding and treatment offer hope. The key to effective management lies in a personalized approach that combines appropriate medications, lifestyle modifications, trigger avoidance, and coping strategies.

If you suffer from migraines, remember that finding the right treatment plan often takes time and patience. Work closely with healthcare providers, maintain detailed records of your symptoms and triggers, and don’t hesitate to seek specialized care if your migraines significantly impact your quality of life.

By taking an active role in your migraine management and staying informed about new developments, you can minimize the impact of migraines and regain control of your daily life.

Frequently Asked Questions

Are migraines dangerous?

While migraines themselves aren’t life-threatening, they can significantly impact quality of life. In rare cases, they may increase risk for certain complications like stroke, especially in people who experience aura and have other risk factors. New or unusually severe headaches should always be evaluated by a healthcare provider to rule out other conditions.

Can migraines be cured?

Currently, there’s no permanent cure for migraines. However, with proper treatment and lifestyle modifications, many people achieve significant reduction in frequency and severity of attacks. Some individuals also experience natural remission as they age, particularly after hormonal changes like menopause.

How can I prevent migraine attacks?

Prevention involves identifying and avoiding personal triggers, maintaining regular sleep and meal schedules, managing stress, staying hydrated, and—for those with frequent migraines—possibly taking preventive medications or using neuromodulation devices. Regular exercise and stress management techniques have also shown effectiveness in reducing migraine frequency.

Are migraines hereditary?

Yes, migraines have a strong genetic component. If one parent has migraines, children have a 50% chance of developing them. If both parents are affected, the risk increases to 75%. Specific genetic variations affecting brain chemistry, pain pathways, and blood vessel function have been identified in migraine sufferers.

How are migraines different from tension headaches?

Tension headaches typically cause mild to moderate pain on both sides of the head with a steady, band-like pressure. They rarely include nausea, vomiting, or sensitivity to light and sound. Migraines, by contrast, often produce moderate to severe throbbing pain (usually on one side), are aggravated by activity, and frequently come with these additional symptoms. Migraines may also progress through distinct phases and include aura symptoms that tension headaches don’t.