Migraine—Adult
Definition
Migraine is a headache disorder. They may happen many times a week or once every few years. Sensations called auras may come before a migraine headache.
Migraines can be so severe that they get in the way of daily activities.
Causes
The exact cause is not known. Genes may play a role. Some things that may trigger a migraine are:
- Things in the environment, such as odors and bright lights
- Certain foods and drinks, such as alcohol
- Some medicines
- Changes in sleep patterns
- Stress
- Changes in the body, such as menstruation and puberty
- Weather changes
Risk Factors
Migraines are more common in people under 50 years of age. They are also more common in women.
Things that may raise the risk of migraines are:
- A family history of migraines
- Changes in hormones during menstruation
Symptoms
Migraines happen in these phases:
Warning
A warning may come before a migraine. A person may have these symptoms in the hours or days before a headache:
- Changes in mood, behavior, and activity level
- Tiredness and yawning
- Food cravings or lack of hunger
- Nausea
- Diarrhea
- Sensitivity to light
Aura
Auras often last about 15 to 30 minutes. Visual auras are the most common type. A person may have:
- Flashing lights, spots, or zig zag lines
- Partial loss of vision that lasts a short time
- Weakness in an arm or leg
- Numbness or tingling in the face and hands
- Confusion
- Lightheadedness
- Problems speaking
Headache
Migraine pain may start within an hour of an aura ending. Problems may be:
-
A headache on one or both sides that may feel:
- Moderate or severe
- Throbbing or pulsating
- More severe with bright light, loud sound, or movement
- Nausea or vomiting
- Diarrhea
- Lightheadedness
Post-Headache Period
Migraines usually last 4 to 72 hours. They often go away with sleep. After the headache, a person may have:
- Problems with focus
- Tiredness
- Sore muscles
- Irritability
- Mood changes
Diagnosis
The doctor will ask about symptoms and past health. A physical exam will be done. The diagnosis is often made based on symptoms. Other tests may be done to rule out other problems.
Treatment
The goal of treatment is to ease headaches to improve function and quality of life. Using cold compresses and trying to sleep in a dark, quiet room may help.
Other options are:
Medications
The doctor may advise these medicines to ease migraine pain:
- Over-the-counter pain medicine, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Triptans
- Dopamine antagonists
- Ergotamine tartrate
- Steroids
- Calcitonin gene-related peptide (CGRP) inhibitors
Regular use of some over-the-counter medicines may cause a rebound headache.
The doctor may advise these medicines to prevent migraines in people who get them a lot:
- Beta-blockers
- Calcium channel blockers
- Anti-seizure medicine
- Tricyclic antidepressants
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs)
- Calcitonin gene-related peptide (CGRP) inhibitors
Therapy
Therapy may be used to reduce the length and frequency of headaches. Methods may be cognitive behavioral therapy, biofeedback, or relaxation methods.
Procedures
Procedures that may be done are:
- Botulinum toxin injections may be used to prevent migraines. They may also reduce headache pain and duration.
- Transcranial magnetic stimulation may also be used by people with migraine with aura who have not been helped by other treatments.
Some people may have surgery when other methods do not help. Some migraines are triggered when a nerve in the head is stimulated. Surgery can be done to find the nerve and turn it off. This may make the headaches go away or make them happen less often.
Prevention
It is not clear how to prevent migraines from ever happening. Migraine events may be prevented by:
- Using relaxation methods
- Eating a healthful diet and drinking plenty of water
- Exercising regularly
- Avoiding known migraine triggers
- Getting enough sleep
- Taking prescription medicine to prevent migraines
RESOURCES:
American Headache Society
http://www.americanheadachesociety.org
The National Migraine Association
http://www.migraines.org
CANADIAN RESOURCES:
The College of Family Physicians of Canada
http://www.cfpc.ca
Health Canada
https://www.canada.ca
REFERENCES:
Migraine in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/migraine-in-adults. Updated November 8, 2018. Accessed April 3, 2020.
Migraine information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page. Updated December 31, 2019. Accessed April 3, 2020.
Migraine prophylaxis in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/management/migraine-prophylaxis-in-adults. Updated March 5, 2020. Accessed April 3, 2020.
Reese O, Lukas RV, et al. Challenge case report: increasing frequency of migraine. Practical Neurology. 2020. Available at: https://practicalneurology.com/articles/2020-jan/challenge-case-report-increasing-frequency-of-migraine/pdf. Accessed April 2, 2020.
Silberstein SD, Holland S, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1337-1345.
Last reviewed February 2021 by EBSCO Medical Review Board Rimas Lukas, MD Last Updated: 2/3/2021