Migraines: Symptoms, Causes, Diagnosis & Treatment

A migraine is a common neurological condition that causes moderate to intense headaches. Other symptoms associated with migraines include general malaise, nausea, vomiting, burning or prickling throughout the body, and light sensitivity.

Migraines are more common in women, and although they can start to appear in childhood, migraines usually first emerge in adulthood. They can happen at any moment, but they are typically triggered by specific events, like sleeping poorly, having PMS or eating a certain food,

A migraine is different from a regular headache, as it has different causes and specific characteristics.

Imagem ilustrativa número 1

Most common symptoms

The symptom that is most characteristic of a migraine is a very intense, pounding headache that affects just one side of the head (although some migraines can cause pain to the entire head).

A migraine can last for several hours and worsens with activity. The pain can radiate to the face and neck, which can interfere with performance of daily, routine tasks.

Other classic symptoms of migraines include:

  • General malaise
  • Nausea and vomiting
  • Dizziness
  • Burning or prickling throughout the body
  • Sensitivity to light or noise

Some people may present with signs of a migraine coming on, before it even happens. These signs can appear 1 to 2 days before a flare-up. Although they can vary from person to person, generally these signs include specific food cravings, excessive fatigue with no apparent cause, irritability and neck stiffness.

Migraine aura

A migraine aura can occur several minutes before the classic symptoms appear. It is described as changes to vision, like a presence of a white fog, or small flashes of light in your visual field.

In some cases, a migraine aura can occur without the other symptoms appearing.

Chronic migraines

A chronic migraine, or a migraine that lasts for longer than 15 days, is relatively rare. Although it is not life-threatening, chronic migraines can seriously affect activities of daily living and quality of life. Therefore, treatment should be sought from a neurologist to help relieve symptoms.

Common causes

The exact origin of migraines is not well-known, however it is possible that migraines arise as a result of abnormal cerebral activity. This can affect the nervous system, as well as the activity of various neurotransmitters.

Although a precise cause does not exist, there are common situations that typically trigger flare-ups, like:

  • Mood changes
  • Changes in sleep pattern
  • Intense physical activity
  • Stress and anxiety
  • Dehydration
  • Prolonged use of medication
  • Rapid changes in weather

Certain foods also appear to be a factor that can contribute to the occurrence of migraines in some people. Foods that are most associated with migraines include pepper, coffee, alcohol, chocolate and citrus fruits.

Menstrual migraine

A menstrual migraine is a migraine that occurs up to 3 days before a period. It is triggered by changes to hormone levels which occur before menstruation. In addition to an intense headache, some other women may also experience PMS, increased fluid retention, irritability, gas and breast pain.

Migraines during pregnancy

Due to an extended period of significant hormonal changes, pregnancy can also trigger migraine flare-ups (particularly during the first trimester). Pregnancy-related migraines typically improve in the second trimester, and disappear completely by the third trimester.

Phases of a migraine flare-up

The majority of migraines occur in 4 phases:

1. Prodrome

This phase occurs 1 to 2 days before the first symptoms of a migraine. It can be identified by changes to energy level, mood, behavior and appetite.

2. Aura

It tends to emerge immediately before the headache (anywhere from 5 minutes to 60 minutes before). It is characterized by changes to vision, especially the appearance of a white fog in the vision field, as well as the appearance of flashing lights.

3. Attack

This is the acute phase of the migraine, in which the intense headache emerges followed by the other symptoms. This phase can last from 3 hours to 3 days.

4. Postdrome

This phase occurs when symptoms start to disappear. It is often described as a hangover, due to excessive fatigue that lasts for days.

How to diagnose

There is no specific test that diagnoses migraines, and therefore it is very important to consult a neurologist if this condition is suspected.

To help with diagnosis, the neurologist may ask you some questions related to your symptoms, such as:

  • Do you feel the pain on one side or both sides of the head?
  • Is the pain throbbing or pulsating?
  • Does the pain impede you from completing your activities of daily living?
  • Does the pain worsen with activity?
  • On average, how long does the pain last for?
  • Are you sensitive to light or noise?
  • Does the pain bring about other symptoms?

The doctor may also consider whether there are any specific situations triggering migraines, and may evaluate any other medications being used

You should ideally track the symptoms of your migraines with a “migraine diary” as this can be a useful tool for reaching a diagnosis.

Treatment options

There is no cure for migraines, however there are different types of treatment that can help to relieve symptoms, and reduce the length of a flare-up.

Migraine medications

The medications most commonly used for relief of symptoms and for treatment of migraine attacks include:

  • Anti-inflammatories and analgesics, like acetaminophen or ibuprofen
  • Triptans, like naratriptan or zolmitriptan
  • Antiemetics, like metoclopramide
  • Corticosteroids, like prednisone or dexamethasone

These medications should always be prescribed by a neurologist, as the medication type and dosing will vary depending on symptoms and their severity.

Rest and relaxation techniques

Resting in a dark room with little stimuli is one of the best, most natural ways to help relieve symptoms. In addition, good sleep habits also help greatly with treatment.

Some people may experience a reduction in symptom intensity by using relaxation techniques (like meditation, yoga or massage).

Use of acupuncture

Some studies show that treatment of migraines with acupuncture (10 sessions over 5 to 8 weeks) can be a great way to relieve migraines.

Adequate diet

When experiencing a migraine, it is recommended that you eat foods that are easy to digest, contain anti-inflammatory properties and help with circulation. Some examples include fish, ginger or chestnuts.

It is also important to avoid foods that could trigger migraines, like coffee, tea with caffeine, processed foods and citrus fruits.

Natural treatment

Natural treatment for migraines is based around the use of medicinal plants for relief of symptoms or prevention of flare-ups. These plants can be consumed in the form of supplements (which have the best effect) or tea.

Some plants that are effective in treating migraines include ginger, valerian or tanacetum. Treatment should ideally be directed by a health care provider who specializes in herbal medicine, as treatments should be tailored to the symptoms you present with.

How to prevent migraines

Prophylactic medication is a very common way of preventing future, frequent migraines. Medication that is typically prescribed includes lisinopril, propranolol or topiramate. These medications should be prescribed by a neurologist, and can take up to 3 months to achieve a therapeutic effect.

Because many medications can have side-effects, the doctor may also recommend some lifestyle changes that can help with prevention of migraines:

  • Avoiding situations that trigger migraines
  • Partaking in regular exercise, at least 3 to 5 times per week, for 30 minutes
  • Ensuring adequate hydration by drinking plenty of water throughout the day
  • Having a healthy, balanced diet with minimal processed foods
  • Utilizing relaxation techniques like yoga or meditation
  • Sleeping at least 8 hours per night

In addition to this, there are new studies supporting alternative treatment options for migraines, use of Botox and vagal nerve stimulation. You should see a neurologist to determine which treatment plan would be best for you.