What Is Migraine? Signs Symptoms,and Causes

A migraine is a neurological condition or disorder which is characterised by severe headaches, usually giving a throbbing or pulsating feeling on either one or both sides of one’s head. The headache will be accompanied by symptoms like nausea, vomiting, speaking difficulties, numbness or tingling, and light and sound sensitivity.

Studies say that Migraine is the sixth most disabling disease in the world. It could be genetic and can affect people of almost all ages. In young children, migraine goes undiagnosed as it is misunderstood to be a common headache or weakness. The duration of migraine varies between individuals. Most of the attacks last for a minimum of 4 hours. If an attack of a migraine lasts longer than three days, it has to be treated in a hospital setting.

What Is Migraine?

Migraine is a neurological disease characterized by repeated episodes of symptoms, called attacks, that usually include headache, often accompanied by nausea; vomiting; sensitivity to light, touch, smell, or sound; dizziness; visual disturbances; and tingling or numbness in the face, hands, or feet.

Migraine attacks may come on suddenly without warning, or they may be preceded by certain known triggers, such as skipping a meal, being exposed to smoke or air pollution, or experiencing a change in hormone levels as part of the menstrual cycle.

The frequency of attacks varies from person to person. Some people have attacks several times a month, while others have them much less frequently.

Most migraine attacks last from 4 to 72 hours, although effective treatment can shorten them to a matter of hours. On the other hand, some migraine attacks can last even longer than 72 hours.

While a variety of triggers can set off migraine attacks, triggers don’t directly cause the attacks or the underlying disease.

There are still gaps in doctors’ understanding of what causes migraine. However, some doctors describe the migraine brain as hyperactive, or supersensitive, by which they mean that the brain of someone with migraine reacts more strongly to environmental stimuli such as stress or sleep disturbance than the brain of someone who doesn’t have migraine, resulting in the symptoms known as a migraine attack.

What does Migraine feel like?

Migraine feels different to different people

A one-sided headache
Pulsating or throbbing pain
Moderate to severe pain
Worsening of pain during movement (walking, climbing stairs)
Sensitivity to sound and light
Nausea with or without vomiting or diarrhea
Migraine usually lasts for about four hours. If they are not treated it can last for a week.

Types of Migraine

There are many types of migraine. Two of the most common types are migraine without aura and migraine with aura. Some people have both types.

Many people living with migraine have more than one type of migraine.

Migraine without aura

Most people with migraine don’t experience an aura with their headaches.

Individuals who have migraine without an aura have had at least five attacks that have these characteristicsTrusted Source:

attack usually lasts 4 to 72 hours without treatment or if treatment doesn’t work

attack has at least two of these traits:

it occurs only on one side of the head (unilateral)

pain is pulsating or throbbing

pain level is moderate or severe

pain gets worse when you move, like when walking or climbing stairs

attack has at least one of these traits:

it makes you sensitive to light (photophobia)

it makes you sensitive to sound (phonophobia)

you experience nausea with or without vomiting or diarrhea

attack isn’t caused by another health problem or diagnosis

Migraine with aura

An aura typically occurs in 25 percent of people who have migraine.

If you have a migraine with aura, you most likely have at least two attacks that have these characteristics:

an aura that goes away, is completely reversible, and includes at least one of these symptoms:
visual problems (the most common aura symptom)
sensory problems of the body, face, or tongue, like numbness, tingling, or dizziness
speech or language problems
problems moving or weakness, which may last up to 72 hours
brainstem symptoms, which includes:
difficulty talking or dysarthria (unclear speech)
vertigo (a spinning feeling)
tinnitus or ringing in the ears
diplopia (double vision)
ataxia or an inability to control body movements
eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur, they’re called retinal migraines)
an aura that has at least two of these traits:
at least one symptom spread gradually over 5 or more minutes
each symptom of the aura lasts between 5 minutes and 1 hour (if you have three symptoms, they may last up to 3 hours)
at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
aura occurs with the attack or 1 hour before the attack begins
attack isn’t caused by another health problem and transient ischemic attack has been excluded as a cause
An aura usually occurs before the headache pain begins, but it can continue once the attack starts. Alternatively, an aura may start at the same time as the attack does.

Migraine With Brain Stem Aura

This type of migraine, formerly known as basilar-type migraine, is a rare type of migraine with aura. It usually includes neurologic symptoms such as double vision, problems speaking and hearing, dizziness, and loss of balance and coordination.

Hemiplegic Migraine

Hemiplegic migraine comes in two forms: familial hemiplegic migraine and sporadic hemiplegic migraine. Both are characterized by aura, fever, and hemiplegia (paralysis on one side of the body). Both are relatively rare.

Retinal Migraine

Retinal migraine is an extremely rare cause of temporary visual loss in one eye, per the IHS. It’s diagnosed when a person has repeated attacks of one-sided visual disturbance — including the types of visual symptoms commonly seen in migraine aura — or blindness associated with migraine headache. These symptoms tend to evolve over five or more minutes, may last as long as an hour, and may be accompanied or followed by a headache.

Chronic migraine

Chronic migraine used to be called a “combination” or “mixed” because it can have features of migraine and a tension headache. It’s also sometimes called a severe migraine headache and can be caused by medication overuse.

People who have chronic migraine have a severe tension headache or migraine attack more than 15 days a month for 3 or more months. More than eight of those attacks are migraine with or without aura.

Some additional risk factors that may make an individual susceptible to chronic migraine include:

anxiety

depression

another type of chronic pain, like arthritis

other serious health problems (comorbidities), like high blood pressure

previous head or neck injuries

Acute migraine is a general term for a migraine attack that isn’t diagnosed as chronicTrusted Source. Another name for this type is episodic migraine.

People who have episodic migraine have attacks up to 14 days a month. Thus, people with episodic migraine have fewer attacks a month than people with chronic ones.

Vestibular migraine is also known as migraine-associated vertigo. About 1 percent of the general population lives with vestibular migraine. The symptoms affect balance, cause dizziness, or both. People of any age, including children, may experience vestibular migraine attacks.

If diagnosed, your doctor may suggest you see a vestibular rehabilitation therapist. They can teach you exercises to help you stay balanced when your symptoms are at their worst. Because these migraine attacks can be so debilitating, you and your doctor may talk about taking preventive medications.

According to the National Headache Foundation, menstrual-related migraine affects up to 60 percent of women who experience any type of migraine. It can occur with or without an aura. Attacks can also happen before, during, or after menstruation and during ovulation.

Research has shown that menstrual migraine tends to be more intense, last longer, and have more significant nausea than migraine not associated with the menstrual cycle.

Migraine aura without headache, also called a silent migraine or visual migraine without headache, occurs when a person has an aura, but doesn’t get a headache. This type of migraine is more common in people who start having migraines after age 40.

Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur, with symptoms spreading over several minutes and moving from one symptom to another. After visual symptoms, people may have numbness, speech problems, and/or tingling in the face or hands.

Hormonal migraine, or menstrual migraine, is linked with the female hormones, commonly estrogen. Many people who ovulate report migraine headaches during:

their period

ovulation

pregnancy

perimenopause

Migraine nausea

Many people experience nausea as a symptom of migraine. Many also vomit. These symptoms may start at the same time the attack does. Usually, though, they start about 1 hour after the headache pain begins.

Nausea and vomiting can be as troubling as the attack itself. If you only have nausea, you may be able to take your usual migraine medications. Vomiting, though, can prevent you from being able to take pills or keep them in your body long enough to be absorbed. If you have to delay taking migraine medication, migraine is likely to become more severe.

Treating nausea and preventing vomiting

If you have nausea and vomiting, your doctor may suggest medication to ease nausea called anti-nausea or antiemetic drugs. In this case, the antiemetic can help prevent vomiting and improve nausea.

Acupressure may also be helpful in treating migraine nausea. A 2012 studyTrusted Source showed that acupressure reduced the intensity of migraine-associated nausea starting as soon as 30 minutes, gaining improvement over 4 hours.

Syndromes That May Be Associated With Migraine

Certain disorders occur more frequently among people with migraine or people, usually children, at a higher risk of developing migraine:

Cyclical Vomiting Syndrome In cyclical vomiting syndrome, an individual experiences attacks of severe nausea and vomiting lasting an hour or more for up to 10 days at a time. Between attacks, which occur on a regular cycle, the person has no symptoms of nausea or vomiting.

Abdominal Migraine This type of episodic migraine is diagnosed mostly in children. Symptoms include abdominal pain, nausea, and vomiting. Kids who experience abdominal migraine often don’t have attacks involving headache in adolescence but go on to develop them as adults

Benign Paroxysmal Vertigo In this syndrome, otherwise healthy children experience recurrent brief attacks of vertigo that come on without warning and resolve spontaneously without loss of consciousness. During the attacks, a child may have nystagmus (uncontrolled horizontal or vertical eye movement), impaired balance or coordination (called ataxia), vomiting, pale skin, and fearfulness.

Benign Paroxysmal Torticollis Occurring in infants and small children, this syndrome causes the head to tilt to one side, with or without slight rotation, and stay tilted for minutes to days before spontaneously resuming its normal position. During the attack, the infant or child may be pale and irritable, seem uncomfortable or generally unwell, vomit, or in older children, have impaired balance or coordination.

Other Types of Headaches

Other rare types of headaches include these varieties:

Cluster Headache These intensely painful headaches last 15 to 180 minutes without treatment and happen in cycles, or clusters, per the IHS.

Paroxysmal Hemicranias Severe, sometimes throbbing pain on one side of the face or around the eyes lasts 2 to 30 minutes and occurs more than five times a day, says the National Institute of Neurological Disorders and Stroke.

Ice-Pick Headache As the name implies, an ice-pick headache is a migraine characterized by stabbing pain. Fortunately, it is relatively uncommon and typically short in duration

Intractable Headache Any headache, including migraine, that doesn't respond to treatment.

Occipital Neuralgia This disorder causes pain in the back of the head and upper neck.

Signs and Symptoms of Migraine

Symptoms of migraine vary depending on the type of migraine and on the person. In general, though, migraine attacks are very painful and can interfere with your daily life.

The most common symptom of migraine is head pain — often described as an intense throbbing or pulsating sensation, usually on one side of the head but sometimes on both sides of the head, and sometimes starting on one side of the head and moving to the other side.

In addition to head pain, these are the most commonly reported migraine signs and symptoms:

Light sensitivity, called photophobia, which contributes to the desire to seek out a dark space during attacks
Sound sensitivity, or phonophobia, which can make ordinary noises unbearable
Touch hypersensitivity, called allodynia, or pain resulting from gentle touches, such as brushing one’s hair or touching one’s face to a pillowcase
Nausea and vomiting
Aura symptoms
Neck pain or stiffness
Fatigue
Brain fog, or difficulty concentrating, remembering, or performing other mental tasks
Light-headedness, dizziness, or vertigo
Depression or anxiety
Ringing in the ears, or tinnitus
Tearing of the eyes
Sinus pain
Diarrhea
Aversion to odors
Other migraine symptoms may be less common or simply less commonly reported:
Colds hands or feet
Constipation
Difficulty speaking clearly
Difficulty understanding written or spoken information
Earaches
Facial swelling
Food cravings
Frequent urination
Increased thirst
Jaw pain
Night sweats
Nightmares
Numbness or tingling in the hands, feet, or face
Physical weakness
Smelling odors (usually unpleasant ones) that aren’t really there
Stuffy nose

Migraine attacks can have four stages, with somewhat different symptoms at each stage:

Prodrome, or Warning, Stage You may notice the first signs of a migraine attack one or two days before the onset of aura symptoms or headache. These early warning symptoms can include changes in mood, cravings for certain foods, muscle stiffness, trouble concentrating, sensitivity to sound or light, fatigue and difficulty sleeping, yawning, and frequent urination.

Aura Stage Up to one-third of people experience the aura phase, which can last five minutes to an hour and increase in intensity over time. Aura may involve seeing bright spots or patterns of light, and numbness or tingling in various areas of the body but not paralysis.

Headache Stage Pain comes with the headache phase, which can last several hours and up to three days. The throbbing pain may start on one side of the head and move to include both sides. It may be accompanied by nausea and vomiting as well as blurred vision and sensitivity to certain stimuli such as light and noise. People typically seek out a quiet, dark room to rest or sleep during this phase of a migraine attack.

Postdrome, or Hangover, Stage In the last phase of a migraine attack, when the headache pain has eased, fatigue and body aches may occur. You may have trouble concentrating and may still be hypersensitive to certain stimuli.

Not everyone who has migraine experiences all four stages, and even those who usually do may not experience all four during every migraine attack.

Causes and Risk Factors of Migraine

The exact cause of migraine remains unknown. Research suggests that genetic and environmental factors may play a role.

Studies have linked changes in the brain stem and the trigeminal nerve, which mediates pain, to migraine.

Chemical imbalances in the brain may also be involved. Depression and anxiety have long been associated with migraine. A study published in Headache found that migraine frequency was associated with the severity of depression and anxiety: The higher the frequency of attacks, the more likely a person was to experience depression or anxiety.

Research has found that serotonin levels drop during migraine attacks, causing the trigeminal system to release substances called neuropeptides, which cause headache pain.

A change in the weather or barometric pressure, which can cause imbalances in brain chemicals, may prompt a migraine attack, according to Mayo Clinic.

Researchers have identified several key risk factors for developing migraine, including the following.

Summary

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 that:

causes slurred speech or drooping on one side of the face

causes new leg or arm weakness

comes on very suddenly and severely with no lead-in symptoms or warning

occurs with a fever, neck stiffness, confusion, seizure, double vision, weakness, numbness, or difficulty speaking

has an aura where the symptoms last longer than an hour

would be called the “worst headache ever”

is accompanied by loss of consciousness

If headaches are getting in the way of your daily life, and you’re not sure if they are a migraine symptom, it’s important to talk with your doctor. Headaches can be a sign of other issues, and while migraine can feel debilitating at times, there are many treatments available.

The sooner you start to talk about your symptoms, the sooner your doctor can get you on a treatment plan that may include medication and lifestyle changes.

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