A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.
Migraines are classified according to the symptoms they produce. The two most common types are migraine with aura and migraine without aura. Less common types include the following:
- Abdominal migraine
- Basilar artery migraine
- Headache-free migraine (auro without migraine)
- Ophthalmoplegic migraine/Ocular migraine
- Status migrainosus
Some women experience migraine headaches just prior to or during menstruation. These headaches, which are called menstrual migraines, may be related to hormonal changes and often do not occur or lessen during pregnancy. Other women develop migraines for the first time during pregnancy or after menopause.
Incidence and Prevalence
Migraines afflict about 30 million people in the United States. They may occur at any age, but usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women.
The cause of migraine is unknown. The condition may result from a series of reactions in the central nervous system caused by changes in the body or in the environment. There is often a family history of the disorder, suggesting that migraine sufferers may inherit sensitivity to triggers that produce inflammation in the blood vessels and nerves around the brain and scalp, causing pain.
A trigger is any stimulus that initiates a process or reaction. Commonly identified migraine triggers include the following:
- Alcohol (e.g., red wine)
- Environmental factors (e.g., weather, altitude, time zone changes)
- Foods that contain caffeine (e.g., coffee, chocolate), monosodium glutamate (MSG; found in Chinese food), and nitrates (e.g., processed foods, hot dogs)
- Glare, contrasting patterns
- Hormonal changes in women
- Lack of sleep
- Medications (over-the-counter and prescription)
Signs and Symptoms
Migraine headache pain is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head. The headache is often so severe that it interferes with daily activity and may awaken the person. The attack is debilitating, and migraine sufferers are often left feeling tired and weak once the headache has passed.
A migraine headache typically begins in a specific area on one side of the head, then spreads and builds in intensity over 1 to 2 hours and then gradually subsides. It can last up to 24 hours, and in some cases, several days.
There may be accompanying symptoms such as nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). Hands and feet may feel cold and sweaty and unusual odors may be intolerable.
Migraine with aura is characterized by a neurological phenomenon (aura) that is experienced 10 to 30 minutes before the headache. Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images, or hallucinations. Others experience temporary vision loss. Nonvisual auras include motor weakness, speech or language abnormalities, dizziness, vertigo, and tingling or numbness (parasthesia) of the face, tongue, or extremities.
Migraine without aura is the most prevalent type and may occur on one or both sides (bilateral) of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (photophobia) often accompany migraine without aura.
Abdominal migraine is most common in children with a family history of migraine. Symptoms include abdominal pain without a gastrointestinal cause (may last up to 72 hours), nausea, vomiting, and flushing or paleness (pallor). Children who have abdominal migraine often develop typical migraine as they age.
Basilar artery migraine involves a disturbance of the basilar artery in the brainstem. Symptoms include severe headache, vertigo, double vision, slurred speech, and poor muscle coordination. This type occurs primarily in young people.
Carotidynia, also called lower-half headache or facial migraine, produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. There is usually tenderness and swelling over the carotid artery in the neck. Episodes can occur several times weekly and last a few minutes to hours. This type occurs more commonly in older people. Doppler ultrasound studies of the carotid arteries are normal.
Headache-free migraine is characterized by the presence of aura without headache. This occurs in patients with a history of migraine with aura.
Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis) and nerves responsible for eye movement become paralyzed. Ptosis may persist for days or weeks.
Status migraine is a rare type involving intense pain that usually lasts longer than 72 hours. The patient may require hospitalization.
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