What Causes It?
Researchers have not yet determined an exact cause of migraines. However, it’s thought that temporarily abnormal brain activity may impact nerve signals and blood vessels within the brain. Genetics is believed to predispose certain individuals toward migraine triggers that are very specific to them.
A broad range of potential triggers have been suggested and can vary from person to person, including:
- Hormonal, particularly around the time of menses
- Emotional, including periods of tension, depression, or even over-excitement
- Physical, such as jet lag or lack of sleep, poor posture, or extreme exercise
- Dietary, including dehydration, low blood sugar, poor nutrition, a wide variety of food items, alcohol, and caffeinated products
- Environmental, like bright or flickering lights, noise, heavy smells, a close atmosphere, or shifts in climate
- Medication-related, including certain drugs or combinations of drugs
What Are the Symptoms?
Migraine without aura may progress through three stages: prodrome, attack, and postdrome, although not everyone will experience each stage. (Note that some people experience a 4th stage – aura – just before the attack of head pain begins. See Migraine with Aura for more details on this migraine type.)
- Prodrome: Occurring 1-2 days before migraine pain sets in, an individual may begin to detect unusual warning signs such as mood swings, food cravings, frequent yawning, or a stiff neck.
- Migraine Attack: The classic symptom of a migraine attack is a period of severe pain, usually at one side of the head and typically lasting 4 to 72 hours. In very serious cases, pain may last even longer.
- Postdrome: For a brief period after head pain recedes, the affected individual may feel confused, overly tired, or even euphoric. Pain may recur briefly with head movement.
Visit a doctor or ER right away in any of the following situations, which may signal a more serious condition:
- Head pain after a head injury
- Headache with fever, dizziness, numbness, or weakness, which may indicate a stroke
- A sudden bad headache that feels like a clap of thunder
- A chronic headache that worsens with coughing or straining
How Is It Diagnosed?
Many people live with recurring bouts with migraine yet are never clearly diagnosed or properly treated. Individuals who regularly experience migraine symptoms are advised to keep a diary of their symptoms and triggers, and consult a head pain specialist to discuss their attacks and how to manage them.
The specialist will perform a physical and gather details of the patient’s health and medication history, including any ongoing medical issues and family history of head pain. They may order specific tests — MRI, CT scan, or bloodwork — to rule out other potential origins of head pain.
The information gathered will help the physician make an accurate, informed diagnosis and recommend suitable treatment, based on frequency and severity of symptoms. Once diagnosed, the doctor will also want to monitor any changes in how the migraines behave or evolve over time.
How Is It Treated?
In many cases, specific medications will effectively relieve a variety of migraine symptoms, and may be combined with certain helpful lifestyle changes or self-help approaches.
Medications for stopping migraine symptoms typically include:
- Over-the-counter pain relievers, like Tylenol or Excedrin, for milder pain. They’re not recommended for long-term use.
- Triptans — available in pills, nasal sprays, or injections — that can effectively block pain signals in your brain.
- Acute CGRP inhibitors — including Rimegepant [gepant] Nurtec ODT and Ubrogepant [gepant] Ubrelvy — that halt pain signals thought to be linked to a protein known as calcitonin gene-related peptide (CGRP).
- Anti-nausea medications, to help treat vomiting or nausea that occur as side effects of the migraine.
Is It Preventable?
Strategies to prevent migraine include identifying and avoiding triggers. Headache specialists recommend keeping a regular diary of attacks, with special attention on capturing any consistent triggers, as well as measures that deliver even partial relief. Avoiding specific triggers may keep migraine away for some people.
Prevention may also include use of medications such as:
- Beta-blockers. Often used to treat high blood pressure, this treatment often proves effective against frequent or severe migraine attacks when used daily.
- Calcium channel blockers, which can prevent the constriction of blood vessels associated with migraine.
- Inhibitors that block calcitonin gene-related peptide (CGRP), a molecule involved in causing migraine pain.
- Antidepressants and anti-seizure medications, which can be beneficial but must be used carefully in conjunction with other medications.
- Botox injections, administered every 12 weeks or so.
Preventive treatments can be very effective, particularly when combined with careful management of migraine triggers and certain self-help approaches like yoga, massage therapy, or biofeedback.