How Is a Migraine Headache Different?

While 30 million Americans suffer from it, migraine is still surprisingly misunderstood. People with migraine suffer in unapparent ways, making this an invisible disease.

Migraine headaches can be famously painful, but migraine is more than just a headache. An estimated 50% of those with migraine have never been diagnosed, or have been improperly diagnosed as having another type of headache. Knowing what kind of headache you have can help you find relief through proper treatment.

The type of headache associated with migraine is throbbing and at least moderately painful—at least a “5” on a scale from 1-10. This headache will last from 4 to 72 hours. It is usually felt only on one side of the head, often behind one eye. And it may be initiated or "triggered" by specific compounds or situations (stress, hormones, foods, and many others).

Women have it about three times more often than men. While these painful headaches get plenty of attention, what mostly distinguishes a migraine attack from any other headache type are the sensory symptoms discussed on the next slide.

Other Symptoms

Migraine headaches—throbbing pain, usually on only one side of the head—can be intense enough to prevent you from completing simple tasks or working. But the accompanying sensory symptoms can also derail your day. And they tend to be a little different for every person. While we commonly talk about the headaches involved, some people with migraine do not get headaches.

Migraine attacks can cause vision problems and nausea. Certain smells, sounds, or light levels may become painful. The pain can be so severe that basic tasks and movements become difficult. More than 50% of patients say that they are less productive at home or at their jobs during an attack.

The headache pain may radiate toward your eyes, forehead, or temple and cause nausea, vomiting, vision problems, or oversensitivity to normal light or mild exertion. You may also experience muscle tenderness and pain from light touch.

With or Without Aura?

Not all migraine cases are the same. One way to distinguish them is to determine whether or not you experience an aura. So-called "complicated" migraine attacks begin with an aura. These can be visual distortions such as dots, wavy lines, or zig zags. Some people experience numbness or tingling across one side of the body. If they accompany headaches, auras usually appear about an hour earlier. If they do not, these auras are called "ocular migraines."

About a quarter of people diagnosed with migraine ("migraineurs") have this type. For those who do not, their condition is known by professionals as "common migraine." Even without aura, you may experience light sensitivity, nausea, and other symptoms.

Warning Signs

"Classic" auras do not occur in all patients, but about 25% of patients can have a prodromal phase—an early stage that begins with mild symptoms. The prodromal phase occurs as long as 24 hours before pain develops. Some experience mood changes (depression, excitability, irritability) and sensations of odd smells or tastes, while others may feel tired or tense.

What Causes Migraine Attacks?

Though it is the world's most common cause of neurological disability, researchers are only beginning to understand what causes migraine. One common explanation was recently thrown out. This is the so-called vascular theory, which was proposed in 1938. It claims that pressure changes in the vascular system near the brain cause migraine. But after testing, this theory is no longer considered valid. Migraine is now considered a gene-related neurological disease, and not a vascular one.

Current research shows a variety of genetic mutations are at least partly responsible. The gene TRESK has been identified as the site of one such genetic mutation. The TRESK gene provides the blueprints for a potassium ion channel that is believed to help your nerve cells rest. When mutations occur in this gene, they may cause nerve cells to become overexcited, making them more responsive to less pain.

Although gene mutations tell part of the story, migraine initiation is enormously complicated. It relies on several processes which either result in a visibly changed brain structure or are caused by these structural changes. In fact, some scientists believe there is not a single cause, but rather multiple causes at play. Research continues in this growing field.

Trigger: Flashing Lights

Migraine headaches are often triggered to occur when the person is exposed to a specific set of circumstances. One of the most common triggers is strong flickering light. For example, faulty fluorescent lights, a television picture rapidly going on and off, or sunlight reflected off of waves in a lake or the ocean are all potential triggers.

Trigger: Anxiety and Stress

As mentioned, stress is sometimes a trigger. While it is unlikely that people can live stress-free lives, many people can reduce their stress and avoid triggering attacks by using relaxation techniques, deep breathing, and other biofeedback techniques.

Trigger: Lack of Food or Sleep

Regular daily patterns of meals and sleep work well for some individuals to avoid attacks. Sleep interruptions and lack of adequate fluid and/or food intake and even some food binges may trigger them.

Trigger: Hormonal Changes

Many women's attacks are linked to their menstrual cycle. The hormonal increases and decreases are thought to be responsible in some women. However, patterns differ from person to person so one type of hormonal therapy may benefit one woman, but it may be unhelpful or even increase migraine symptoms in other women.

Trigger: Headache Foods

Although studies have not proven that any food is a migraine trigger, patients often suggest certain foods trigger them. Common food or food ingredients cited by patients are red wine, cheese, chocolate, soy sauce, processed meat, and MSG.

Trigger: Tyramine

Tyramine, produced from the amino acid tyrosine, may be a trigger because it can cause blood vessel constriction and expansion. Many aged and fermented foods that are associated with attacks contain tyramine, like cheeses, soy sauce, pickles, and aged meats like pepperoni.

Caffeine: Help or Hindrance?

The caffeine in coffee may help relieve attacks when used with some medications. However, when the caffeine levels drop, the patient may then be prone to develop headaches. Consequently, it may be both a help and a hindrance.

Tracking Personal Triggers

Individuals should keep a diary or list of things that act as warning signs or triggers of an oncoming migraine. This information may help migraine sufferers to avoid future attacks.

Who Has Migraine?

Attacks occur in women about three times more often than in men. People with relatives who get them are more likely to as well. In addition, attacks occur more often in people with epilepsy, depression, stroke, asthma, anxiety, and in individuals with neurologic and hereditary (genetic) disorders.

Migraine in Children

Migraine episodes occur in children about equally until puberty when attacks become more common in girls. However, in children, migraine symptoms are somewhat different than those in adults; children may experience stomach pains (abdominal migraine), frequent and forceful vomiting, or benign paroxysmal vertigo where the symptoms are unsteady balance, involuntary eye movements, vomiting, and behavioral changes.

Diagnosing Migraine

Migraine is usually diagnosed based on a clinical history of your symptoms. However, most doctors will do a CT or MRI brain scan to determine if other causes of headaches (brain tumor or bleeding into the brain, for example) are present.

Non-Migraine Headaches

Is your headache pain caused by migraine? Or is it something else? “Something else” usually means one of the two commonly diagnosed headache types discussed below. However, migraine experts warn that many people diagnosed with these headaches are actually migraineurs. Roughly half of all people with migraine in the US are thought to be undiagnosed, and mistaken diagnosis of these headaches may prevent you from receiving the care you need.

Although becoming familiar with other types of headaches may help you find relief, it can be tricky to get the right diagnosis. That’s because these various headache types share many of the same symptoms, and because no definitive test has been developed to test for them. Some experts have begun to describe all of these headaches as part of a continuum, with occasional, mild tension headache on one side, and chronic migraine headaches on the other.

Tension Headaches

Are your shoulders and neck tense? It’s a common problem that sometimes leads to chronic headaches. Tension headaches are defined as mild to moderate in terms of pain. You can feel these headaches around your head, but especially the back of your head and forehead. They usually cause no other symptoms.

Sinus Headaches

Sinus headaches are described as mild to moderate pain in the places near your sinuses—your cheeks, eyes, and across your nose. These headaches require the patient to first have a sinus infection. Often a seasonal condition, these headaches are rarely chronic. Doctors are encouraged to test the immune system if more than one bacterial sinus headache is confirmed in a single year.

Calculating Your Headache Burden

Some doctors like to estimate how much migraine disrupts normal activities before treatment begins. A questionnaire is given to the patient to estimate how often they miss various functions (school, work, family activities) because of their attacks.

Migraine Treatment: Over-the-Counter Drugs

There are many types of over-the-counter (OTC) medicines for headache pain. Some of the most common medications for headaches include nonsteroidal anti-inflammatory drugs. Aspirin, naproxen sodium, ibuprofen, and acetaminophen may provide relief. Anti-nausea medications like Dramamine may also be useful. Some OTCs are marketed as treatments for migraine. Although all of these OTCs may be helpful for some headache types, people should not overuse them to avoid toxicity, ulcers, and other gastrointestinal problems. In addition, overdoing it can lead to medication-overuse headaches that may make your attacks worse.

Treatment: Triptans

Triptans (Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, and Zomig) are the most commonly prescribed medication for the treatment of migraine. However, people with hypertension, heart disease, stroke, and those who take certain medications may not be able to take triptans; your doctor can help with medication choices. Unfortunately, side effects of nausea, dizziness, chest pain, and paresthesia may occur with triptans.

Treatment: Ergotamines

Ergotamines (Cafergot, Migergot, or Migranal) are some of the first medications created to treat migraine, and they are usually not as effective as triptans. They have side effects such as nausea, dizziness, muscle pain, or an unusual or bad taste in the mouth and may interact with other drugs. These side effects and drug interactions may limit the patient's use of the drug.

Novel Migraine Therapies: Gepants, Ditans, and More

Not long ago, the medications used to treat migraine were designed for other diseases such as hypertension and epilepsy. While these may still be useful for some individuals, a better understanding of how migraine works has led to more targeted drug therapies. Together, three new classes of pharmaceuticals are transforming migraine treatment.

Gepants & Monoclonal Antibodies

Two of these new drug classes work by blocking a molecular structure known as CGRP (calcitonin gene-related peptide). CGRP is released during migraine attacks, and blocking it may stop the attack before it gets going. This may help your nerves relax.

To do this, gepants and monoclonal antibodies have been used. The first of these to receive FDA approval was Erenumab (Aimovig), followed soon by two more in the same year. These drugs may cause side effects, and the consequences of long-term use are unknown. So, discuss them thoroughly with your doctor. It may help if you bring a list of relevant questions on your visit.

Ditans

The ditan class of drugs work differently. They target a receptor (5-HT1F) found in different brain regions. By doing so, these drugs seem to reduce inflammation that arises in your nervous system. These drugs are still being tested, and seem to include side effects like drowsiness and vertigo.

Novel Migraine Therapies: Nerve Stimulation (Neuromodulation)

Can electrical devices stop headache pain cold? For some people they work well. Sometimes called electrical stimulation devices, these tools can alter brain activity—sometimes by stimulating activity, but more often by calming it in the case of migraineurs. The treatment is known more broadly as neuromodulation.

Some neuromodulation devices have been approved by the FDA for home use. Two devices attach to your head, while one is pressed against your throat to reach the vagus nerve. Other stimulators still in development can be implanted.

The advantage of these devices is that they can provide relief when medication use is hampered by side effects or contraindications. However, they have not taken off yet in the consumer market, perhaps due to their cost. They also seem to work better for some patients than for others.

Is Your Treatment Working?

Sometimes the initial treatments for migraine either do not reduce the symptoms or only marginally reduce them. If, after trying the prescribed treatment(s) about two or three times and getting little or no relief, you should ask your doctor to change the treatment. However, patients are urged to treat their attacks early (within about 2 hours) to get full benefit of treatments.

Limits of Medication Use

Some chronic headaches are due to overuse of medicine; avoid using migraine-prescribed medicines more than twice per week. Using and tapering medicine for migraine should proceed under your doctor's supervision. Narcotics are used as a last resort for migraine because they can be addictive.

Treatment: Vitamins and Supplements

Some vitamins and supplements may be useful therapies. Some of these are currently being tested. These are collectively known as nutraceuticals. The nutraceuticals that have shown some evidence of relief in preliminary testing include magnesium, riboflavin (vitamin B2), butterbur root extract and feverfew.

Treatment: Preventive Medicines

If your attacks are frequent and severe, your doctor may prescribe medication(s) to lessen the frequency or to prevent the headaches. Medicines that are used in this manner include Timolol (Blocadren), divalproex sodium (Depakote), propranolol (Inderal), and topiramate (Topamax), although the drugs were designed to reduce hypertension or prevent seizures.

Alternative Therapy: Biofeedback

Other methods that may reduce or prevent migraine include biofeedback techniques to reduce headache triggers like stress and early symptoms such as muscle tension.

Alternative Therapy: Acupuncture

Although studies on acupuncture are not definitive, some patients’ headaches may respond well to this Chinese method of inserting needles into specific body locations to reduce or stop pain. Because the results are so variable, some doctors do not recommend this treatment. But because some patients report headache relief, it is another treatment method to consider.

An Advantage of Aging

The peak intensity and frequency of attacks occur between ages 20 to 60. As you age past 60, migraine intensity and frequency of headache and related symptoms decreases, and in some patients, attacks cease.

When You Need Quick Care

Most people know the pattern of their attacks (triggers, auras, and headache pain intensity). However, new headaches, in people with or without a migraine history, that last about 2 or more days should be checked by a doctor. However, if a headache develops with symptoms such as fever, stiff neck, confusion, or paralysis, the person should be examined emergently. The person should be taken by their relative, friend, or caretaker to an Emergency Medicine Department.

1. Acupuncture

In this traditional Chinese practice, an expert inserts tiny needles at specific points on your body. Small studies suggest it can ease migraine pain and may also lower the number of headaches. You should still keep up with your other treatments, too.

2. Biofeedback

Your body responds to pain with physical changes like a faster heart rate, tensed muscles, and cold hands. In biofeedback, sensors measure these shifts, then feed the information to you as a blinking light or a tone you can hear. You learn to respond to the feedback and relax your muscles. Some studies show it can often reduce headache pain and/or how often you get migraines.

3. Massage

Although it hasn't been studied in depth, massage may lower the number of headaches in some people, early research shows. It doesn't help with pain once a migraine starts. Massage can also ease stress, a common headache trigger.

4. Vitamin and Mineral Supplements

Research suggests that taking riboflavin (vitamin B2) and magnesium might help you get migraine attacks less often, though it doesn't seem to relieve pain during a headache. Coenzyme Q10 may also lead to fewer migraines in adults and children, although you usually need to take it for several months to see a benefit.

Before you start, talk with your doctor to be sure it won't have side effects for you.

5. Relaxation Techniques

Because migraines are often triggered by stress, relaxation training is a great idea. Methods include deep breathing and progressive muscle relaxation, in which you tense and relax the muscles in different parts of your body. With practice, this technique can improve how you handle stress, which may cut down on headaches.

6. Exercise

Regular cardio exercise -- workouts that get your heart pumping -- could make a difference. A Swedish study compared exercise with relaxation and a drug that prevents migraines. The cardio routine -- 40 minutes, three times a week -- worked as well as relaxation or a drug medicine in cutting down on pain and how often headaches strike.

7. Spinal Manipulation

Spinal manipulation, also called getting "adjusted" by a chiropractor, may help with migraines. Limited studies have shown it may be effective at reducing the number of days experiencing migraine, as well as the pain or intensity of a migraine attack.

There are some risks with this treatment, so talk to your doctor before trying it.

8. Talk Therapy

Cognitive-behavioral therapy, which focuses on changing your thoughts and actions, may help you have fewer migraines. Getting therapy doesn't mean you have emotional or mental problems. It can give you a fresh approach to situations that usually give you headaches. It works especially well when you also do other preventive treatments.

9. Transcranial Magnetic Stimulation (TMS)

A doctor holds a device against your scalp to send painless magnetic pulses into your brain. If you have migraines with aura, TMS done during the aura phase may shorten the length of the headache and make it less intense.

10. Diet Changes

Some people find that certain foods trigger their migraines. Some of the most common culprits are alcohol, caffeine, chocolate, canned foods, cured or processed meats, cultured dairy (such as yogurt), MSG, and aspartame.

Write down your meals and snacks in a "food diary" to help you remember what you ate before a headache came on. Then cut out these foods one at a time to see if it helps.

11. Herbal Remedies

Feverfew may ease pain, nausea, and sensitivity to light during a migraine, and help you have fewer headaches, but the research is mixed.

Some studies show that an extract of the herb butterbur may help prevent migraines. But the plant itself is toxic, so only use a commercially prepared product.

Talk with your doctor about any herbal remedy before you try it.

12. Pressure

Many people find that applying gentle pressure to the head, face, and neck during a migraine can help ease the pain. Techniques to try:

• Press your brow line and under your eyes.
• Rub your temples and jaw in a circular motion.
• Massage the base of your skull with a tennis ball.

A variety of head wraps and bands claim to ease migraine pain. They're inexpensive and might be worth a try.

13. Sleep

Studies show that poor sleep and migraines often go hand in hand. So, rethink your routine. Things to try:

• Don't read, watch TV, or listen to music in bed.
• Don't take naps.
• Don't eat heavy meals within a couple of hours of bedtime.
• Don’t use your phone, laptop, or tablet at bedtime.

14. Keep Up Good Habits

Your lifestyle can have a big impact on how often you get your headaches. These tips can help:

• Don't skip meals.
• Stay hydrated.
• Get regular exercise.
• Stay at a healthy weight.

Why Try Treatments That Aren't Drugs?

They may be a good option if you:

• Don't get relief from prescribed treatments
• Have trouble with medicine side effectss
• Have a condition that keeps you from taking migraine drugs
• Simply don't want to take medication

Do Your Homework

If you'd like to try a new way to treat your migraines, your doctor can tell you how well it works and if there are any risks. They may know of an expert who specializes in these treatments. And they can check to make sure these migraine treatments won't have bad side effects.

Does light makes you wince in pain? You could be one of the many people with migraine who have light sensitivity, called photophobia. If you can't dim the brightness around you by drawing the curtains or turning off the lights, make your own darkness and wear sunglasses indoors.

Stick to a Schedule

The key word is "regular." Pick set times to go to bed and wake up every day. Exercise regularly. Stick to usual times for meals and snacks. Consistency helps your body know what's coming up next and may give you fewer migraine attacks.

Get a Grip on Your Stress

It's one of the biggest triggers for migraine pain. So aim to boost calm in your life. Un-busy your schedule where you can, but carve time for things you enjoy. Steady relief is your friend. If you stay stressed during the work week and relax only on the weekend, the shift can bring on migraine, too.

Block the Scents

If someone's perfume or other odors set off your migraine, reach for a soothing scent like mint or coffee beans. A sniff of the substitute scent can block the smell that causes pain and may head off an attack.

Aromatherapy Therapy

Speaking of scents, some smells may help dull headaches. Peppermint may make you less aware of pain, and lavender may lower your anxiety. You can apply them in their oil form to your temples or the inside of your wrist.

Turn Up the Heat

Warm compresses, a steamy shower, or a toasty soak in a bath can ease the tension of tight muscles that might add to your migraine pain.

Cool Down

Go the other way and try a cold comfort. Some studies show that wrapping a cold pack around your neck when a migraine hits can lower your headache pain. Experts don't know why that helps. Cooling down the blood as it makes its way to your brain may lower swelling and dull your pain.

Tame Screen Glare

Blue light is usually the hardest hue to handle when you deal regularly with migraine. That's the color that glows from your computer and smartphone. So break away from screens when you feel a migraine coming on. Some people say rose-tinted glasses help by blocking blue light.

Have an Orgasm

It doesn't work for everyone, but sex can be a migraine-buster for some. Experts think it may be because endorphins, aka the feel-good hormones, released during an orgasm act like natural painkillers. Masturbation is also an option.

Roll Away Pain

Relaxing your feet can ease tension in other parts of your body, including your head. Sit and put your bare or sock-covered foot on a tennis ball and roll it around. Notice areas that are especially tender and focus in on those. Repeat on the other foot.

Pinch Your Hand

Another spot you can target for tension relief is the fleshy pad between your thumb and first finger. Pinch this area with two fingers and feel around for soreness. One reason this might help is by giving you a feeling of control over your pain.

Breathe Mindfully

Focus as you breathe in and out for at least 10 minutes. That can flood your body with calm and lower your stress. Boost your relaxation and target the different muscle groups in your body as you inhale and exhale to release all your tension.

Mute the Noise

Migraine can be triggered by just about any of your senses, including your hearing. Just like lights, loud noise can set off your migraine. Get to a quiet space when it hits. If you can't, carry earplugs to block out the din on the spot.

Settle Your Stomach

If migraines give you nausea, keep motion-sickness bands handy to ward off a queasy stomach. Sip peppermint tea and nibble saltines, which also can help a crummy tummy.