Migraine – Not an Ordinary Headache

Migraine Symptoms

The symptoms of migraine vary from one person to the next but if you relate to one or more of the statements below, your headaches could be migraine.

• Your head pain is intense and sometimes feels unbearable.
• Your head pain includes a throbbing, pounding, or pulsating sensation and gets worse with movement.
• The pain gets so bad that you may have to miss school, work, or other activities.
• The pain could be on one or both sides of your head, in the front or the back, or even in or around the eyes and behind the cheeks.
• Your headache is accompanied by nausea and/or vomiting.
• You experience heightened sensitivity to lights, noise, and/or odors.
• The headache lasts a long time, from four hours to several days.
• Before the headache hits, you experience an “aura” – blurred vision, blind spots, flashes of light.

Phases and frequency

Migraine can be classified as episodic or chronic depending on the frequency of the attacks. People with episodic migraine have 14 or fewer monthly headache days, whereas those with chronic migraine experience more than 15 headache days per month, for three months or longer.

There are four distinct phases of a migraine attack: prodrome, aura, headache, and postdrome. The prodrome and aura phases are warning signs to take preventive medication before the headache begins.

1. Prodrome precedes the migraine by hours or even days. You may feel tired and grouchy, yawn a lot, have difficulty concentrating, and experience food cravings. An estimated 75% of migraine sufferers experience a prodrome. However, they don’t necessarily recognize it as a precursor to migraine.
2. Aura is less common and occurs shortly before the headache begins. You may experience vision changes, tingling, numbness, or trouble speaking.
3. The headache phase can last from several hours to three days and include nausea, vomiting, and/or sensitivity to light.
4. During the postdrome, or “migraine hangover,” people experience fatigue, body aches, light sensitivity, dizziness, and trouble concentrating. About 80% of migraine sufferers report a postdrome.

Causes of Migraine

Migraine tends to run in families. It can also happen after a concussion or head injury. Researchers believe that fluctuations in chemical compounds and hormones, such as serotonin and estrogen, affect the brain in a way that causes pain in migraine sufferers. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body, including the brain. While serotonin is thought to contribute to migraine in both sexes, changing estrogen levels only affect women. Women of childbearing age experience estrogen fluctuations as part of their menstrual cycle and are three times more likely to suffer from migraine than men. In fact, many girls experience their first migraine along with their first period.

People who get migraines sometimes notice possible triggers for an attack, such as:

• Stress
• Allergies
• Hormonal shifts
• Fatigue or changes in sleep pattern, such as with jet lag or the switch to daylight savings time
• Glaring or flickering lights
• Barometric pressure changes
• Certain foods and drinks. Some common triggers include caffeine, chocolate, cheese, processed meats, MSG, and aspartame.

Some migraine sufferers can’t pinpoint any specific triggers. However, it’s worth keeping a migraine diary, as recommended by the American Headache Society, to see if any patterns emerge.

Treating Migraine

There are two primary types of migraine treatment: acute, which you use during an attack to relieve pain and stop the migraine from progressing, and preventive, which aims to reduce the frequency, duration, and intensity of the attacks.

• Acute treatments
  • Over the counter pain relievers such as aspirin, ibuprofen, or acetaminophen
  • Triptans (sumatriptan, rizatriptan)
  • Ergots, such as dihydroergotamine
  • Anti-nausea medications
• Preventive treatments
  • Anti-hypertensives, such as propranolol and verapamil
  • Antiseizure drugs, such as topiramate and valproate
  • Certain antidepressants, such as amitriptyline and venlafaxine
  • Botox injections in the forehead, temples, back of the head, or neck
• Newly approved treatments
  Research recently uncovered the role of a brain protein called calcitonin gene-related peptide (CGRP) in triggering migraine pain. Levels of this protein rise during a migraine and contribute to headache pain and other unpleasant symptoms. This discovery has led to the development of a new class of drugs, CGRP antagonists, which bind to CGRP receptors in the brain and prevent the release of pain signals. Some CGRP antagonists can be taken preventively, either in pill form, dissolved in water, or by self-injection at home. One such drug, eptinezumab-jjmr, is given as an IV infusion every three months. Others CGRP antagonists, such as ubrogepant (Ubrelvy) and rimegepant (Nurtec), are taken orally for acute treatment.
• Neuromodulation devices
  A neuromodulation device is a medical tool that uses electrical, magnetic, or chemical stimulation to alter nervous system activity. These devices can be used to treat a migraine episode in the moment or as daily preventive therapy. Some devices are worn on the arm, head or neck, and some are held against the forehead or back of the head.

What if it’s not a migraine?

Not all recurring headaches are migraines. If you are prone to headaches, it could be due to one of these types:

• Tension Headaches. Sometimes called “hatband headaches,” because they can feel like your head is being squeezed by a too-small hat, tension headaches are the most common type.
• Hypnic Headaches. This rare form of headache only occurs at night during sleep, usually around the same time, and wakes the person up.
• Cluster Headaches. More common in men, cluster headaches occur on one side of the head and are usually centered around one eye, although the pain can radiate to the face, head, and neck. The eye may appear swollen, teary, droopy, and red. Nasal congestion can also be a symptom. A person may have several of these a day for days or even weeks.
• Exertional Headaches. These headaches occur during or after physical exertion, such as exercise or sex.
• Caffeine Headaches. Excessive caffeine consumption or sudden withdrawal from caffeine can lead to headaches.
• Hunger/Thirst Headache. Headaches when you’re hungry or thirsty are a signal that you need to eat or drink something! You could be experiencing muscle tension or hypoglycemia (low blood sugar).

Whether it’s a migraine or another type, talk to your doctor about headaches that occur with increased frequency or intensity. If you experience sudden onset of a severe headache, it may be something serious and you should call 911.

This article first appeared in the June 2025 edition of the HealthPerks newsletter.