Headaches - What is a Migraine
Migraine Types
Migraine is a type of primary headache, meaning it's not caused by another health problem (like the headache you get from a blow to the head) or underlying health condition, per the American Migraine Foundation. (AMF).
Within the umbrella of migraine, the International Headache Society (IHS) describes these main types:
Migraine Without Aura, Migraine With Aura and Chronic Migraine
Migraine Without Aura: This type of migraine occurs without warning. You won't have any signs or symptoms to let you know that a migraine is coming. It's also the most common type. You might be diagnosed with migraine without aura if you have a history of least five headache episodes, each lasting four to 72 hours, says the IHS.
Migraine With Aura: This type of migraine typically strikes within an hour of certain neurological symptoms. Symptoms are wide-ranging and, per the AMF, may include changes affecting one or more of the following:
Vision (such as seeing spots or zig-zag lines), Sensory (having tingling or numbness), Speech or language (which may include slurred or garbled speech), Motor (a feeling of muscle weakness), Brainstem (dizziness, for example),Retinal (temporary vision loss).
Chronic Migraine: Fifteen or more headache days a month over a period of more than three months is considered chronic migraine, according to the IHS. Up to 5 percent of the U.S. population experiences chronic migraine, per the AMF.
Migraine Symptoms
It's not just head pain that you'll feel. Migraine comes with a slew of uncomfortable symptoms that can completely derail your day. In fact, migraine-related disability is a leading cause of lost workdays and productivity, according to a 2021 study in The Journal of Headache Pain.
Everyone has different symptoms and depends on what type of migraine you're having and the stage of the attack.
There are four phases of migraines:
Prodrome. This pre-headache phase that can occur hours or days before a migraine. The AMF describe symptoms such as: Fatigue, Problems concentrating, Neck stiffness, Light sensitivity, Nausea, Frequent yawning, Increased need to urinate, Feeling irritable and Feeling depressed
Aura. People who have migraine with aura may experience a range of neurological symptoms. According to the American Headache Society, most auras involve visual changes, such as: Flashes of light, Blind spots, Seeing stars or patterns, Headache.
Attack: Typically, during the hours or days of the attack, you can have symptoms such as Throbbing pain, often on one side of the head, Nausea, Vomiting, Dizziness, Sensitivity to light, sound, or odors
Postdrome. In the hours or days afterward you may have: Fatigue, Sleepiness, Decreased energy, Problems concentrating, Irritability, Nausea, Sensitivity to light, Pain while moving your head
Migraine Causes: Migraine is believed to be caused by certain genetic mutations but genes alone don't account for who develops a migraine. Certain lifestyle habits and environmental changes, called triggers, can influence a person's risk of having an attack, according to The Migraine Trust. Per MedlinePlus and the AMF, migraine triggers differ from one person to another and may include:
Stress, Anxiety, Hormonal changes, Irregular sleeping habits (e.g., too much or too little sleep, going to bed or waking up at inconsistent times), Skipping meals, Caffeine or caffeine withdrawal, Alcohol
Inadequate hydration, Weather changes, Smoke exposure, Strong odors, Light, Overuse of headache medicines and Certain foods (examples include chocolate, cheese, monosodium glutamate, and cured meats)
Migraine Diagnosis:
Migraine often goes undiagnosed or misdiagnosed, per the National Headache Foundation. Talk to your health care provider if you have symptoms of migraine. If you are not feeling better, consider seeing a neurologist or headache specialist who cares for people with migraine.
When being evaluated for a migraine, your provider will take your medical history and ask about your symptoms, including the location, intensity, and duration of your headaches. Your provider may conduct a physical or neurological exam to check your reflexes, motor movement, and vision.
Depending on your symptoms, you may also be evaluated for another health condition that could be causing the headaches. If suspected, an imaging scan, like an MRI, may be ordered to rule out certain problems, like an aneurysm, or tumor.
Migraine Treatment
The goal of treatment is twofold, according to the AMF: (1)to relieve the pain so you can feel well and return to your daily activities and (2) to prevent future attacks
Finding the right treatment for your migraine can be challenging, but there are many options available. Your health care provider may discuss with you two main categories of migraine medication.
Acute Medication
These are drugs you take to stop migraine when an attack starts. Acute medicines (sometimes called abortive therapy, according to the Agency for Healthcare Quality and Research ) include:
Over-the-counter (OTC) pain relievers (also called analgesics), like nonsteroidal anti-inflammatory drugs (such as ibuprofen) or acetaminophen. A 2018 article in American Family Physician describes these as first-line treatments for mild to moderate migraine.
Triptans, a class of prescription medicines for tamping down the pain of moderate to severe migraine, per the review in American Family Physician. Commonly prescribed triptans, per the AMF, include drugs like Imitrex (sumatriptan) and Zomig (zolmitriptan).
Gepants, also known as calcitonin gene-related peptide (CGRP) agonists, are a class of drugs that target the CGRP protein, which is linked to inflammation in the brain, according to the AMF. This class includes Nurtec (rimegepant) and Ubrelvy (ubrogepant).
Reyvow (lasmiditan), the first FDA-approved drug in a class of medications called ditans. It can stop a migraine without tightening blood vessels, according to a 2020 review in Headache: The Journal of Head and Face Pain.
Ergot alkaloids, drugs sometimes prescribed for people whose migraine symptoms do not respond to OTC medicines or triptans. People can take dihydroegotamine, for one, by nasal spray, injection, or intravenous infusion, according to the AMF.
Preventive Medication
If you get more than four migraines per month, experience medication overuse headaches, or have disabling migraines, you may be a candidate for one of the preventative medications, per a 2019 review in American Family Physician.
The AMF describes the following categories of preventive medicines (sometimes called prophylaxis):
Drugs to treat high blood pressure (called antihypertensives). This category includes beta blockers and calcium channel blockers
Antiseizure medicines (also called anticonvulsants) such as Topamax (topimirate)
Antidepressants, such as amitriptyline and Effexor (venlafaxine)
Botox (onabotulinumtoxinA) injections for treating chronic migraines, which is defined as having 15 or more headache days per month.
Anti-CGRP monoclonal antibodies, a newer class of drugs that target CGRP, a protein involved in migraine pain, per the National Headache Foundation. Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab) are delivered by injection.
Vyepti (eptinezumab) is given by infusion. Qulipta (atogepant) comes in tablet form, according to the American Headache Society.
Non-Pharmaceutical Treatment
Use of a neuromodulation device is another option for the prevention and/or treatment of migraine. This type of therapy uses magnets or electrical current to change brain activity, per the AMF. Several devices are on the market, including an over-the-counter gadget called Cephaly Dual, cleared by the FDA in 2020.
Neuromodulation treatments may benefit people for whom drug treatment isn't recommended or effective, according to a 2020 review in the Journal of Headache and Pain. However, the article noted that larger, well-controlled studies are needed to confirm how well it works and to quantify the size of the treatment's effect.
Migraine Prevention
Better to prevent a migraine from happening at all than to tamp it down after symptoms develop. Here are some things you can do that may help:
Keep a headache diary. Keeping track of when you experienced migraine, for how long, and under what circumstances, may help you identify what may be triggering your migraines.
Manage stress in your life. Using relaxation techniques, such as biofeedback or progressive muscle relaxation and Talk to your health care provider about taking a preventive medication.
Migraine is a neurological disorder not caused by trauma or an underlying health condition. A diagnosis is typically made based on symptoms. The good news is that there are a number of options for treating migraine pain and preventing these attacks from happening in the first place
Until Next Time: Stay Safe, Stay Healthy and be careful out there
James A Vito,D.M.D