What Is a Migraine?

A migraine is a severe, painful headache that can be preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound.

A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head and can last for hours or even days. Migraine is a common problem affecting 36 million Americans, about 12% of the population.

What Are the Symptoms of a Migraine?

Symptoms of migraine can occur for a period before the headache, during the headache, and/or after the headache. Although not all migraines are the same, typical symptoms include:

  • A severe, throbbing, pulsing pain.
  • Increasing pain during physical activity, even to the point of being unable to perform regular activities due to pain.
  • Increased sensitivity to light and sound, relieved by lying quietly in a darkened room.
  • Some people experience other symptoms such as sweating, temperature changes, stomach ache and diarrhea.

Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages, including prodrome, aura, headache and postdrome, although not everyone with a migraine experiences all the stages:

  • Prodrome – One or two days before a migraine, you may notice subtle changes that signify an oncoming migraine including constipation, depression, food cravings, hyperactivity, irritability, neck stiffness, or uncontrollable yawning.
  • Aura – Aura may occur before or during migraine headaches. Auras are nervous system symptoms that may cause visual disturbances, such as flashes of light, blind spots or blank patches in the vision, zigzag lines in the visual field. Auras may also cause confusing thoughts or experiences, the sensation of pins and needles in an arm or leg, difficulty speaking, stiffness in the shoulders, neck or limbs, and unpleasant smells. Most people experience migraine headaches without aura.
  • Attack – When untreated, a migraine usually lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less often. During a migraine, you may experience the following symptoms: pain on one side or both sides of your head, pain that has a pulsating, throbbing quality, sensitivity to light, sounds and sometimes smells, nausea and vomiting, blurred vision, and lightheadedness, sometimes followed by fainting.
  • Postdrome – The final phase, known as postdrome, occurs after a migraine attack. During this time you may feel drained and washed out, though some people report feeling mildly euphoric.

Causes

Although much about the cause of migraines isn’t understood, genetics and environmental factors appear to play a role.

Whatever the underlying cause of a migraine might be, a number of things may trigger them. Common migraine triggers that have been identified include: hormonal changes in women, foods and food additives, alcohol and highly caffeinated beverages, stress, bright lights and sun glare, loud sounds, unusual smells, changes in wake-sleep pattern, a change of weather, skipping meals or fasting causing low blood sugar, smoking or exposure to smoke, dehydration, and certain medications.

Treatments and drugs

Migraine treatments focus on prevention, avoiding triggers, controlling symptoms and taking medicines. If you have migraines or a family history of migraine headaches, your doctor will likely diagnose the condition on the basis of your medical history, a review of your symptoms, and a physical and neurological examination.

Your doctor may also recommend a variety of tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe.

Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache gets worse

A chronic headache that is worse after coughing, exertion, straining or a sudden movement