Chances are if you don’t live with migraine headaches yourself, you know someone who does. About 39 million Americans experience migraine in some form, according to the Migraine Research Foundation. The medical condition affects women, men, and children—and is even known to run in families.
If migraines are totally new to you, don’t worry: June is Migraine and Headache Awareness Month. Now is the perfect time to learn more about the definition of “migraine” and other common terms. Read on to find out what migraines are, how they differ from normal headaches, and the many ways they present.
What is a migraine?
Migraine is a neurological condition characterized by intense, throbbing head pain and, typically, includes other physical symptoms such as nausea, vomiting, and sensitivity to light, sound, or smell. It’s not simply a bad headache, but a full-body event that, by definition, is a recurrent event.
Migraine headaches don’t have one cause. Migraines often run in families. The common forms of migraine are thought to be complex genetic disorders—such that multiple genes at different gene sites act with environmental factors to make the patient susceptible to migraines. The triggers are different for everyone, and include hormonal changes, stress, anxiety, lack of sleep, and environmental risk factors such as weather changes, certain foods (like aged cheeses), drinks, and exposure to allergens. Whatever the specific cause, though, people with migraine all have abnormal activity in the area of their brain that regulates pain.
“The trigeminal nerve of the brain has terminal fibers that conduct pain signals,” says Medhat Mikhael, MD, pain management specialist and medical director of MemorialCare Orange Coast Medical Center’s Spine Health Center.
When these terminal fibers, which act like messenger neurons, get irritated by a trigger, the fibers release a protein called calcitonin gene-related peptide (CGRP). CGRP causes inflammation in the mast cells of your brain, Dr. Mikhael explains, which then triggers the signature intense throbbing pain of a migraine.
This pain is often, but not always, unilateral. In other words, it usually affects one side of the head. In fact, unilateral pain is one of a handful of signs that you’re experiencing a migraine, not a typical tension or sinus headache.
In short, migraine headaches happen when nerves in your brain responsible for sending pain signals become irritated, releasing a protein that inflames the brain and causes intense pain, a.k.a. a migraine headache.
Migraine vs. headache symptom comparison
Common migraine symptoms and other types of headaches may have the following characteristics.
|Unilateral pain||Pain on both sides of head; may feel like a band around the whole head or may only affect temples, back of head, forehead, etc.|
|Throbbing, pulsing pain||Tight, aching pain|
|Moderate to severe||Mild, moderate, or severe|
|Nausea and/or vomiting||Mild nausea possible|
|Sensitivity to light, sound, or smell||–|
|Gets worse with movement or physical activity||–|
|Has known triggers (hormones,
change in temperature, strong smells, etc.) as well as unknown ones
|Usually triggered by sleep deprivation, excessive caffeine or alcohol, stress, illness, poor posture, etc.|
Migraine vs. migraines
If you’ve ever talked to someone about their migraine headaches, they might have said “I get migraines.” Or, they might have said “I have migraine.” And you…well, you might have been confused. Is there really a difference, or is this just a “You say po-TAY-to, I say po-TAH-to” kind of situation?
Yes, there is a difference! It’s fairly easy to understand, too, says Deborah I. Friedman, MD, professor of neurology and ophthalmology at UT Southwestern Medical Center.
“We use migraine to describe the overall disorder and migraines to describe the actual episodes [of headaches],” Dr. Friedman explains. “So we would say ‘The patient has migraine,’ just like we would say ‘The patient has hypertension [high blood pressure].’”
So your hypothetical friend would be right either way: If you’re telling someone you live with recurring episodes of migraine headaches, you can use the plural and say “I get migraines.” The singular use of migraine, on the other hand, can be used to describe your neurological disorder (“I have migraine.”) or a single headache attack (“I have a migraine right now.”).
Want to know more about migraine? These terms will give you a more complete picture of this condition.
Chronic migraine means you have 15 or more migraine days per month, says Dr. Mikhael. Less than that, and you’re classified as having episodic migraine.
“Chronic migraine headaches not only happen frequently but last much longer, sometimes more than one day, and don’t ease up or go away [without intervention],” he adds.
The distinction between episodic and chronic migraine is especially important when it comes to treatment; typically, once your migraines become chronic, you meet the diagnostic criteria for being prescribed a preventive medication instead of relying only on acute treatment of migraine. Meaning, your physician may prescribe you daily medicine to take prophylactically to prevent attacks rather than only treating attacks after they start.
There are four main ways to approach treatment of migraine.
- Avoid triggers: The best defense is a strong offense. So, take note of your migraine triggers. Avoid them. Change your diet. Decrease stress. Sleep more. Limit use of acute headache medicine to decrease overuse headaches.
- Preventive medications: These daily medications stop a migraine headache before it starts. They can include:
- Beta blockers such as Inderal (propranolol)
- Anticonvulsants—also used to treat epilepsy—such as Depakote (divalproex sodium) and Topamax (topiramate)
- Antidepressants such as Elavil (amitriptyline)
- Calcitonin gene-related peptide (CGRP) antagonists such as Emgality (galcanezumab-gnlm)
- Botox (botulinum toxin) injections
- Abortive medications: Designed to stop migraine pain in its tracks, these prescriptions can include triptans such as Imitrex (sumatriptan), ergotamines such as Migranal (dihydroergotamine nasal spray), and CGRP antagonists such as Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant).
- Rescue medications: These medications are used if abortive treatments fail, or can’t be taken. They include prescription medications such as Zofran (ondansetron) or Toradol (ketorolac), and over-the-counter pain relief meds like Tylenol (acetaminophen), or Advil (ibuprofen).
Many people with migraine need more than one kind of meds to prevent and treat migraines. Lifestyle change can decrease the frequency and severity of episodes—allowing you to be more reliable at work and more involved in your relationships.
People use the term migraine attack to refer to the stages of having a migraine. The term episode can be used interchangeably with attack. Someone who says they are having a migraine attack means they are somewhere in the timeline of starting, experiencing, or recovering from a migraine. If they say they had an attack in the past tense, try to understand that they may not have a headache only for a few hours—they may have been in various stages of a migraine for days!
Phases of migraine
There are four parts to a migraine. Not everyone will experience all four phases with every attack and the duration of each phase can differ with each migraine attack.
This is the early warning stage of migraine: you don’t have a headache yet, but it’s coming. The prodrome phase can start anywhere from minutes to days before the actual headache begins, according to Dr. Friedman.
Typical symptoms of migraine prodrome phase include:
- Excessive yawning
- Irritability and fatigue
- Excessive thirst and/or urination
- Food cravings
- Mood swings
- Sleep disturbance
- Mild sensitivity to light, sound, or smell
Maybe you can recognize your prodrome symptoms instantly and maybe you don’t even notice them, but this stage happens in “upward of 30% to 50% of people, if they really stop and think about it,” Dr. Friedman says. If abortive medication is taken at this stage, there is a better chance of stopping the migraine from progressing.
RELATED: How long do migraines last?
To the general public, the phenomenon called aura goes hand-in-hand with migraine—but in reality, only about one-third of migraine sufferers actually experience it (and even then, not all of them have an aura every time they have a migraine).
Still, it’s worth noting that this is the second stage of the timeline for people who have migraine with aura, and it manifests as several different types of visual disturbances: blurred vision, loss of vision, pulsating or flashing lights, zigzag or patterned lines across your vision, blind spots, or shimmering patches in your vision.
An aura can be visual, sensory, auditory, or motor. Some people also complain of strange sensations, like tingling, noticing odd smells that aren’t really there, or slurred speech patterns or the inability to speak. This stage usually happens within an hour of the onset of the headache phase.
This is the stage most think of when they hear the term migraine. Throbbing, stabbing, or pulsing unilateral pain, extreme sensitivity or aversion to light, sound, or specific smells, nausea, and vomiting are all rolled into the headache phase, which can last a few hours to a few days. Depending on the person, other symptoms may include insomnia, neck pain, and nasal congestion.
It’s important to note that while some people are completely debilitated by their migraine headaches (read: stuck in bed with the curtains drawn), others may experience milder headaches that are hugely uncomfortable but don’t limit functioning quite as much. And the same person may experience both mild and severe headaches depending on the situation or the specific trigger.
The final phase of migraine, called postdrome, is sometimes called a migraine hangover because of how similar it is to an alcohol hangover. “My patients tell me they feel like they’ve been hit by a truck,” says Dr. Friedman.
During this phase, your headache and severe symptoms will have resolved, but you may still feel awful: exhausted, achy, and somewhat sensitive to bright lights and loud noises. You may have a residual headache or, commonly, mild neck pain. This phase can last for a day or two, Dr. Friedman adds, before you feel normal again.
Types of migraine
Didn’t know there were so many ways to describe the migraine experience? Believe it or not, there are actually several more descriptors.The constellation of symptoms differs for each person, so there are different migraine types.
Also called acephalgic migraine, this is when the migraine aura is not followed by the traditional migraine headache. It’s treated the same as any other type of migraine, because even though it’s characterized by visual aura symptoms, it has nothing to do with your eyes or vision. You can’t stop these migraines once they start—you can only work to prevent them—but Dr. Friedman says unless they pose a risk (like if you’re a truck driver or surgeon who can’t risk temporarily losing their vision on the job, for example), you don’t have to treat them at all.
A menstrual cycle is a migraine trigger even for women who don’t regularly suffer from migraine, so women who do are particularly susceptible to a hormonally triggered attack. If you only get a migraine around your period, it’s called menstrual migraine; if you get them other times of the month, but they’re especially bad around your period, it’s called menstrually-associated migraine. According to Dr. Friedman, both of these migraine conditions can cause a migraine attack two days before or three days after menstruation begins.
This, thankfully, rare form of migraine plays out like a traditional migraine attack, but its aura phase includes weakness on one side of the body. (You might also have the other usual aura symptoms, too.) Since this is an atypical type of migraine and the symptoms are similar to more serious conditions like strokes and seizures, the American Migraine Foundation suggests seeing your healthcare provider right away if you have a hemiplegic migraine for the first time with no existing history. This neurologic presentation may warrant brain imaging such as a CAT scan, MRI, or MRA.
A vestibular migraine feels very much like a regular migraine, but will have additional symptoms including dizziness, loss of balance, and sensitivity to motion. At the same time, sometimes people only experience the vestibular symptoms without the headache. It can be difficult to diagnose this disorder, especially if the intense vertigo occurs without a headache; it’s important to see your physician if you experience extreme periods of dizziness to rule out other possible causes.
This is a type of migraine condition that starts in children and is common in childhood, but can continue into adulthood, too. Similar to silent migraine, this is a migraine without headache—but instead of a visual aura, the migraine symptoms are nausea, vomiting, and abdominal pain. Dr. Friedman says these migraines can also be treated like traditional ones if they’re chronic or debilitating, and that often, a child with abdominal migraine will grow up to have more “normal” migraine attacks as they get older.
Ocular migraine refers to a rare group of migraine subtypes that affect vision—with or without headache. Migraine with aura is a type of ocular migraine. Retinal migraine is another type. Symptoms may include zigzag or flashing lights, decreased vision, or temporary vision loss. Since these symptoms can be a sign of other medical problems, it’s best to consult with a physician the first time you experience what you think may be an ocular migraine.