ADDITIONAL EDUCATION ABOUT MIGRAINES
Migraines are a particular type of headache that affects roughly 12% of adults in the U.S. It is more common in women than men. The cause of migraines is not clearly understood but appears to be the result of a complex process of nerve dysfunction in and outside of the brain.
4 Phases of Migraine Cascade
Migraines are a disorder of recurrent attacks that occur as a cascade of events over the course of hours to days. A typical migraine attack progresses through four phases.
Migraine Cascade
1
Prodrome
Prodrome: Symptoms that occur 24 - 48 hours before the headache and may include things like yawning, depression, cravings, neck stiffness. The symptoms vary widely and not everyone with migraines will have a prodrome.
2
Aura
Aura: Approximately 25% of migraine sufferers develop neurological symptoms that can include visual changes, numbness, burning sensation, weakness, jerking, or difficulty speaking. Auras can occur just before or with the headache. Auras can also occur without ever developing a headache.
3
Headache
Headache: Migraine headaches are usually one-sided and throb. Light, sound, and/or smells typically make the pain worse. The headache intensity usually increases over several hours and is accompanied by nausea and sometimes vomiting.
4
Postdrome
Postdrome: Once the headache subsides, patients might have a period where they feel drained while others feel euphoric.
Migraine Triggers
Most migraine patients have identified conditions that "trigger" their migraines.
Most Common Migraine Triggers
1
Emotional Stress
2
Hormone Changes in Women
3
Not Eating
4
Weather Changes
5
Sleep Disturbances
6
Odors
Vision
Treatments for Migraines
Migraines can be difficult to treat. There are are two main categories of treatment. Preventative and acute (abortive).
Preventative Treatments for Migraines
1
The purpose of these treatments is to reduce headache frequency, severity, and duration. There are several classes of medications and treatments used to prevent migraines. Some of these are:
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Certain blood pressure medications
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Certain antidepressants
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Certain antiseizure medications
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Calcitonin gene-related peptide (CGRP) antagonists
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Botulinum toxin (Botox) injections
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Transcutaneous supraorbital nerve stimulation
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Transcranial magnetic stimulation
2
Acute Treatments for Migraines
The purpose of these treatments is to treat the symptoms of an existing migraine. There are several classes of medications used to treat the symptoms of migraines:
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NSAIDs and acetaminophen
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Calcitonin gene-related peptide (CGRP) antagonists
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Certain serotonin agonists
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Dihydroergotamine (DHE)
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Migraine cocktails
How Migraines are Diagnosed
The process for diagnosis of migraines is complicated and depends on many factors. A short summary of migraine diagnosis criteria are:
Migraine with aura (complicated migraine)
You must have a headache, plus:
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Visual symptoms (seeing spots, sparkles, or lines) or vision loss.
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Sensory symptoms (feeling pins and needles, for example).
Migraine without aura (common migraine)
You must have a headache and:
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The attacks included pain on one side of your head.
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You’ve had at least five attacks in a month, each lasting between four and 72 hours.
Plus, you’ve experienced at least one of the following:
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Nausea and/or vomiting.
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Lights bother you.
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Sounds bother you.
Keep in mind that only a medical professional can diagnose migraines. If you are having headaches, please contact your primary care provider or a neaurologist for evaluation.
Get Started with Ketamine
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When to Seek Emergency Help
Although migraines can be debilitating, they are typically not dangerous. However, there are certain headache "reg flags" that are concerning for emergency conditions.
Red Flags for Possibly Dangerous Headaches
1
New or "worst" headache
2
New headaches after age of 50
3
New neurological (stroke-like) symptoms
4
Headache with fever
5
Headache with a stiff neck
6
Headache with confusion
This is not an all-inclusive list of concerning symptoms. If you have any of the above symptoms, get directly to your nearest emergency department. If you have other symptoms that are concerning to you, please be evaluated.
The information on this website is NOT comprehensive and should NOT be used as a substitute for the medical advice, diagnosis, or treatment by a health care provider. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. All patients must be examined and diagnosed individually to determine appropriate diagnosis and treatment for each individual patient.