Overview
Migraine is a severe, throbbing headache usually felt on one side of the head. About 1 in 6 people experience migraine. It is 3 times more common in women than in men.
Migraine attacks can last for hours, even days, and are accompanied by nausea, vomiting, and sensitivity to light and sound. Some people experience visual or sensory symptoms called "aura" before an attack.
Symptoms
Migraine generally progresses in 4 phases:
1. Prodrome (1-2 days before):
- Constipation or diarrhea
- Mood changes
- Excessive yawning
- Cravings for certain foods
- Frequent urination
2. Aura (not in all patients):
- Visual disturbances (bright lights, zigzag lines)
- Numbness or tingling in the face or hand
- Difficulty speaking
- Lasts 5-60 minutes
3. Attack (4-72 hours):
- Throbbing, one-sided headache
- Nausea, vomiting
- Sensitivity to light, sound, smell
- Worsening with physical activity
- Blurred vision
4. Postdrome:
- Fatigue, weakness
- Difficulty concentrating
- Sometimes a feeling of mild euphoria
Causes
The exact cause is unknown; changes in brainstem and trigeminal nerve activity, serotonin imbalance, and genetic predisposition play a role.
Triggers
- Hormonal changes: Menstruation, pregnancy, menopause, birth control pills
- Foods: Aged cheese, chocolate, processed meats, MSG
- Beverages: Alcohol (especially red wine), caffeine
- Stress
- Sleep irregularity
- Hunger, skipping meals
- Environmental stimuli: Bright light, loud noise, strong smells
- Weather changes
- Some medications
- Excessive physical exertion
Risk Factors
- Family history
- Female sex
- Age 10-40
- Hormonal changes
Complications
- Chronic migraine (more than 15 days per month)
- Migraine status (attack lasting longer than 72 hours)
- Medication overuse headache
- Increased stroke risk (especially in migraine with aura)
- Loss in work, school, and daily life
When to See a Doctor
- If you have more than 4 attacks per month
- Loss of consciousness, weakness, or speech disorder during an attack
- New headache starting after age 50
- A sudden, severe headache described as "the worst headache of my life"
- Headache with fever or stiff neck
- Headache after head trauma
Diagnosis and Treatment
Diagnosis: Based on symptoms and patient history. Brain MRI may be done when needed.
Treatment has two parts:
1. Attack treatment:
- NSAIDs (ibuprofen, naproxen)
- Paracetamol
- Triptans (sumatriptan, rizatriptan)
- Anti-nausea medications
- Ergotamine derivatives
2. Preventive treatment (4 or more attacks per month):
- Beta blockers (propranolol)
- Antidepressants (amitriptyline)
- Antiepileptics (topiramate)
- CGRP antagonists (new class)
- Botox (for chronic migraine)
Prevention
- Keep a migraine diary; identify triggers
- Sleep regularly (at the same time each day)
- Do not skip meals
- Drink plenty of water
- Manage stress (meditation, yoga)
- Exercise regularly
- Avoid trigger foods
- Limit caffeine intake