Migraine Headaches: Types, Causes, Symptoms & Treatment

Migraine headache (neurological disease) is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Your migraine headache will likely get worse with physical activity, lights, sounds or smells. It may last at least four hours or even days. About 12% of Americans have this genetic disorder. Research shows that it’s the sixth most disabling disease in the world.

There are up to 150 types of headaches, divided into two categories:

• primary headaches

• secondary headaches.

A migraine headache is a primary headache, meaning that it isn’t caused by a different medical condition. Primary headache disorders are clinical diagnoses, meaning there’s no blood test or imaging study to diagnose it. A secondary headache is a symptom of another health issue.

Health professionals estimate that nearly half of the adult population experiences headaches and 12% of Americans people get migraine headaches. Women are about three times more likely than men to experience this condition.

Types of migraine headaches

The following are the different types of migraines:

• Common migraine (migraine without aura): This type of migraine headache strikes without the warning an aura may give you. The symptoms are the same, but that phase doesn’t happen.
• Complicated migraine (migraine with aura): Around 15% to 20% of people with migraine headaches experience an aura.
• Hemiplegic migraine: You’ll have temporary paralysis (hemiplegia) or neurological or sensory changes on one side of your body. The onset of the headache may be associated with temporary numbness, extreme weakness on one side of your body, a tingling sensation, a loss of sensation and dizziness or vision changes. Sometimes it includes head pain and sometimes it doesn’t.
• Retinal migraine (ocular migraine): You may notice temporary, partial or complete loss of vision in one of your eyes, along with a dull ache behind the eye that may spread to the rest of your head. That vision loss may last a minute, or as long as months. You should always report a retinal migraine to a healthcare provider because it could be a sign of a more serious issue.
• Chronic migraine: A chronic migraine is when a migraine occurs at least 15 days per month. The symptoms may change frequently, and so may the severity of the pain. Those who get chronic migraines might be using headache pain medications more than 10 to 15 days a month and that, unfortunately, can lead to headaches that happen even more frequently.
• Migraine without head pain: “Silent migraine” or “acephalgic migraine,” as this type is also known as, includes the aura symptom but not the headache that typically follows.
• Status migrainosus. This is a rare and severe type of migraine that can last longer than 72 hours. The headache pain and nausea can be extremely bad. Certain medications, or medication withdrawal, can cause you to have this type of migraine.
• Migraine with brainstem aura. With this migraine, you’ll have vertigo, slurred speech, double vision or loss of balance, which occur before the headache. The headache pain may affect the back of your head. These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in the ears and vomiting.

Symptoms of migraine headaches

The primary symptom is a headache. Pain is sometimes described as pounding or throbbing. It can begin as a dull ache that develops into pulsing pain that is mild, moderate or severe.

If left untreated, your headache pain will become moderate to severe. Pain can shift from one side of your head to the other, or it can affect the front of your head, the back of your head or feel like it’s affecting your whole head.

Some people feel pain around their eye or temple, and sometimes in their face, sinuses, jaw or neck.

Other symptoms include the following:

• Dizziness and blurred vision.
• Sensitivity to light, noise and odors.
• Nausea and vomiting, upset stomach and abdominal pain.
• Loss of appetite.
• Feeling very warm (sweating) or cold (chills).
• Pale skin color (pallor).
• Feeling tired.
• Tender scalp.
• Fever (very rare).
• Diarrhea (very rare).

Some symptoms of migraines last about four hours, while severe ones can last much longer. Every phase of a migraine attack can come with different signs and symptoms:

Depending on which phase, symptoms can include:

Symptoms Prodrome

• Sensitivity to light and sound.
• Irritability and/or depression.
• Problems concentrating.
• Difficulty speaking and reading.
• Difficulty sleeping. Yawning.
• Nausea.
• Fatigue.
• Food cravings.
• Muscle stiffness.
• Increased urination.

Symptoms of Aura

• Visual disturbances. You might be seeing the world as if through a kaleidoscope, have blurry spots or see sparkles or lines.
• Numbness and tingling.
• Temporary loss of sight.
• Speech changes.
• Weakness on one side of the body.

Symptoms of headache

• Sensitivity to light, smell and sound.
• Neck pain, stiffness.
• Depression, giddiness and/or anxiety.
• Nasal congestion.
• Nausea and vomiting.
• Insomnia.

Symptoms of Postdrome

• Depressed mood.
• Inability to concentrate.
• Fatigue.
• Euphoric mood.
• Lack of comprehension.

Migraines are often undiagnosed and untreated. If you regularly have its signs and symptoms, keep a record of your attacks and how you treated them. Then you should make an appointment with your health care provider to discuss how you are feeling.

Even if you already have a history of headaches, see your health care provider if the pattern changes over time or your headaches suddenly feel different.

Seek medical attention right away, if you notice any of this symptoms, which can indicate a serious or severe medical conditions, this include:

• Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke.
• An abrupt, severe headache like a thunderclap.
• Headache after a head injury.
• New headache pain after age 50.
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement.

You can also read about types and symptoms of stroke.

Causes of migraine headaches

Researchers haven’t fully understood the actual cause of migraines. But research suggest this condition is due to “abnormal” brain activities that affects nerve signaling, chemicals and blood vessels in the brain.

Different changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals, including serotonin, which helps regulate pain in your nervous system.

Health professionals are still studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide.

Triggers of migraine headaches

There are so many migraine triggers that are continually reported, this include:

• Sensitivity to specific chemicals and preservatives in foods. Certain foods and beverages such as aged cheese, beverages containing alcohol, chocolate and food additives such as nitrates (found in pepperoni, hot dogs and luncheon meats) and fermented or pickled foods may be responsible for triggering up to 30% of migraines.
• Emotional stress. Emotional stress is one of the most common triggers of migraine headaches. During stressful events, certain chemicals in the brain are released to combat the situation (known as the “flight or fight” response). The release of these chemicals can bring on a migraine. Other emotions like anxiety, worry and excitement can increase muscle tension and dilate blood vessels. That can make your migraine more severe.
• Missing a meal. Delaying a meal might also trigger your migraine headache.
• Too much Caffeine. Having too much caffeine or withdrawal from caffeine can cause headaches when the caffeine level abruptly drops. Your blood vessels seem to become sensitized to caffeine and when you don’t get it, a headache may occur. Caffeine is sometimes recommended by healthcare providers to help with treating acute migraine attacks but should not be used frequently.
• Daily use of pain-relieving medications. If you use medicine meant to relieve headache pain too often, that can cause a rebound headache.
• Light sensitivity. Flashing lights, fluorescent lights, light from the TV or computer and sunlight can trigger you.
• Hormonal changes in women. Migraines in women are more common around the time of their menstrual periods. The abrupt drop in estrogen that triggers menses can also trigger migraines. Hormonal changes can also be brought on by birth control pills and hormone replacement therapy. Migraines are generally worse between puberty and menopause since these estrogen fluctuations generally don’t occur in young girls and post-menopausal women. If your hormones are a strong factor in your migraines, you may have fewer headaches after menopause. Hormonal changes do not appear to trigger migraines in men.

Other reported triggers include the following:

• Being overly tired. Overexertion.
• Changing weather conditions such as storm fronts, barometric pressure changes, strong winds or changes in altitude.
• Dieting, or not drinking enough water.
• Changes in your normal sleep pattern.
• Loud noises.
• Certain medications cause blood vessels to swell.
• Exposure to smoke, perfumes or other odors.

You can also read about symptoms and types of diabetes.

Stages of migraine headaches

The four stages (phases) of migraine are in chronological order, and can take about 8 to 72 hours to go through the four stages. This stages include:

• Prodrome phase: This first stage lasts a few hours, or it can last days. you might notice subtle changes that warn of an upcoming migraine, including constipation, Mood changes, from depression to euphoria, Food cravings, Neck stiffness, Increased urination, Fluid retention and Frequent yawning.
• Aura phase: This phase can last as long as 60 minutes or as little as five. Auras are reversible symptoms of the nervous system. They’re usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes. Examples of symptoms include Visual phenomena, such as seeing various shapes, bright spots or flashes of light, Vision loss, Pins and needles sensations in an arm or leg, Weakness or numbness in the face or one side of the body and Difficulty speaking.
• Headache or attack phase: About four hours to 72 hours is how long the headache lasts. The word “ache” doesn’t do the pain justice because sometimes it’s mild, but usually, it’s described as drilling, throbbing or you may feel the sensation of an icepick in your head. Typically it starts on one side of your head and then spreads to the other side.
• Post-drome phase: This phase goes on for a day or two. It’s often called a migraine “hangover” and 80% of those who have migraines experience it. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

Risk factors of migraine headaches

There’re several factors that can expose you to a migraine attack or having migraines. This can include:

• Your Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
• Your Sex. Women are three times more likely than men to have migraines.
• Having Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.
• Your Family history. If you have a family member with migraines, then you have a good chance of developing them too.
• Stress level. You may get migraines more often if you’re high-stress. Stress can trigger a migraine.
• Smoking cigarettes

Prevention of migraine headaches

If you are diagnosed with migraine headache, there are a few steps that may help you prevent or reduce a migraine attack. This can work better for you than other people:

• Avoid skipping meals when possible.
• Stay hydrated. Dehydration can lead to both dizziness and headaches.
• Learn the foods, smells, and situations that trigger your migraine attacks and avoid those things when possible.
• Focus on quality sleep. A good night’s sleep is important for overall health.
• Make it a priority to reduce stress in your life.
• Invest time and energy in developing relaxation skills.
• Exercise regularly. Exercise has been linked to lowered stress levels.
• Quit smoking.

You can also read about risk factors and prevention of sciatica (nerve pain).

Complications of migraine headaches

The following are some of the complications you may experience with medications:

• Taking painkillers too often can trigger serious medication-overuse headaches. The risk seems to be highest with aspirin, acetaminophen (Tylenol, others) and caffeine combinations.

• Overuse headaches may also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt) for more than nine days a month.

• Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.

Diagnosis of migraine headaches

Keeping a migraine journal can help in the diagnosis of your migraine. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. You can keep track of the following:

• What are your symptoms? Be specific.
• The date and time of when the migraine began, specifically when the prodrome started, if you’re able to tell it’s happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage you’re in and how long it lasts. If there’s a pattern, that may help you anticipate what will happen in the future.
• Note how many hours of sleep you got the night before it happened and your stress level. What’s causing your stress?
• Note the weather.
• Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
• Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain you’ve ever experienced.
• Where is the pain located? One side of your head? Your jaw? Your eye?
• List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
• How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
• Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If you’re a woman, are you on your period?
• There are some smartphone apps you can use to keep a migraine journal if you don’t want to use pen and paper.

A neurologist or migraine specialist will diagnose your migraine based on your medical history and symptoms, with a physical and neurological examination.

If your condition is unusual, this can be, if complex or suddenly becomes severe. The following are the tests to rule out other causes of your pain which may include:

• MRI scan. This is a magnetic resonance imaging (MRI) scan, which uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system, known as neurological conditions.
• CT scan. This is a computerized tomography (CT) scan, which uses a series of X-rays to create detailed cross-sectional images of the brain. This helps diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.
• Blood tests
• Electroencephalogram (EEG): This may be ordered to rule out seizures.

This tests can rule out causes like tumors, abnormal brain structures and also stroke.

You can also read about diagnosis and treatment of paralysis.

Treatment of migraine headaches

The treatment of migraine headaches is aimed at stopping symptoms and preventing future attacks.

Migraines are chronic disease. They can’t be cured, but they can be managed and can be improved. There are two main treatment approaches that use medications. This include:

• Abortive medications: This are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
• Preventive (prophylactic) medications: This may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.

Medications used to relieve migraine pain

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine. 

Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are: 

• Motrin (Migraine Pain)
• Excedrin (Migraine)
• Advil (Migraine)

Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem.

If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs for migraine headaches include

Triptan class of drugs (these are abortives):

• Naratriptan.
• Sumatriptan. 
• Zolmitriptan. 

Calcitonin gene-related (CGRP) monoclonal antibodies:

• Fremanezumab.
• Erenumab.
• Galcanezumab. 
• Eptinezumab.

Beta blockers:

• Atenolol. 
• Propranolol.
• Nadolol.

Antidepressants:

• Amitriptyline. 
• Nortriptyline. 
• Doxepin. 
• Venlafaxine. 
• Duloxetine. 

Antiseizure drugs:

• Valproic acid. 
• Topiramate. 

Other:

• Steroids. 
• Phenothiazines. 
• Corticosteroids.

Calcium channel blockers:

• Verapamil.

Your doctor might also recommend vitamins, minerals, or herbs, including:

• Riboflavin (vitamin B2).
• Magnesium. 
• Feverfew. 
• Co-enzyme Q10.
• Butterbur.

Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed, if needed. All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare provider’s advice.

Home remedies for migraine headaches

You can try a few things at home that may also help reduce the pain from migraine:

• Lie down in a quiet, darkroom.
• Massage your scalp or temples.
• Place a cold cloth over your forehead or behind your neck.

Medical devices for migraine headaches

Surgery for migraine isn’t recommended, but some medical tools have been studied and endorsed for helping lessen migraine attacks by either decreasing or increasing nervous system activity. Currently, the FDA has approved four neuromodulation treatments:

• transcutaneous vagus nerve stimulator, a small, noninvasive tool that targets the vagus nerve in the neck via electrical stimulation
• single-pulse transcranial magnetic stimulator, a handheld device that produces a magnetic impulse that affects electrical signaling in the brain
• multi-channel brain neuromodulation system, a headset that can target multiple nerves in the head
• transcutaneous supraorbital neurostimulator, a device that simulates the supraorbital nerves with electrical stimulation

Discuss with your healthcare provider, about the best neuromodulation treatment for you and your specific type of migraine headaches.

Sometimes the symptoms of migraine can mimic those of a stroke. It’s important to seek immediate medical attention if you or a loved one has a headache.

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