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Understanding Migraine- All That You Need To Know About Migraine

Medically reviewed by Dr. Samra

What is a Migraine?

A migraine is a mild to severe headache felt as a throbbing, pulsating, or pounding debilitating headache that may be accompanied by symptoms such as nausea, vomiting, and sensitivity to light and sound. The pain is usually localized to one side of the head, most commonly the forehead area. Although, it can also occur on the whole head or shift from one side to another. The pain can be initially mild, but the intensity can vary and worsen without treatment. Research indicates that it’s the sixth most disabling disease worldwide.

What is the Difference Between a Headache and a Migraine?

There are around 150 types of headaches divided mainly into primary and secondary headaches. A migraine is a primary headache, implying that it does not occur due to another or pre-existing medical condition. A secondary headache is a result of another medical condition or disease such as sleep disorders, brain tumors, head trauma, or stroke. 

What are the Four Phases of Migraine?

The four phases in chronological order are the prodrome, aura, attack, and postdrome. The duration and intensity of these phases can vary from individual to individual. Occasionally, a phase can be skipped, and an attack may occur without causing a headache. It can take a few hours to a few days to go through the four stages.

The phases include:

  1. Prodrome: 

The first stage lasts from a few hours to days. Migraine symptoms may begin one to two days before the headache, but this stage may not happen every time. It is also known as the “preheadache” or “premonitory” phase.

 2. Aura: 

The aura occurs after the prodrome stage. This phase can last from five minutes to one hour. Most people don’t experience an aura, while others simultaneously experience both the aura and the headache. The National Institute of Neurological Disorders and Stroke states that about one in every three individuals with migraine has reported experiencing an aura before the migraine attack.

  3. Attack:

During this phase, the actual migraine occurs, and the headache can last about four to 72 hours. The headache starts on one side of your head and then spreads to the other side. The symptoms of migraine can vary from individual to individual. 

4. Postdrome:

The postdrome phase can last for 1-2 days. It’s often referred to as a migraine “hangover”. During this stage, an individual usually experiences a dull persisting headache and changes in mood ranging from feeling euphoric, exhausted, or apathetic. Research shows that 80% of those who have migraines go through this stage. 

What are the Symptoms of Migraines?

Headache is the main symptom of a migraine. The headache can start as a dull ache and progress to a pounding or throbbing pain that can be mild, moderate or severe. The pain can occur on one side of the head, but it can affect the whole head, or the pain may alternate from one side to another. Some people feel pain around their eyes sometimes in the region of the temples, sinuses, jaw or neck. 

Symptoms of migraine include:

  • Sensitivity to light, noise, and odors.
  • Nausea and vomiting.
  • Abdominal pain.
  • Loss of appetite.
  • Sweating or chills.
  • Pale skin color. 
  • Fatigue.
  • Dizziness.
  • Blurred vision.
  • Scalp tenderness.
  • Diarrhea (uncommon).
  • Fever (uncommon).

Most migraines usually last about four hours, but severe ones can last much longer. 

Different symptoms accompany each phase of the attack:

Prodrome symptoms:

  • Difficulty in concentrating.
  • Irritability. 
  • Food cravings.
  • Depression.
  • Difficulty speaking and reading.
  • Difficulty sleeping. 
  • Yawning.
  • Nausea.
  • Fatigue.
  • Sensitivity to light and sound.
  • Increased urination.
  • Muscle stiffness/Neck stiffness.
  • Hyperactivity.

Aura symptoms:

  • Numbness and tingling. A person may feel a prickling or tingling sensation on the face, arms, or legs.
  • Visual disturbances. A person may visualize shapes, seeing bright spots or flashes.
  • Temporary loss of sight.
  • Weakness on one side of the body.
  • Speech changes.

Attack symptoms:

  • Neck pain, stiffness.
  • Depression.
  • Dizziness.
  • Anxiety.
  • Sensitivity to light, smell and sound.
  • Insomnia.
  • Nausea and vomiting.

Postdrome symptoms:

  • Inability to concentrate.
  • Depressed mood.
  • Fatigue.
  • Inability to comprehend things.
  • Euphoria.
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What are the Different Types of Migraines?

Migraine affects more than 10% of people worldwide and occurs most often among people aged 20 to 50 years.

Different types of migraine include:

Migraine with aura:

 This type of migraine is often complicated. 

Migraine without aura:

 This type of migraine is most common. It is usually of sudden onset and occurs without the warning an aura provides.

Migraine without a headache:

  This type is also called the “Silent migraine” or “acephalgic migraine,”. This includes the aura symptoms, but a headache does not follow them. 

Hemiplegic migraine:

This type of migraine results in temporary paralysis (hemiplegia). This is a rare type in which neurological or sensory changes can occur on one side of the body. The headache may be associated with tingling, temporary numbness, visual disturbances, loss of sensation, weakness on one side of the body or dizziness. 

Retinal/ocular migraine: 

This type of migraine is characterised by temporary, partial or complete loss of vision in one of your eyes. A dull ache may occur behind the eye, spreading to the rest of the head. The vision loss may last only a minute or can persist for months.

Migraine with brainstem aura:

Also known previously as basilar migraines are headaches that involve the brainstem. The symptoms usually occur before the headache starts and include vertigo, slurred speech, double vision or loss of balance. There is a sudden onset of the pain, and the headache affects the back of the head. Other symptoms include vomiting, inability to speak, and ringing in the ears(tinnitus).

Chronic migraine: 

If an individual experiences headaches with a frequency of fifteen days per month, and eight of these episodes are accompanied by migraine symptoms, lasting at least three months. In that case, the migraines are referred to as chronic migraine. The intensity of the pain can symptoms can vary. Individuals who experience less frequent headaches symptoms have episodic migraine. 

Vestibular migraine:

Vestibular migraines are characterized primarily by vertigo(spinning sensation), lack of balance, sensitivity to motion, and muffled hearing or ringing in the ears. An actual headache doesn’t always accompany these symptoms.

Status migrainosus:

This is a severe and rare type of migraine that can last longer than 72 hours. The headache is deliberating and is accompanied by nausea/vomiting. The common cause is medication withdrawal.

Abdominal migraine:

According to research conducted in 2018, abdominal migraines usually affect children between the ages of 3 and 10 years old. The main symptoms are abdominal pain, nausea, and vomiting. In addition, people who have this type of migraine may develop a dull headache or no headache at all. This is also called stomach migraine, and the triggers include stress, skipping meals, exposure to bright light, poor sleep, and food items containing caffeine, chocolate, and monosodium glutamate.

What are the Risk Factors for Migraines?

The following risk factors make you more prone to developing a migraine, some of which include:

  • Genetics

 Most people who get migraines have a first-degree relative with the disease. Studies have in addition, shown an increased familial risk for common migraine, which is considered to be polygenic, with heritability estimates of 34–64%

  • Gender

 Migraine headaches are common in women, especially between the ages of 15 and 55, due to hormonal influences, usually by a factor of about 2:1.

  • Age

Migraines usually first occur during adolescence but tend to peak during the 30s. However, it is noted that they gradually reduce in intensity and frequency as the person ages.

What Triggers a Migraine?

A migraine is defined as a painful primary headache disorder. The exact cause of migraine has not been identified. However, several factors, such as genetics and environmental factors, come into play. During. an attack, imbalances in brain chemicals, nerve signals, and blood vessels may occur. In addition, many possible triggers have been identified, including:

  • Dehydration
  • Bright lights
  • Loud sounds
  • Severe heat or drastic changes in temperature 
  • Changes in barometric pressure, changes in weather conditions, for instance, strong winds or changes in altitude.
  • Hormone fluctuations, for example, during menstruation, pregnancy, or menopause.
  • Stress.
  • Overexertion.
  • Skipping meals.
  • Sensitivity to chemicals or preservatives in foods such as nitrates (a preservative in cured meats), monosodium glutamate (MSG) or aspartame (an artificial sugar). 
  • Changes in sleep patterns
  • Certain medications, including oral contraceptives or nitroglycerin.
  • Unusual smells.
  • Travelling.
  • Smoking.
  • Alcohol consumption.

How Long do Migraines Last?

A migraine attack can last about 4 hours. However, if left untreated or in case it does not respond to treatment, it can last from 72 hours up to a week. 

How are Migraines Diagnosed?

Your doctor may take your detailed medical history and family history to diagnose a migraine. Your physician may:

  • Ask you to recall a specific period during which you experience the headache.
  • Ask you to describe the exact location of your pain and describe the type/nature of pain. For example, whether the pain is pounding, pulsating or throbbing?
  • Enquire about specific triggers such as activities, foods, stressors or the situations that may have brought on the migraine.
  • Ask about the frequency of getting a headache.
  • Discuss the medications that you take to relieve the pain
  • Ask you to explain how you felt before, during, and after the attack.

Your doctor may order certain additional tests to rule out other conditions. which may include blood tests, imaging (CT scan or an MRI), or an electroencephalogram (EEG).

How are Migraines Treated?

Migraines are a chronic condition. There may be no permanent cure, but the disease can be managed with a proper treatment plan. 

Two main treatment approaches use medications: abortive and preventive.

  • Abortive

These medications are most effective if taken immediately at the first sign of a migraine. Abortive medications help halt or reduce the intensity of the symptoms, such as pain, nausea, and light sensitivity. In addition, some medications help relieve the pain by constricting your blood vessels.

  • Preventive (prophylactic) 

Such medications are prescribed when the migraines are severe and frequent and interfere with everyday activities. A person needs to take the drug regularly to reduce the frequency and severity of the headaches. 

Over-the-counter medications :

These are effective for some people with mild to moderate symptoms. The main pain-relieving medications contain ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

Over the counter medication commonly used to deal with a migraine that is approved by Food and Drug Administration include:

  • Excedrin® Migraine.
  • Motrin® Migraine Pain.
  • Advil® Migraine.

However, while using these medications, it is wise to be cautious as overuse can result in analgesic-rebound headaches or a dependency problem. The best logical solution is to consult your doctor for prescription medications if you take the analgesics more than 2-3 times a week.

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Prescription drugs for migraine include:

Calcium channel blockers:

  • Verapamil.

Triptan class of drugs:

  • Sumatriptan.
  • Zolmitriptan.
  • Naratriptan.

Calcitonin gene-related (CGRP) monoclonal antibodies:

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

Antidepressants:

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

Beta-blockers:

  • Atenolol.
  • Propranolol.
  • Nadolol.

Antiseizure drugs:

  • Valproic acid.
  • Topiramate.

Others:

  • Steroids.
  • Phenothiazines.
  • Corticosteroids.
  • Botox injections: A Botox injection administered every three months may help prevent migraine in some people.

Some vitamins or supplements that may help deal relieve pain include:

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

Medications to relieve migraine pain are available in different formulations, including pills, injections, suppositories and nasal sprays. Your doctor will help prescribe the best treatment for you according to your condition. Additionally, drugs to relieve nausea are also prescribed, if required.

Home remedies to manage a migraine: 

A few remedies that may help alleviate the pain and manage symptoms include:

  • Resting in a dark, cool, and quiet room.
  • Application of a cold compress or heating pad to your forehead or behind your neck.
  • Scalp massage.
  • Application of pressure to your temples in a circular motion.
  • Meditations/Yoga.
  • Aromatherapy.
  • Acupuncture

Devices used to relieve a migraine:

The FDA has approved some devices for neuromodulation treatments:

  • Single-pulse transcranial magnetic stimulator:

 This handheld device affects electrical signalling in the brain by producing a magnetic impulse.

  • Multi-channel brain neuromodulation system:

This is a headset that can affect several nerves in the head.

  • Transcutaneous vagus nerve stimulator

This is a small, noninvasive device that targets the electrically stimulates the vagus nerve in the neck.

  • Transcutaneous supraorbital neurostimulator: 

The device electrically stimulates the supraorbital nerves and may provide relief.

You will need to consult with a doctor to determine the best treatment plan for you. 

What is in a Migraine Cocktail?

The term “migraine cocktail” refers to a combination of medications administered to people in the hospital when they experience severe migraine.

Migraine cocktails typically reduce symptoms within 60 minutes. Several medications are usually administered at once to provide relief. The drug is chosen based on the patient’s presenting symptoms and medical history.

A cocktail is a combination of the following medications:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications reduce inflammation, targeting the pain and throbbing.

  • Acetaminophen

Acetaminophen is given only if the patient has not already used the medication. This pain medication can be helpful together with NSAIDs.

  • Triptans: 

These medications, such as sumatriptan, have anti-inflammatory effects and constrict the blood vessels in your brain, helping to ease the pain.

  • IV fluids

Administred to prevent dehydration as a person may be experiencing severe vomiting along with the headache. 

  • Antiemetics

These drugs combat nausea and vomiting. In addition, to reduce the risk of side effects, doctors may administer the antihistamine diphenhydramine.

  • Dexamethasone: 

This is a steroid which acts by reducing inflammation in the body. Dexamethasone usually helps prevent migraine from recurring after initial treatment.

  • IV magnesium: Magnesium is often used to prevent attacks.
  • IV valproic acid: This antiseizure medication can treat a severe attack.

Can Migraines be Prevented?

Some measures that may help manage the symptoms effectively include:

  • Maintaining a migraine diary and taking notes about any foods and other triggers.
  • Use prescription medications as advised by your doctor.
  • Wearing migraine glasses and reducing screen-time may help manage light sensitivity and subsequently may reduce the frequency of attacks.
  • Getting sufficient sleep and maintaining a proper sleep schedule.
  • Avoid skipping meals and keep yourself hydrated.
  • Exercise regularly.
  • Practising relaxation techniques to manage stress.
  • Counselling from a therapist to manage stress.

When to Consult a Doctor?

An immediate check-up or visit to the ER is warranted if you:

  • Are experiencing the ‘worst headache of your life.’
  • Are experiencing neurologic symptoms like difficulty in speaking, balance problems, vision problems, numbness and tingling, mental confusion or seizures.
  • Have developed a sudden headache after a head injury.
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Migraine is a chronic condition and is life-wrecking, but there is no need to endure the pain. There are several ways to prevent and manage migraine symptoms. Connect with our online doctor at Your Doctors Online for medical advice. Working closely with healthcare providers will help prevent migraines from affecting your everyday life and help you live your life to the fullest. 

Doctors Treating this Issue
dr asim cheema

Dr. Asim Cheema

Internal Medicine

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