- Genetics: Migraines, especially those with aura, often run in families, suggesting a strong genetic component.
- Brain Chemistry: Changes in brain chemicals, particularly serotonin, which helps regulate pain, can play a role. A drop in serotonin levels may trigger migraine symptoms.
- Brain Regions Involved: Areas like the trigeminal nerve and the brainstem are thought to be involved in the pain pathways.
- Triggers (often individual-specific):
- Hormonal Changes in Women: Fluctuations in estrogen (before or during menstrual periods, during pregnancy, or around menopause) are common triggers.
- Stress: High stress or even the "let-down" period after stress can trigger migraines.
- Certain Foods and Drinks: Aged cheeses, processed meats, chocolate, caffeine withdrawal, alcohol (especially red wine), and artificial sweeteners.
- Skipping Meals: Can lead to low blood sugar, a migraine trigger.
- Sensory Stimuli: Bright or flickering lights, loud noises, strong smells (perfume, smoke, certain foods).
- Changes in Sleep Pattern: Both too little and too much sleep can trigger migraines.
- Physical Exertion: Intense exercise or prolonged physical activity can sometimes trigger an attack.
- Weather Changes: Barometric pressure changes, strong winds, or storms.
- Medication Overuse: Overuse of pain relievers can lead to medication overuse headaches, which can mimic or worsen migraines.
- Prodrome (Warning Stage - 1 to 2 days before):
- Constipation.
- Mood changes (from depression to euphoria).
- Food cravings.
- Neck stiffness.
- Increased urination.
- Frequent yawning.
- Aura (Occurs in 20-30% of people, just before or during the headache):
- Visual Aura: Flashing lights, zig-zag lines, blind spots, shimmering lights (most common).
- Sensory Aura: Numbness or tingling in an arm or leg, or on one side of the face.
- Verbal/Language Aura: Difficulty speaking or finding words.
- Motor Aura: Weakness on one side of the body (rare, indicates hemiplegic migraine).
- Attack (Headache Phase - 4 to 72 hours without treatment):
- Moderate to Severe Pain: Often throbbing or pulsing.
- Unilateral Pain: Usually on one side of the head, but can be bilateral.
- Nausea and Vomiting.
- Photophobia: Increased sensitivity to light.
- Phonophobia: Increased sensitivity to sound.
- Osmophobia: Increased sensitivity to smells.
- Worsened by physical activity.
- Postdrome (After the Attack - lasts 24-48 hours):
- Fatigue, drained feeling.
- Confusion.
- Mood changes.
- Muscle weakness.
- Head pain may recur with sudden head movement.
- Medical History:
- The doctor will ask detailed questions about your headaches, including frequency, severity, location, type of pain, accompanying symptoms (nausea, sensitivity), and any triggers.
- Family history of migraines.
- Impact on daily life.
- Physical and Neurological Exam: To rule out other conditions that could cause similar symptoms (e.g., tumors, strokes, or other neurological disorders). This involves checking reflexes, sensation, vision, and coordination.
- Imaging Tests (not for routine diagnosis of migraine, but to rule out other conditions):
- CT Scan (Computed Tomography) or MRI (Magnetic Resonance Imaging): May be performed if symptoms are unusual, severe, or suggest other neurological problems, such as a tumor, stroke, or bleeding in the brain.
- Keeping a Headache Diary: Can be very helpful for both diagnosis and identifying triggers. Patients record details of each headache episode.
- Acute (Abortive) Treatments (taken at the first sign of a migraine):
- Over-the-Counter Pain Relievers: (e.g., ibuprofen, naproxen, acetaminophen, aspirin). Effective for mild to moderate migraines.
- Triptans: (e.g., sumatriptan - Imitrex, zolmitriptan - Zomig). Specific migraine drugs that constrict blood vessels and block pain pathways in the brain. Highly effective for many.
- CGRP Receptor Antagonists (Gepants): (e.g., ubrogepant - Ubrelvy, rimegepant - Nurtec ODT). Newer oral medications that block the CGRP protein, involved in migraine pain.
- Ditans: (e.g., lasmiditan - Reyvow). Targets serotonin receptors different from triptans; does not cause vasoconstriction.
- Ergots: (e.g., ergotamine with caffeine - Cafergot). Older class of drugs, less commonly used due to side effects.
- Anti-Nausea Medications: (e.g., prochlorperazine, metoclopramide) To relieve nausea and vomiting.
- Preventive (Prophylactic) Treatments (taken regularly to reduce frequency/severity):
- Beta-Blockers: (e.g., propranolol, metoprolol). Commonly used for high blood pressure or heart conditions, but also effective for migraine prevention.
- Antidepressants: (e.g., amitriptyline, venlafaxine). Tricyclic antidepressants and SNRIs can help prevent migraines.
- Anticonvulsants: (e.g., topiramate - Topamax, valproic acid). Used for epilepsy but also effective for migraine prevention.
- CGRP Inhibitors (Monoclonal Antibodies): (e.g., erenumab - Aimovig, fremanezumab - Ajovy, galcanezumab - Emgality, eptinezumab - Vyepti). Newer injectable medications that target CGRP or its receptor to prevent migraines.
- Botulinum Toxin (Botox) Injections: For chronic migraine (15 or more headache days per month), injections into specific head and neck muscles can help prevent attacks.
- Blood Pressure Medications (e.g., candesartan): Can be used for prevention.
- Lifestyle Management:
- Identify and Avoid Triggers: Keeping a headache diary is crucial.
- Stress Management: Relaxation techniques, yoga, meditation.
- Regular Sleep Schedule: Consistent bedtime and wake-up times.
- Regular Meals: Avoid skipping meals.
- Regular Exercise: Moderate, consistent physical activity.
- Biofeedback: Learning to control certain body responses to reduce tension.