Migraines

What is a Migraine?

A migraine is a headache that may cause severe pain or pulsing, often on one side of the head, according to the Mayo Clinic. A migraine attack can last anywhere from several hours to several days—with pain so severe that it interferes with your ability to work and carry out other daily activities.

What’s the difference between a headache and a migraine? Penn Medicine explains that a headache is only one of many possible migraine symptoms, which may also include nausea, dizziness, fatigue, and sensitivity to various stimuli like light, sounds, or smells. Before a migraine attack, many people experience what’s called an aura—symptoms that occur right before migraine pain, such as flashing lights or other visual disturbances, difficulty speaking, or a tingling sensation.

Types of Migraines

There are various types of migraine. Some examples include:

• Migraine with aura
• Migraine without aura
• Hemiplegic migraine (involves paralysis on one side of the body)
• Retinal migraine (associated with vision loss)
• Chronic migraine (migraine pain occurs at least 15 days per month)
• Status migrainosus (a rare, severe migraine that lasts more than three days)

What Causes a Migraine?

According to the National Institutes of Health, migraines can be caused by genetic and environmental factors. Some of the most common causes of migraines include:

1. Stress
2. Anxiety
3. Hormonal changes
4. Bright lights
5. Loud noise
6. Very strong smells
7. Side effects of certain medications
8. Disturbances in sleep patterns
9. Sudden weather changes
10. Excess physical activity
11. Smoking
12. Caffeine (or caffeine withdrawal)
13. Skipping meals
14. Medication overuse (also known as rebound headaches, which occur from taking migraine medication often)

Certain foods, beverages, or ingredients, are known to trigger headache pain, such as:

• Alcohol
• Chocolate
• Aged cheeses such as gouda or parmesan
• Monosodium glutamate (MSG; a flavor enhancer often found in Asian cooking)
• Fermented or pickled foods
• Yeast
• Cured or processed meats like prosciutto, salami, or pepperoni

Possible Migraine Symptoms

Migraine symptoms may vary, based on the phase and type of migraine. The Mayo Clinic reports that some individuals experience symptoms before they have headache pain. Keeping track of symptoms every day in a journal or app may help you to recognize symptoms as they occur—as well as find ways to prevent future attacks. The four stages of a migraine, in order, are:

1. Prodrome: One or two days before migraine pain occurs, you may notice subtle symptoms—sometimes referred to as "silent migraine symptoms"—like mood changes, fatigue, and food cravings.
2. Aura: Visual and other disturbances, such as seeing bright spots or flashes of light, experiencing vision loss, numbness and weakness, and difficulty speaking.
3. Headache: Migraine headache pain lasts from four to 72 hours if untreated. Symptoms may include throbbing pain (which often occurs on one side of the head, but may occur on both sides), nausea, vomiting, and sensitivity to light and sound.
4. Postdrome: After the pain diminishes, you may feel exhausted and confused.

You may not have the same symptoms each time. During the headache phase of a migraine, according to the Cleveland Clinic, symptoms may include:

• A pounding, throbbing headache which worsens if untreated
• Pain around the eyes, forehead, face, or even the sinuses, jaw, and neck
• Gastrointestinal symptoms like nausea, vomiting, and stomach pain
• Appetite loss
• Sensitivity to light, sound, and smell
• Sweating
• Chills
• Pale skin
• Fatigue
• Dizziness
• Vision disturbances such as blurry vision
• Tender scalp

Migraine Diagnosis and Testing

If you are experiencing migraine symptoms, you can see a primary care provider (PCP), neurologist, or urgent care provider. To diagnose migraine, the healthcare provider will ask about symptoms, take a medical and family history, and perform a physical and neurological examination. If necessary, they may order imaging tests like an MRI or CT scan.

The American Migraine Foundation recommends an emergency room visit for certain symptoms, which could indicate a severe or life-threatening condition. These symptoms include:

• Severe pain
• Confusion
• Fever
• Vision changes
• Stiff neck
• Difficulty speaking
• Numbness
• Weakness
• A headache that starts suddenly and becomes intensely painful within several minutes

Questions Your Doctor May Ask About Migraines

In addition to taking a detailed medical history, family history, and list of medications, some questions your doctor may ask include:

• Where does the pain occur? Is it on one side? Is it always the same, or does it vary?
• Can you tell me about the severity of your pain?
• Can you describe the pain - for example, is it dull or throbbing?
• How often do you have migraine pain? How long do your migraines last?
• Do you keep a journal or keep track of your migraine symptoms on an app?
• Does anything help your symptoms? Have you tried any medications?
• Does anything worsen your symptoms? For example, do you notice that your migraine pain is worse with certain foods, stress, or weather?
• Does anyone in your family have a history of migraine?

Can I Go to Urgent Care for Migraine?

An urgent care facility is an excellent option for migraine treatment. You can receive high-quality care from healthcare providers who are well-equipped to diagnose and treat migraine. Urgent care centers offer many convenient locations as well as evening and weekend hours, too.

However, those with severe or emergent symptoms should go to an emergency room. Also, if you have recurrent migraine attacks, you should see a neurologist for a treatment plan—but you can still see an urgent care provider if needed for acute pain.

Possible Migraine Treatment Options

The National Institute of Neurological Disorders and Stroke outlines guidelines for treatment.

Nonmedicinal measures you can take for migraine include resting in a dark, cool, quiet room with an ice pack on your head and drinking plenty of fluids.

For acute migraine attacks, your doctor may prescribe or recommend the below, according the the Mayo Clinic:

• A triptan drug such as Imitrex (sumatriptan) or Maxalt (rizatriptan). These medications are the first-choice, preferred prescription treatment—they work fast to help with migraine pain. What’s more, they are available in a variety of formulations, such as oral tablets, disintegrating tablets, injections, and nasal sprays.
• Ergots such as dihydroergotamine
• Over-the-counter (OTC) pain relief medications like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen)
• Combination OTC migraine medications such as Excedrin Migraine
• Oral CGRP inhibitors can be used to treat an acute migraine, including Nurtec ODT (rimegepant) or Ubrelvy (ubrogepant). There’s also a CGRP inhibitor nasal spray, Zavzpret (zavegepant), used to treat acute migraine.
• Reyvow (lasmiditan) can help with headache pain, but causes sedation and dizziness, so people who take this medication should not drive for at least 8 hours, according to Mayo Clinic.

According to the American Academy of Family Physicians, experts from the American Headache Society and the American Academy of Neurology recommend not using butalbital-containing drugs (such as Fioricet) or opioid medications, except as a last resort. They also recommend avoiding prolonged or frequent use of OTC pain medications to treat migraine, because they could lead to rebound headaches. People with frequent migraine attacks should speak to their healthcare provider about preventive medication.

Preventative Migraine Medication

People who have frequent migraine attacks are generally prescribed preventive medication. According to WebMD, many preventive medications were originally developed for other conditions but also can help prevent migraine attacks, such as:

• Anticonvulsants, such as Topamax (topiramate)
• Beta-blockers, such as Inderal (propranolol)
• Antidepressants such as Elavil (amitriptyline)

Newer medications have been developed that are targeted toward the root of migraine and are constantly being studied, such as calcitonin gene-related peptide (CGRP) inhibitors. According to WebMD, CGRP is a substance often found at higher levels in the blood of people who get migraine attacks. CGRP causes pain and inflammation, making headaches more painful and longer-lasting.

CGRP inhibitors block this process of pain and inflammation. These FDA-approved medications are available in various formulations, including injections, nasal sprays, and oral medications. They can be used to prevent or treat migraine.

CGRP medications that prevent migraine include injectable medications Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab)—as well as Vyepti (eptinezumab), which is given intravenously. Oral preventive CGRP inhibitors include Qulipta (atogepant) and Nurtec ODT (rimegepant).

Migraine Prevention: 7 Ways You Can Prevent Migraines

Ask your healthcare provider about the best ways for you to prevent migraine. Here are some general tips that may help stave off migraine attacks:

1. Healthcare providers often recommend that their patients take certain supplements to prevent migraines, such as riboflavin, magnesium, and coenzyme Q10. Check with your provider before beginning any type of supplement.
2. Reduce stress with therapy, biofeedback, relaxation, meditation, or yoga.
3. Get regular exercise. Consult your healthcare provider before beginning a new exercise program.
4. Keep a migraine journal, or use a mobile app to keep track of triggers and symptoms.
5. Avoid foods and drinks that trigger migraine.
6. Eat meals at regular intervals and drink plenty of fluids.
7. Keep a consistent sleep schedule. Go to sleep and wake up at about the same time every day, even on weekends.
8. Lose weight, if needed.