woman having a migraine

Types and Management of Migraines

There are various types of headaches, but migraine is one of the worst. It is not just a passing headache nor is it a symptom of a different medical disorder. Cleveland Clinic defines migraine as a neurological disease and a primary headache disorder, which means it is not diagnosed through a blood test or imaging study.

According to the Harvard Business Review (HBR), more than a billion people worldwide and 47 million Americans have migraines. Migraine attacks peak from the age of 25 to 55 years old, affecting the most productive working years.

The Migraine Research Foundation (MRF) states that migraine is the third most common and the sixth most disabling disease worldwide. During a migraine attack, 90 percent of people cannot work or function normally. Most attacks occur once or twice a month. There are over four million people who have chronic daily migraines, though, and suffer 15 or more days with attacks every month.

Symptoms of Migraine

According to Cleveland Clinic, a migraine headache can last four hours or several days. It has four phases: the prodrome, aura, headache, and postdrome. Doctors check for these symptoms in diagnosing migraines.

The prodrome can include sensitivity to light and sound, problems concentrating, fatigue, muscle stiffness, irritability, depression, difficulty sleeping, difficulty speaking and reading, food cravings, nausea, and increased urination. This can last from three hours to a few days.

The aura can include numbness and tingling sensations; visual disturbances like blurred vision or seeing spots, sparkles, lines, or waves; momentary loss of sight; changes in speech; and weakness on only one side of the body. This lasts from five minutes to an hour.

The headache is a throbbing, drilling, or icepick-like pain that starts on one part of the head, usually behind one eye, and either stays there or spreads. It includes neck pain and stiffness, nasal congestion, nausea, and vomiting. Physical movement, light, sounds, and smells worsen the pain. The sufferer is unable to sleep and feels depressed and anxious. The headache can last from four to 72 hours.

The postdrome, sometimes called a migraine hangover, can include the inability to concentrate and comprehend, fatigue, and either depression or euphoria. This can last for a day or two.

Types of Migraine


There are different types of migraines named according to the symptoms linked with them. The common migraine is also called migraine without aura. The complicated migraine or migraine with aura happens to 15 to 20 percent of sufferers. There is also a migraine without a headache but only the aura.

Migraine with brainstem aura includes vertigo, loss of balance, double vision, and slurred speech. The headache is at the back of the head and occurs with ringing in the ears, inability to speak well, and vomiting.

Hemiplegic migraine includes short-term paralysis or neurological or sensory changes on only one side of the body. Retinal or ocular migraine includes short-term partial or complete vision loss in one eye.

Chronic migraine has attacks occurring 15 days or more every month. Status migrainosus has extreme headache pain and nausea that can last for more than 72 hours.

Healthline adds menstrual migraine that occurs during the premenstrual or menstrual phase linked to hormonal fluctuations. This usually lasts longer and is more severe than migraine attacks at other times.

Risk Factors and Triggers of Migraine

MRF states that migraine is hereditary and affects even children. Women comprise 85 percent of sufferers due to hormonal changes.

The triggers of a migraine attack include emotional stress, lack of sleep, exhaustion, bright lights, loud noises, hunger, dehydration, exposure to certain odors, or changes in altitude. Up to 30 percent of attacks are due to sensitivity to alcoholic beverages, chocolate, aged cheese, fermented or pickled food, and food additives like nitrates. Too much intake of caffeine can cause withdrawal attacks. Overuse of pain medication can cause rebound attacks while other types of medication can cause swelling of blood vessels leading to an attack.

Migraine Prevention and Management

HBR cites that migraine prevention and management can include identification and avoidance of triggers and use of proper medication.

In October 2010, the U.S. Food and Drug Administration (FDA) approved the use of Botox injections to prevent chronic migraine attacks in adults who suffer 14 days or more of attacks monthly. According to Healthline, this entails 31 injections around the head and neck every three months. These injections block chemicals from transmitting pain to nerve endings.

ScienceNews reports that there are other prescription medications for migraine prevention. Antidepressants increase the production of serotonin, decreasing sensitivity to pain. Antiseizure medication decrease overactive brain sensory pathways.  Beta-blockers stop the dilation of blood vessels. CGRP-blocking monoclonal antibodies and gepants block a certain chain reaction that results in migraine.

CGRP-blocking monoclonal antibodies and gepants are also effective in stopping acute migraine attacks. Other drugs for acute migraine are triptans that increase serotonin and reduce the release of CGRP, opioids, and other prescription medication. Over-the-counter analgesics sometimes help when taken at the start of an attack. These include aspirin, naproxen, ibuprofen, and acetaminophen combined with caffeine.

In addition to avoiding triggers and getting preventive or acute medication, experts suggest lifestyle changes such as regulating sleep patterns and lowering levels of stress. During an attack, it helps to lie down in a dark, quiet, and cool room with a cold compress where the pain is on the head.

Seeking Professional Help

consulting a doctor

MRF reports that most migraine sufferers do not consult medical professionals about their headaches, hence, they are not diagnosed and treated. Only 12 percent of sufferers receive preventive treatment.

This is such a waste because there are neurologists and certified headache specialists who can help. There are also various types of treatments and medications available to improve the quality of life of migraine sufferers worldwide.

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