It is often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with daily activities. Risk factors for migraines include family history, age, and female gender. Migraines typically begin in childhood or adolescence and peak in young to mid adulthood but can be a lifelong disease. It is estimated that 37 million Americans have migraines, with 148 million people worldwide suffering from migraines. The World Health Organization (WHO) ranks migraine as one of the top 10 causes of disability worldwide. It is estimated that industry loses $31 billion per year due to absenteeism, lost productivity, and medical expenses caused by migraine.
A typical migraine “attack” involves four phases: (1) prodrome, (2) aura, (3) headache, and (4) postdrome. The exact progression and symptoms differ from person to person.
Prodrome: Many people start having symptoms 24 to 48 hours before a migraine headache begins. These may include increased yawning, a feeling of euphoria, depression, irritability, food cravings, constipation, and neck stiffness.
Aura: Approximately 25% of people with migraines experience an “aura” before the headache. Flashing lights, bright spots, zigzag lines, changes in vision, numbness or tingling in the fingers, lips, tongue, or lower face are examples of an aura. You may have one or more of these aura symptoms. Auras may also involve other senses and can occasionally cause temporary weakness or changes in speech. Aura symptoms typically last five to twenty minutes and rarely more than an hour in duration. The headache usually occurs soon after the aura stops, although some people experience aura without a headache.
Headache: The pain of the migraine headache usually begins gradually, intensifies over one to several hours, and resolves gradually at the end of the attack. It normally affects only one side of the head but can be bilateral. The headache pain is typically dull and steady when mild to moderate in severity but escalates to throbbing and pulsating pain when more severe. Migraine headaches may be aggravated by light, loud noises, physical activity, and motion. Many people try to get relief by lying down in a dark, quiet room. Migraines usually last a few hours, but in some cases, a migraine can last up to 72 hours in duration. Migraines are often accompanied by nausea and vomiting, as well as sensitivity to light and noise. Some people also feel very sensitive to touch and may find normal activities impossible to perform.
Postdrome: Also known as the recovery phase, a postdrome occurs after the end of the actual head pain. It is often described as a “hangover-like” experience which may take 24 to 48 hours to fully resolve. Symptoms may include poor concentration, extreme fatigue, body aches, depressed mood, and confusion.
Migraines can be triggered by a variety of things and can vary from person to person. Examples include stress, physical exertion, fatigue, lack of sleep, hunger, odors, weather changes, certain foods or medications, and environmental factors. In females, migraines can be brought on by the normal decrease in estrogen levels which occur before menstruation each month.
The treatment of migraines depends on frequency, severity, and symptoms of migraine and is individualized based on patient need. Many people who experience regular migraines need both acute and preventative treatment. Acute treatment refers to medicines you can take when you have a migraine to relieve the pain immediately. Preventative treatment refers to medicines you take regularly (usually daily) to avoid migraines in the future.
Acute Treatment: The pain of migraines can be tough to get rid of and the first step in proper migraine management is to treat promptly.
Preventative Treatment: Preventive therapies are used to help reduce the frequency and severity of migraines and are generally recommended in individuals who have frequent, long-lasting, or severe migraines that impact quality of life and ability to function. There are various strategies used to prevent migraines and may include the following medications:
Lifestyle modifications: Certain lifestyle changes can improve migraines and should be incorporated into daily living. Examples include the following:
The Mayo Clinic, The National Institutes of Health, UptoDate.com