Migraines Explained: Types, Causes, Symptoms & Treatments

Types of Migraine

Migraines come in several types, often classified by whether they include an aura or changes in sensory perception before the headache starts.

Migraine with Aura

The aura is a disturbance of the senses in the early stages of an episode. This can serve as a warning that a migraine is approaching. Aura can involve:

• Having confusing thoughts or experiences
• Seeing weird, twinkling, or flashing lights that aren't there
• See zigzag lines of light
• Have blind spots or white spots in vision
• Feeling tingling and needles in an arm or leg
• Have difficulty speaking
• Have weakness in the shoulders, neck, or limbs
• Seeing things that are not there with one eye, such as transparent chains of objects not being able to see part of something remove part of the field of view, then reappear
• An aura can feel like the after-effect of a bright camera flash, but the visual disturbances often last much longer—anywhere from a few minutes to an hour.

Migraine Without Aura

More commonly, a person does not experience any sensory disturbance before an episode. According to the Migraine Trust, 70 to 90% of episodes occur without aura.

Other Types of Migraines

Other types of migraine include:

• Chronic Migraine: This involves having an episode for more than 15 days per month.
• Menstrual Migraine: This happens in a pattern that follows the menstrual cycle.
• Hemiplegic migraine: This type causes temporary weakness on one side of the body.
• Abdominal migraine: These are episodes of migraine related to the irregular function of the bowel and abdomen, often accompanied by nausea or vomiting. It mainly affects children under the age of 14.
• Vestibular migraine: Severe dizziness is a symptom of this form of migraine.
• Basilar migraine: This rare type is also known as a migraine with brainstem aura and can affect neurological functions, such as speech

Common Causes of Migraine

• While the causes of migraine are not fully understood, genetics and environmental factors appear to play a role.
• Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, could be involved. The same goes for imbalances in brain chemicals - including serotonin, which helps regulate pain in your nervous system.
• Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in migraine pain, including the peptide linked to the calcitonin gene (CGRP).

Migraine Triggers

There are migraine triggers, including:

• Hormonal changes in women: Fluctuations in estrogen, such as before or during menstruation, pregnancy, and menopause, seem to trigger headaches in many women. Hormonal medications, such as birth control pills and hormone replacement therapy, can also make migraines worse. However, some women find that their migraines occur less often when taking these medications.
• Drinks: This includes alcohol, particularly wine, and high caffeine intake like in coffee.
• Stress: Migraines can be triggered by stress at home or work.
• Sensory stimuli: Bright lights and glare from the sun can cause migraines, as can loud sounds. Strong smells, including perfume, paint thinner, second-hand smoke, and others trigger migraines in some people.
• Sleep changes: Not getting enough sleep, getting too much sleep, or jet lag can trigger migraines in some people.
• Physical factors: Heavy physical exertion, including sexual activity, can cause migraines.
• Weather changes: A change in weather or barometric pressure can cause a migraine.
• Medication: Oral contraceptives and vasodilators, such as nitroglycerin, can make migraines worse.
• Foods: Aged cheeses and salty and processed foods can trigger migraines. The same goes for skipping meals or fasting.
• Food additives: This includes sweeteners like aspartame and flavor enhancers such as MSG, both commonly found in processed foods.

Conditions that Cause Migraine

Certain health conditions may trigger or worsen migraine attacks. Below are more possible causes to consider:

• Hormonal Changes - Fluctuations in estrogen can trigger migraines, especially in women.
• Sleep Disorders - Irregular sleep or insomnia can make migraines more severe.
• Chronic Stress or Anxiety - Stressful emotions can easily bring on migraines.
• Depression - Mental health issues may lead to more frequent and intense migraines.
• High Blood Pressure (Hypertension) - Can lead to pulsating headaches like migraines.
• Neck or Spinal Problems - Poor posture or cervical issues may contribute to migraines.
• Neurological Conditions - Disorders like epilepsy or past strokes can play a role.
• Medication Overuse - Frequent use of headache medicine can lead to rebound migraines.
• Food Allergies or Sensitivities - Certain foods like aged cheese or MSG may trigger attacks.
• Caffeine Withdrawal - Sudden drop in caffeine intake can cause migraine headaches.
• Dehydration - Even mild dehydration is a common and preventable migraine trigger.

Symptoms of Migraine

Migraine symptoms differ among individuals, but common ones are as follows:

• Throbbing or pulsating headache, usually on one side of the head
• Nausea or vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Visual disturbances or aura (flashing lights, blind spots)
• Tingling or numbness in the face, arms, or legs
• Difficulty speaking or confusion
• Dizziness or lightheadedness
• Fatigue or weakness before, during, or after the headache
• Neck stiffness or pain

When to Visit a Doctor?

At times, headaches may indicate a serious issue. Consult your doctor about your headache if you notice the following:

• You have several headaches per month, and each one lasts several hours or days
• Your headaches are interfering with your life at home, at work, or at school
• You may experience nausea, vomiting, visual issues, or sensory changes like tingling or numbness.
• You have pain around your eyes or ears
• You're experiencing a stiff neck and strong headache
• You're experiencing a headache with confusion or disorientation.
• You have a headache with seizures
• You have a headache after a blow to the head
• Before you didn't have a headache, but now you have a lot of headaches

Diagnosis and Tests for Migraine

Migraines are typically diagnosed based on your symptoms and medical history. While there's no specific test to confirm a migraine, doctors use a few methods to rule out other causes.

• Symptom Review & History: Your healthcare provider will ask about your symptoms and any family history of migraines to make an initial diagnosis.
• Physical Examination: A full physical exam helps rule out other causes like muscle tension, sinus issues, or neurological conditions.
• Imaging or Tests (if needed): Brain scans (MRI or CT), EEGs, or lumbar punctures may be recommended if symptoms are unusual or to rule out serious conditions.

Treatment & Management

Migraines cannot be cured, but your doctor can help manage them to reduce frequency and severity. Treatment depends on factors like:

• Your age
• Frequency and type of migraines
• Severity and duration of symptoms
• Impact on daily life (school, work)
• Presence of nausea, vomiting, or other symptoms
• Existing health conditions and medications

Prevention Tips

• Maintain a migraine journal to spot and avoid triggers.
• Get 7–9 hours of sleep per night.
• Eat meals at regular intervals; don't skip meals.
• Drink plenty of water throughout the day.
• Exercise regularly and maintain a healthy weight.
• Practice stress control techniques like meditation, yoga, relaxation, or mindful breathing.
• Take medications as prescribed by your doctor.
• Discuss hormone therapy with your doctor if migraines are menstrual-related.
• Consider using a transcutaneous supraorbital nerve stimulation device (FDA-approved) to help prevent migraines.

Home Remedies

These natural, medication-free treatments can reduce migraine symptoms and frequency:

• Nitrates (hot dogs, bacon, sausage)
• Chocolate
• Cheese
• Red wine and alcohol
• MSG-containing foods
• Cold items (ice cream, iced drinks)
• Processed or pickled foods
• Beans and dried fruits
• Cultured dairy (yogurt, sour cream, buttermilk)

Lifestyle Changes

Integrating healthy habits can significantly reduce migraines:

• Maintain a regular sleep schedule (7–9 hours)
• Eat on time don't skip meals
• Stay hydrated throughout the day
• Exercise regularly and maintain a healthy weight
• Practice stress management: meditation, yoga, deep breathing
• Get regular massages to reduce stress and improve sleep
• Use migraine prevention tools/devices if prescribed

Risk factors of Migraine

Several factors make you more vulnerable to migraines, including:

• Family history: Migraines often run in families, so your risk increases if a relative has them too.
• Age: Migraines can start at any age, although the first often occurs in adolescence. Migraine attacks often reach their peak intensity in your 30s and usually decrease in both frequency and severity in later decades.
• Gender: Women are three times more likely to suffer from migraines compared to men.
• Hormonal changes: For women who have migraines, the headaches may start right before or shortly after the start of their period. They can also change during pregnancy or menopause. Migraines usually get better after menopause.