All About Migraines

The American Migraine Foundation estimates at least 36 million Americans have migraines.

Migraines are recurring neurological disorders that can be debilitating and/or affect your simple day-to-day routine. With as many as five different types of migraines, there’s a lot to learn when recognizing warning signs of a migraine and how to properly treat it.

To mark National Migraine and Headache Awareness Month, Dr. Charles Morgan, a board certified neurologist at INTEGRIS Health, explains the science behind migraines and how to help manage and treat symptoms.  

What’s the difference between a migraine and a headache?

A headache is caused by the contraction of muscles between the head and neck, whereas a migraine tends to range from moderate-to-severe throbbing pain at the front or the side of the head. It can also be accompanied by symptoms other than pain, such as an aura, nausea and sensitivity to light or sound.

"A migraine is not just a headache," Dr. Morgan says. "A migraine is usually associated with a 'prodrome' (a sense that something is going to happen), along with symptoms that might be as simple as fatigue, or a change in mood or behavior that happens hours or days before the migraine, and sometimes has an aura associated with it. When this happens a patient may say to herself, 'Uh oh, I think this is going to be a migraine day.'"

What is a migraine aura?

An aura is a warning sign of a migraine that usually occurs before the headache. The most common aura is visual, often described as "shimmering or flashing lights," or an area of lost vision that moves from one side of your field of vision to the other. Says Dr. Morgan, "The aura can be extremely variable between patients."

What are the common types of migraines?

There are several sub-types of migraines. Dr. Morgan breaks down each type below.

Common Migraine

Typically, in a common migraine the patient has a headache but does not see an aura. A common migraine is usually associated with nausea, photophobia (when bright lights are uncomfortable) and phonophobia (when loud noises are uncomfortable.)

Classic Migraine

A classic migraine is associated with an aura, typically visual, followed by the symptoms of the common migraine.

Chronic Migraine

When someone is experiencing a chronic migraine, it is usually defined as 10-14 days a month with migraine symptoms.

Complex Migraine

A complex migraine can be associated with an unusual aura such as failure to understand language, and/or failure to express language.

Persistent Aura Migraine

This type of migraine can be deceiving. Even a well-trained examiner can have difficulty deciding whether prolonged neurologic changes are a persistent aura migraine or an acute stroke. The persistent aura could be loss of speech fluency, unilateral sensory loss, unilateral motor loss, unsteadiness, loss of vision in one part of the visual field, abdominal pain or a combination of the above. 

"Many patients will come in reporting that they have had 'lots of little strokes' when actually they have been having migraines with auras," Dr. Morgan explains.

Diagnosing a migraine

Tracking and sharing information about your headache with your doctor helps with the process of making an accurate diagnosis. Consider writing down the following information to take to your medical appointment.

• Time of day when your headaches occur
• Specific location of your headaches
• How your headaches feel
• How long your headaches last
• Any changes in behavior or personality
• Effect of changes in position or activities on the headache
• Effect of headaches on sleep patterns
• Information about stress in your life
  
• Information about any head trauma, either recently or in the past

How does Dr. Morgan typically treat migraines?

Depending on which kind of migraine you are experiencing, your doctor can recommend a personalized treatment plan that is best for you. Specific treatment for migraine headaches will be determined based on your age, overall health and medical history as well as type, severity and frequency of your migraines, your tolerance for medications and your personal preferences. Treatments may include:

• Rescue medicines: Medicines purchased over-the-counter, such as pain relievers, to diminish or stop the headache.
• Abortive medicines: Medicines prescribed by your doctor that act on specific receptors in both the brain and the blood vessels in the head, stopping a headache once it is in progress.
• Preventive medicines: Medicines prescribed by your doctor that are taken daily to suppress the onset of severe migraine headaches.
• Avoiding known triggers: These might include certain foods and beverages, lack of sleep and fasting.
• Injections: Including Botox, nerve blocks and trigger point injections

"In general, when patients come in asking, 'What do I do when I have the pain?' I first suggest an anti-inflammatory like aspirin, naproxen or ibuprofen," Dr. Morgan says. "For some, a combination of acetaminophen with low-dose caffeine available over-the-counter can be effective, but this is not a good choice for frequent migraines because the combination tends to cause a rebound headache."

Additional at-home remedies to try 

• Use a cold compress: Wrap a thin cloth around a cold pack, a cold can of soda or a bag of frozen vegetables. Apply this to your temple or other pain site.
• Drink fluids: If nausea makes it hard to drink, try sucking on ice.
• Rest: If possible, lie down. Try not to bend over, as this may increase your pain. Sometimes, resting in a quiet, dark room can help the migraine from becoming aggravated.
• Try caffeine: Some people find that drinking fluids with caffeine, such as coffee or tea, helps to lessen migraine pain.

How to prevent migraines from happening

For headaches that are frequent and interfere with daily functions, a migraine-preventing medication can prove to be helpful.

"Commonly prescribed migraine preventives include beta blockers such  as propranolol, some seizure medications such as sodium valproate or topiramate, and candesartan blood pressure medication," Dr. Morgan says. "Each of these medications can have potential side effects, and you will want to talk with your physician before starting them."

When to see a doctor for your migraines

In general, call a doctor when the migraine syndrome is hindering your ability to function occupationally (missing work, calling in late, unable to concentrate at work, suddenly losing partial vision while driving or operating machinery) or socially (difficulty interacting with family and friends).

"The most important information I would like to share is that narcotics for recurrent migraines is a very bad idea," says Dr. Morgan. "It is terribly ineffective in the long run and leads to rebound headaches and addiction."