What Is Migraine?

Complications of and Conditions Related to Migraine Certain disorders occur more frequently among people with migraine or people, usually children, at a higher risk of developing migraine: Cyclical Vomiting Syndrome In cyclical vomiting syndrome, an individual experiences attacks of severe nausea and vomiting lasting an hour or more for up to 10 days at a time. Between attacks, which occur on a regular cycle, the person has no symptoms of nausea or vomiting.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a5c35ee-9283-4555-8f4e-ce66b3a3e0be Abdominal Migraine This type of episodic migraine is diagnosed mostly in children. Symptoms include abdominal pain, nausea, and vomiting. Kids who experience abdominal migraine often don’t have attacks involving headache in adolescence but go on to develop them as adults.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0cb1533-d497-4965-8d69-0097dc04fb36 Benign Paroxysmal Vertigo In this syndrome, otherwise healthy children experience recurrent brief attacks of vertigo that come on without warning and resolve spontaneously without loss of consciousness. During the attacks, a child may have nystagmus (uncontrolled horizontal or vertical eye movement), impaired balance or coordination (called ataxia), vomiting, pale skin, and fearfulness.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299a3b916c-e6cb-47ee-af2f-dc5bb64aadff Benign Paroxysmal Torticollis Occurring in infants and small children, this syndrome causes the head to tilt to one side, with or without slight rotation, and stay tilted for minutes to days before spontaneously resuming its normal position. During the attack, the infant or child may be pale and irritable, seem uncomfortable or generally unwell, vomit, or, in older children, have impaired balance or coordination.e60dc2a1-f33c-4a05-9b50-8e3e8e597629367f196d-91a4-45cd-a626-8b0047481334 Other Types of Headaches Other rare types of headaches include these varieties: Cluster Headache These intensely painful headaches last 15 to 180 minutes without treatment and happen in cycles, or clusters.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290098eb12-9bed-4c68-9af9-ff42d1fe2e5f Paroxysmal Hemicrania This is a severe, sometimes throbbing pain on one side of the face or around the eyes that lasts 2 to 30 minutes and occurs more than five times a day.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296555de48-3292-49f8-b4d5-543e222689fc Ice-Pick Headache As the name implies, an ice-pick headache is a migraine characterized by stabbing pain. Fortunately, it is relatively uncommon and typically short in duration.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c8080732-0ebc-49db-ae06-1b1c8e23685c Intractable Headache Any headache, including migraine, that doesn’t respond to treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e59762965d12864-ab7b-4c0b-9a69-0792aa6a136c Occipital Neuralgia This disorder causes pain in the back of the head and upper neck.e60dc2a1-f33c-4a05-9b50-8e3e8e597629caaa28cf-5899-481e-ac51-0e0859f59f2f
Causes Causes and Risk Factors of Migraine The exact cause of migraine remains unknown. Some studies suggest that genetic and environmental factors may play a role, while others associate changes in the brain stem and trigeminal nerve with migraine and pain.e60dc2a1-f33c-4a05-9b50-8e3e8e59762951e4ab91-1445-4460-bfd8-aee5c50f206d Chemical imbalances in the brain may also be involved. Studies have found that migraine frequency is associated with increased risks of depression and anxiety . In one study, the higher the frequency of attacks, the more likely a person was to experience depression or anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d081d5e3-f3b1-4068-9215-96c43a82a4da A change in the weather or barometric pressure, which can cause imbalances in brain chemicals, may prompt a migraine attack.e60dc2a1-f33c-4a05-9b50-8e3e8e597629785c43b7-9f3a-4bae-863a-83be054b2208 Researchers have identified several key risk factors for developing migraine, including the following: Genetics Studies show that migraine has a strong genetic component, but the specific genes involved and the mechanism of inheritance are poorly understood.e60dc2a1-f33c-4a05-9b50-8e3e8e59762988148cc9-acf2-4895-addf-65629e8cba7d For some rare migraines, like familial hemiplegic migraine, specific gene mutations are responsible. But for most types, it’s believed several genes raise the likelihood of migraine. Age Most people who have migraine experience their first attack before they reach age 40. But migraine can start at any time in life, including infancy or childhood.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292477ced5-b93f-4485-b432-dfd7283a1bb2 Gender Migraine typically affects boys more than girls in childhood, but this trend reverses during adolescence. Women are much more likely than men to experience migraine, likely due to hormonal changes involving estrogen .e60dc2a1-f33c-4a05-9b50-8e3e8e597629411745e7-b0ef-47b9-b8ae-d31972095d5b Menstruation and Menopause Women with migraine often experience attacks immediately before or shortly after their menstrual period , when a drop in estrogen occurs. Similarly, hormonal medications like contraceptives or hormone replacement therapy can worsen migraine. Pregnancy and menopause can also change the frequency, duration, and severity of migraine attacks. Because of the strong hormone connection, many women find that migraines subside after menopause.e60dc2a1-f33c-4a05-9b50-8e3e8e59762994cae909-bf99-44bb-811b-820e18c8f2a8 Common Migraine Triggers Migraine triggers don’t directly cause migraine. But they can contribute to the onset of a migraine attack. Often, you need several triggers to lead to a migraine attack, not just one. Common triggers include the following: Changes in Weather Heat, humidity, wind, reduced light exposure, poor air quality, and changes in barometric pressure can trigger migraine attacks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629746b0b64-77ac-4f62-94e6-acc55e09ed61 Lights, Sounds, or Smells Natural or fluorescent lights can trigger migraines for people with the disease. Loud noises and strong smells, like perfume or cleaning products, are also common triggers. In some cases, these sensory symptoms are early signs of an attack.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989ebded3-7e62-4a15-a93d-43eb2ef59250 Medications Birth control pills and vasodilators like nitroglycerin have been linked to migraine attacks.e60dc2a1-f33c-4a05-9b50-8e3e8e59762976881381-8ddf-45f4-8aff-55f753c2bf10 Overusing pain medications may also lead to headaches.e60dc2a1-f33c-4a05-9b50-8e3e8e59762912eea482-ae16-4a31-afad-a3f0e0571f98 Dehydration About one-third of people with migraine cite dehydration as a common trigger.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6d0a615-7a87-4ccb-a499-64f6e194e4da Disrupted Sleep Getting too little or too much sleep can trigger migraine in some people, as can changes in your sleep-wake pattern, such as jet lag.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f36fc3f9-5abc-429b-b019-1ba665c64e84 Foods and Food Additives Certain foods and beverages, particularly alcoholic beverages, can be triggers. The flavor enhancer monosodium glutamate can also be a trigger, as can caffeine . Foods containing the amino acid tyramine have been associated with migraine onset.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e12a2cbd-4fe8-4725-b8f8-41506dfb0ae1 Examples include aged cheese, smoked fish, chicken livers, figs, certain beans, and red wine. Other foods that can cause headache pain are cured meats, artificial sweeteners, such as aspartame and sucralose, fruits like avocados, bananas, and citrus, nuts, and seeds. Missing or skipping meals can trigger attacks, too.e60dc2a1-f33c-4a05-9b50-8e3e8e597629607db77f-0b59-4a8d-ae77-14163f8a8848 Stress or Relief From Stress About 70 percent of people with migraine report that everyday stress is a common trigger. Also, relaxing after a stressful day can lead to migraine — something known as a “letdown” headache.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954283e1a-3842-412e-96f8-c86f105bbcfb
Types Types of Migraine Migraine is characterized by episodes of symptoms called attacks, which usually involve headache and sometimes nausea, vomiting, sensitivity to light, and dizziness. Attacks can happen suddenly or due to certain triggers, and the frequency of attacks varies from person to person. There are two main types of migraine: migraine with aura and migraine without aura. Migraine with aura is further divided into four subtypes:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292456997f-ce88-499d-82e8-0ad9647014ca Migraine with typical aura Migraine with brain stem aura Hemiplegic migraine Retinal migraine A person can have more than one type of migraine simultaneously, as well as other types of headaches . Migraine is also categorized as chronic or episodic, based on the number of days per month a person has symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dee6df45-dce1-4fac-9884-963aef5678cb Chronic migraine is defined by the American Migraine Foundation as a headache occurring on 15 or more days per month for more than three months, which, on at least eight days per month, has the features of migraine headache. It affects about 3 to 5 percent of the U.S. population.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290d2475d2-9552-4459-a58d-23da8638554c Episodic migraine is defined as fewer than 14 days of migrainous symptoms per month.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5f91a0d-a646-47f2-863f-2bcd21af1162 Identifying what type of migraine you have may help you and your doctor choose the right treatment for you. It can be essential if you want to participate in clinical trials. Migraine Without Aura Formerly known as common migraine, migraine without aura is characterized by a headache that’s usually on one side of the head, has a pulsating quality, is worsened by physical activity, and is accompanied by nausea or light and sound sensitivity.e60dc2a1-f33c-4a05-9b50-8e3e8e59762984b4cff1-de98-4cf1-8c0b-aea0ff613c8b Migraine without aura may have a prodrome, or warning, phase, in which a person has symptoms such as depression, food cravings, difficulty focusing, uncontrollable yawning, and others. It can also have a postdrome phase, when the headache pain has receded, but a person feels tired and achy and has trouble concentrating.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e85fee85-55f9-496d-af2b-46beb6ed9619 Alternatively, a person may feel elated and even euphoric after the headache phase of a migraine has passed.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295357a8c4-9f0a-4f6d-9a53-079e349257dc Migraine With Aura Migraine with aura, formerly called classic migraine, occurs in up to 30 percent of people who have migraine. It usually causes the same symptoms as migraine without aura, except that the headache phase of the migraine attack is preceded by neurologic disturbances that may include visual, speech, or sensory changes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629515104c1-c7df-4296-9984-98256bf6e76d Examples of visual aura include seeing stars, zigzags, or flashing lights; blurred vision; temporary blindness or colored spots; and tunnel vision. Sensory disturbances may include a feeling of pins and needles or numbness in a part of the body, face, or tongue.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b04180d1-d2d5-4f07-a7ce-a2879d607c0a In some cases, aura symptoms occur with no headache accompanying or following them. Migraine With Brain Stem Aura This type of migraine, formerly known as basilar-type migraine, is a rare type of migraine with aura. It usually includes neurologic symptoms such as double vision, problems speaking and hearing, dizziness, and loss of balance and coordination.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a4be6dfe-60fb-4469-b743-f39b7ab2ae59 Hemiplegic Migraine Hemiplegic migraine comes in two forms: familial hemiplegic migraine and sporadic hemiplegic migraine. Both are characterized by aura, fever, and hemiplegia (paralysis on one side of the body). Both are relatively rare.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d281e5b4-605b-4f76-b3eb-d60d86539954 Retinal Migraine Retinal migraine is an extremely rare cause of temporary visual loss in one eye. It’s diagnosed when a person has repeated attacks of one-sided visual disturbance — including the types of visual symptoms commonly seen in migraine aura — or blindness associated with migraine headache. These symptoms tend to evolve over five or more minutes, may last as long as an hour, and may be accompanied or followed by a headache.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a585c8f-26e2-4d74-a8b4-508ebd9a3f28
Migraines aren’t just headaches — they’re a neurological disorder that can be debilitating, leading to missed days of work, school, and daily life. About one billion people worldwide have migraine, and it occurs most often in women and people ages 20 to 50.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294ffbcb65-ade9-40cf-b059-0fe5f7540df6 There’s no cure for migraine, but treatment and lifestyle changes can help minimize and prevent the number of attacks you have. Depending on the cause, avoiding or limiting certain environmental, dietary, and medication triggers can help reduce pain and additional symptoms of an attack.
Prognosis of Migraine Migraines have a highly variable long-term prognosis. Some people have fewer and less severe migraine attacks over time, while others have more attacks, sometimes transitioning from episodic migraine to chronic migraine. Still others have long periods of remission, during which they have no migraine attacks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc9eb148-6773-41b8-ab40-acc2f542401b One study surveying 380 people with migraine found that over 47 percent reported a decrease in migraine attack frequency of 50 percent or more at the 10-year mark. Factors associated with this improvement were a baseline of more than 10 headache days per month at the start of the study, not smoking, and having medical follow-up visits for migraine.e60dc2a1-f33c-4a05-9b50-8e3e8e59762951305e45-c0a2-4658-9299-d27285aa0c95
Prevention Lifestyle Changes and Prevention for Migraines While there’s no way to completely prevent migraine, some people can lower their risk of attacks by implementing lifestyle measures, such as: Getting Enough Sleep Both too much and too little sleep can trigger a migraine attack, so it helps to do what you can to keep your sleep consistent every night of the week. That means going to bed and getting up at about the same time every day, avoiding excessive naps, and addressing anything about your health or your daily routine that may be getting in the way of restful sleep.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295fa03d54-e63a-4717-9afe-8e19a61c7f10 Eating Regular Meals Skipping meals is a common migraine trigger. When food isn’t consumed at regular intervals, blood sugar levels can drop too low, potentially leading to a migraine attack or a headache that is not migraine-related.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a21f7f29-18e2-4883-a172-9f9cb795a36b Staying Hydrated Drinking adequate liquid throughout the day is as important as eating regularly. Even in people who don’t have migraines, dehydration can lead to headaches, and in people who do, it can lead to migraine attacks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e87e60c4-c334-4d37-8de7-99614b4e4925 Managing Stress Many people say stress is a migraine trigger, so it makes sense to find ways to manage life stress. What works best depends on the individual. Taking a class in mindfulness-based stress reduction is one option that has helped many people deal with the stress of chronic pain. Practicing yoga or meditation may reduce stress for some. And working with a psychotherapist on issues that contribute to stress can also help you reduce your stress levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299ec1f83c-cf51-4404-b7a8-1917ee87555a Exercising Regularly Getting regular exercise is another way to manage stress, and it also may reduce the frequency and severity of migraine attacks. The trick is to start with low-impact, low-intensity movement and work your way up gradually.e60dc2a1-f33c-4a05-9b50-8e3e8e59762977425752-76b5-47b6-872b-3659e45ded0c
Diagnosis How Is Migraine Diagnosed? There’s no single test that can lead to a migraine diagnosis. Instead, your doctor will take your medical history, as well as your family history of migraine, and perform a physical and neurological exam.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299a8c5ea8-f67d-45b8-a087-d7d6ecb9b7d6 Your healthcare provider may order certain blood tests and imaging tests to rule out other causes of headache. But having one type of primary headache disorder doesn’t rule out having another. In fact, many people have both migraine and tension-type headache. Keeping a detailed log of your symptoms, when they occur, how long they last, and what, if anything, relieves them, can help with diagnosis.
Stages of Migraine Attacks Migraine attacks can have four stages, with somewhat different symptoms at each stage: Prodrome, or Warning, Stage You may notice the first signs of a migraine attack one or two days before the onset of aura symptoms or headache. These early warning symptoms can include mood changes, cravings for certain foods, muscle stiffness, trouble concentrating, sensitivity to sound or light, fatigue, difficulty sleeping, yawning, and frequent urination .e60dc2a1-f33c-4a05-9b50-8e3e8e597629200db2d2-ea6e-45ea-ab16-289aef7935ad Aura Stage Up to one-third of people experience the aura phase, which can last five minutes to an hour and increase in intensity over time. Aura may involve seeing bright spots or patterns of light, and feeling numbness or tingling in various areas of the body, but not paralysis.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291bc55876-d346-451c-8d5b-d5ddffcf2f7c Headache Stage Pain comes with the headache phase, which can last several hours and up to three days. The throbbing pain may start on one side of the head and move to include both sides. It may be accompanied by nausea and vomiting as well as blurred vision and sensitivity to certain stimuli such as light and noise. People typically seek out a quiet, dark room to rest or sleep in during this phase of a migraine attack.e60dc2a1-f33c-4a05-9b50-8e3e8e59762949e6afb7-3815-4308-be36-b9404f8a1972 Postdrome, or Hangover, Stage In the last phase of a migraine attack, when the headache pain has eased, fatigue and body aches may occur. You may have trouble concentrating and may still be hypersensitive to certain stimuli.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291dda1bb7-a652-4a64-8d77-be210afd7189 Not everyone who has migraine experiences all four stages, and even those who usually do may not experience all four during every migraine attack.
Symptoms Signs and Symptoms of Migraine Symptoms of migraine vary depending on the type of migraine and on the person. In general, though, migraine attacks are very painful and can interfere with your daily life. The most common symptom of migraine is head pain — often described as an intense throbbing or pulsating sensation, usually on one side of the head but sometimes on both sides of the head, and sometimes starting on one side of the head and moving to the other side.e60dc2a1-f33c-4a05-9b50-8e3e8e597629448384f2-b7e2-404f-abc2-7ef37bc341d6 In addition to head pain, these are the most commonly reported migraine signs and symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e597629448384f2-b7e2-404f-abc2-7ef37bc341d6e60dc2a1-f33c-4a05-9b50-8e3e8e597629c6b7b45f-2bad-4c58-a58e-63026c030cfe Light sensitivity , called photophobia, which contributes to the desire to seek out a dark space during attacks Sound sensitivity, or phonophobia, which can make ordinary noises unbearable Touch hypersensitivity, called allodynia, or pain resulting from gentle touches, such as brushing one’s hair or touching one’s face against a pillowcase Nausea and vomiting Aura symptoms Neck pain or stiffness Brain fog, or difficulty concentrating, remembering, or performing other mental tasks Light-headedness, dizziness , or vertigo Depression or anxiety Ringing in the ears, or tinnitus Sinus pain Diarrhea Aversion to odors Other migraine symptoms may be less common or simply less commonly reported:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297c99f480-3c39-41dc-b290-ca75075f9560 Cold hands or feet Constipation Difficulty speaking clearly Difficulty understanding written or spoken information Earaches Facial swelling Food cravings Frequent urination Increased thirst Jaw pain Night sweats Nightmares Numbness or tingling in the hands, feet, or face Physical weakness Smelling odors (usually unpleasant ones) that aren’t really there Stuffy nose
Support for People With Migraine People living with migraine or a headache disorder can benefit from reliable resources offering information and support. Many organizations provide educational materials and can assist you in finding doctors specializing in migraine care. There are also online communities that offer support as well as practical advice and tips. Essential Migraine Information and Support American Headache Society The American Headache Society is specifically dedicated to helping healthcare providers stay up to date on treatments for headaches and facial pain, but patients will also find a wealth of information on new migraine therapies as well as colorful infographics that present a range of tips. American Migraine Foundation Working alongside the American Headache Society, this nonprofit organization strives to connect people with migraine with the care and support they need. The website features a handy doctor locator tool and guidance on a range of issues, including managing migraine at work, identifying types of headaches, applying for Social Security disability income, and handling emergency room visits related to migraine. Association of Migraine Disorders The Association of Migraine Disorders recognizes that migraine is a full-body condition, with a broad spectrum of symptoms. In addition to providing extensive educational materials, the organization hosts Shades for Migraine , a campaign in which participants raise migraine awareness and address the stigma associated with the disease by wearing sunglasses in unexpected places. Migraine at Work The Migraine at Work campaign aims to help employees with migraine stay employed and productive on the job, and to help employers support and accommodate those employees. The website offers articles, taped webcasts, newsletters, and links to more information. Migraine at Work is a project of the World Health Education Foundation . Online Magazines and Toolkits My Chronic Brain This online magazine for people with chronic migraine is put together by volunteers who want to connect readers with real helpful stories from patients, sources of treatment, nutritional advice, and news related to migraine care. The INvisible Project The INvisible Project, the flagship program of the U.S. Pain Foundation , produces online magazines with real stories and photographs of people coping with chronic pain. Several editions are dedicated to people with migraine, who share how they deal with pain-related challenges in their everyday lives. Migraine Again Migraine Again calls itself a lifestyle website for people with migraine and the people who love them. It features expert information and advice, tips, and personal stories from people who have migraine, and articles on just about every aspect of living with migraine. Migraine Patient Toolkit: A Guide to Your Care The downloadable resource was created by the Society for Women’s Health Research to assist those with migraine in getting the care they need, dealing with health insurance issues, and incorporating wellness practices into their lives. Migraine Apps Headache and Migraine Tracker This app gets strong ratings from people with headaches and migraine who use it to track medications, disability, and triggers, and share data with their doctors. The app also analyzes your data to determine the type of headache you’re having. Migraine Buddy Designed with neurologists and data scientists, this graphic-heavy app makes it easy to record and monitor migraines. The technology helps patients identify likely triggers associated with their migraine and prevent future headaches. The website also features interesting articles on the effect of alcohol on migraine, how pets may help, migraine auras, and other topics. Migraine Diaries The Migraine Trust This British organization dedicated to supporting people affected by migraine offers a template for tracking attacks and any drug you may be taking. Finding patterns in migraine can help with treatment. Hartford HealthCare Headache Center Migraine Diary The PDF from this center for headache care gives a comprehensive system for recording episodes and medicines. A key helps pinpoint types of triggers and evaluate migraine severity.
Treatment Treatment and Medication Options for Migraines Drug treatment options for migraine are twofold: drugs that work to alleviate symptoms once an attack has started, and drugs that prevent attacks from happening or reduce their frequency and severity. Acute Medications to Stop a Migraine Attack Acute, or abortive, treatments for migraine include over-the-counter (OTC) pain relievers and several classes of prescription medications. In addition, antinausea medications can help relieve symptoms for those who experience nausea and vomiting with migraine. OTC pain relievers commonly used to treat migraine include acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB), and naproxen (Aleve, Naprosyn).e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c8dc3af-43bf-420d-b5f4-07c27ec02c1c Prescription medications include triptans, gepants, ditans, and ergots. Triptans Triptans were the first migraine-specific drug to come on the market in the 1990s, and they’re still widely used today. They include almotriptan (Axert), eletriptan (Relpax), sumatriptan (Imitrex and other brands), rizatriptan (Maxalt), and zolmitriptan (Zomig). All triptans are available in pill form; zolmitriptan and sumatriptan are also available as nasal sprays, and sumatriptan is additionally available as an injection. Triptans should be taken at the first sign of an attack, and for many people, they effectively stop the attack or significantly reduce migraine symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e59762992e366b4-f55e-4580-af5b-f6b77c3228fb However, triptans are contraindicated or not recommended for some people, including those with uncontrolled high blood pressure or a history of stroke or certain heart problems, and those with rare forms of migraine, such as hemiplegic migraine and migraine with brain stem aura.e60dc2a1-f33c-4a05-9b50-8e3e8e59762992e366b4-f55e-4580-af5b-f6b77c3228fb Gepants More formally called calcitonin gene-related peptide (CGRP) receptor antagonists, gepants were developed specifically to treat migraine and include the oral medicines ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) and the nasal spray zavegepant (Zavzpret) . Gepants work by blocking the action of CGRP, a protein in the brain and nervous system involved in the transmission of pain. Unlike triptans, gepants can be used by people with cardiovascular risk factors or stroke risk. They are also the only class of acute migraine drugs that doesn’t appear to cause medication-overuse headache when used frequently.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c17f717c-c49b-4fb0-bd16-a8fa8a29a9bc Ditans Lasmiditan (Reyvow), which is taken as an oral tablet, is the only approved drug in the ditans, or 5-HT1F receptor agonist, class. It works similarly to triptans but doesn’t constrict blood vessels, so it can potentially be used by some people who can’t take triptans because of cardiovascular risk factors.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f223d4e-f8ee-4ed4-bf9a-99d8d8fc2140 Ergots One of the oldest classes of drugs used to treat migraine, ergots, such as ergotamine (Ergomar), are not commonly used in the United States today because they tend to be less effective than other options and have more side effects. The one form of ergot that is still widely used is dihydroergotamine (Migranal, Trudhesa), which can be given intravenously in a hospital or clinic setting or taken at home as a nasal spray.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e0a54aa-c107-4c99-83f2-027c49faeff7 Antinausea Medications Drugs that may be prescribed to treat nausea associated with migraine include metoclopramide (Reglan) and prochlorperazine (Compro). Metoclopramide is available in tablet, liquid, and injection form, as well as a nasal spray. Prochlorperazine is given by tablet, suppository, or injection. For the most effective symptom relief, it’s important to take antimigraine prescription medications and OTC pain relievers as directed and to follow your healthcare provider’s instructions. Overuse of most medications for migraine, including OTC drugs, can cause medication-overuse headache (also known as rebound headache). Preventive Medications for Migraine Most of the medications that have a preventive, or prophylactic, effect on migraine weren’t developed specifically for migraine; they’re primarily used to treat cardiovascular conditions, seizures, and depression.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f2e0227-e603-4556-9965-8c316db26c4b Two exceptions are the CGRP antibodies and the CGRP receptor antagonists , or gepants. Preventive treatment is usually recommended for people who have very severe or frequent, long-lasting migraine attacks. Some people with migraine may require both preventive treatments and acute treatments to control their attacks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629509bd39a-05dd-4d2a-ba16-d2b5a6610283 CGRP Antibodies Developed specifically to lower the frequency of migraine attacks, the CGRP antibodies include erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab (Vyepti). These drugs are injected once a month or infused intravenously once every three months. Similar to gepants, CGRP antibodies work by blocking the action of CGRP. They’ve been shown to reduce migraine days in both episodic and chronic migraine.e60dc2a1-f33c-4a05-9b50-8e3e8e59762951f40f5a-36f1-4055-873b-4ff54747ead7 Gepants The CGRP antagonists rimegepant (Nurtec ODT) and atogepant (Qulipta) are available as oral medications and are approved by the U.S. Food and Drug Administration (FDA) for the preventive treatment of migraine.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293aeff010-a219-4638-8425-204ab45b1be1 Botox Injections of onabotulinumtoxinA (Botox) every 12 weeks may also help prevent migraine in some people with chronic migraine. (It’s not FDA-approved for episodic migraine.) However, it may take more than one set of injections to feel the benefits. Research shows that the beneficial effects of Botox for migraine increase with multiple treatments.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297c64207f-9617-4ac5-a5ac-c9d78e660656 Beta-Blockers These are drugs that lower blood pressure. When taken daily, they can help prevent migraine attacks in some people. Beta-blockers used for this purpose include metoprolol tartrate (Lopressor) and propranolol (InnoPran XL).e60dc2a1-f33c-4a05-9b50-8e3e8e59762904c082ab-8c43-452b-adfe-7ef3f93a41f3 Metoprolol is taken by tablet or capsule or given by injection; propranolol is given by capsule, liquid, or injection. Typically, beta-blockers are started at a low dose, which is slowly increased until an effective dose is reached.e60dc2a1-f33c-4a05-9b50-8e3e8e59762974a10d8f-b6d2-461a-8331-29ad911c02f9 Antidepressants As their name implies, antidepressants are taken most often to treat depression. But they can sometimes prevent migraine attacks as well. Antidepressants that research has shown to be effective at preventing migraine include nortriptyline, venlafaxine (Effexor), and duloxetine (Cymbalta). These drugs are all taken as pills or capsules.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954c7f725-7cfc-464d-8c5c-8e364e51881e Antiseizure Drugs Certain anticonvulsant, or antiseizure, drugs are considered first-line treatment for preventing migraine. Those include valproate, valproic acid, and topiramate (Topamax).e60dc2a1-f33c-4a05-9b50-8e3e8e59762978a4be66-760d-43de-93f3-5afa0b845be8 Nerve Stimulation Devices for Migraine Relief When medications aren’t providing adequate migraine relief, it may be worth trying a nerve stimulation device. These devices, of which there are several types, reduce pain or help prevent migraine episodes by delivering electrical or magnetic pulses to selected nerves.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b7d2455e-b5a5-4a20-b75a-c865c7d729e8 They are unlikely to replace medications in a person’s migraine management plan, but they may help control pain when used alongside meds. The available external devices target the upper branch of the trigeminal nerve, on the forehead; the vagus nerve, via the neck; the occipital nerve, on the back of the head; and the peripheral nerves in the upper arm. An implanted device also targets the occipital nerve.e60dc2a1-f33c-4a05-9b50-8e3e8e59762976399b38-393e-471d-b59d-1073e2da3c4f Side effects from nerve stimulation tend to be mild and mainly include redness, irritation, or muscle twitching at the site of the stimulation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762976399b38-393e-471d-b59d-1073e2da3c4f The main drawback of nerve stimulation devices may be that they’re expensive and not always covered by health insurance plans.
The Takeaway Migraine is a neurological disorder characterized by intense head pain and other sensory, gastrointestinal, and neurological symptoms. Migraines can be chronic or episodic and can be categorized under subtypes like migraine with or without aura. Migraine attacks can occur due to various environmental, dietary, or hormonal triggers, and can last from hours to days. Most migraine attacks follow phases such as prodrome, aura, headache, and postdrome, with a variety of symptoms indicating which phase you might be in. Common migraine triggers include bright lights, foods like chocolate or aged cheese, alcohol, nicotine or secondhand smoke, menstruation and menopause, changes in weather or barometric pressure, lack of sleep (or too much sleep), and stress. Diagnosing migraine often involves describing your symptoms to a neurologist, getting magnetic resonance imaging scans, and tracking your symptoms in a diary. A variety of medications can stop migraines or prevent them from occurring, as can lifestyle changes like proper sleep, stress reduction, and hydration.

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