Most headaches are considered to be primary headaches, meaning that they are not symptomatic of an underlying medical disorder. While tension is the main cause of these headaches, some 36 million Americans suffer from primary headaches of a different breed—migraines.¹

If you think you have migraines, you are probably asking the question, “What is a migraine headache?” The more you know, the more you may be able to relieve the pain and accompanying symptoms and even help prevent them or reduce migraine frequency.

So, what is a migraine? Here are some basic facts:

A migraine is an episodic headache event that you might describe as a throbbing or pulsating pain affecting one side of your head (unilateral). If you experience these headaches 15 or more days a month for at least 6 months, you may have chronic migraines.

The majority of migraine sufferers are women. In fact, according to the American Migraine Foundation, “migraines are 3 times more common in women than men.²” Many have at least one other family member who suffers attacks. Children can also experience migraines. In fact, there is some evidence that as patients grow older the frequency of attacks may decrease or disappear altogether. And most people predisposed to migraines will have had at least one attack by the time they reach the age of 40. Women may experience their first migraine around the onset of menstruation.

Types of Migraines

There are many types of migraines, with the major subclasses called “with aura” and “without aura.” The following is an abbreviated list of migraine types, classified by symptoms:

• Migraine without Aura—Sometimes called common migraines, they account for about 80% of migraine headaches.

• Migraine with Aura—Patients see a flashing or glaring light, a blind spot and sometimes both prior to onset of the headache.

• Migraine with Brainstem Aura—Also known as basilar-type migraine and sometimes called Bickerstaff syndrome, this begins in the brainstem. Pain is usually on both sides of the head (bilateral).

• Hemiplegic Migraine—A rare form of migraine. These are migraines with aura that tend to run in families (called familial hemiplegic migraine).

• Retinal Migraine—The term is sometimes referred to as an ocular migraine with brief changes in vision, including repeated occurrences of temporary blindness. A retinal migraine usually affects only one eye.

• Vertiginous Migraine and Vestibular Migraine—These are migraines with vertigo. In addition to feeling dizzy and lightheaded, patients will sense the room spinning.

Phases and Symptoms of Migraine

There are four phases of a migraine. Not every migraine sufferer will experience all four. And while there are symptoms associated with each phase, many common migraine symptoms will appear in any or all phases:

The Prodrome

Prodrome may occur anywhere from minutes, hours or a day before onset of an attack. Symptoms include: food cravings, excessive yawning, mood changes, difficulty concentrating, constipation or diarrhea and hyperactivity.

The Aura

This phase is associated with temporary visual disturbances that may last up to an hour, including flashes of light, blind spots in your field of vision, tingling sensations, numbness and temporary speech loss (aphasia). According to the International Headache Society’s Classification, about 25-30% of people with migraines experience aura.³

The Attack (or The Headache)

The primary symptom during an attack is the pulsating, throbbing headache which is commonly on one side of the head. Some patients have pain on both sides of their head (bilateral), as well as experience sensitivity to environmental stimuli (lights, noises, and odors) and blurred vision. Others have neck pain, dizziness, vertigo and more. While the attack is in your head, the effects are throughout the whole body and can often include nausea, vomiting, diarrhea or constipation. This phase can last anywhere from an hour to 72 hours.⁴

The Postdrome

While the postdrome is the calm after the storm, many patients are left feeling weak, totally drained and requiring sleep. A few patients experience a sense of euphoria.

Causes and Triggers

While the specific cause of most migraines is unknown, migraines are often associated with:

• Genetic predisposition—Migraines tend to run in families.
• Environmental sensitivities—Changes in weather, altitude, bright lights, loud noises and even certain odors.
• Fluctuations in body chemistry—Such as changes in the serotonin levels that regulate nerve pain.
• Changes in the brainstem—Specifically, its interaction with the trigeminal nerve, which is a major pain pathway.

As you try to understand what is a migraine, you need to be alert to its causes and triggers—most specifically the foods, environmental conditions and activities that trigger your own migraines. These vary widely among patients:

• Foods—Aged cheeses, preservatives (nitrates), monosodium glutamate, artificial sweeteners, chocolate, dairy products and more.
• Alcohol and Caffeine— Particularly red wine and highly-caffeinated beverages.
• Stress—Responsible for many types of headaches and illness
• Intense physical activity—Including running upstairs, rushing to catch a train and heavy workouts.
• Environmental stimuli—Bright lights, loud noises, strong smells, changes in weather or altitude.
• Irregular eating and sleeping habits—In particular, irregular sleeping habits disrupt the deep, restorative REM sleep.
• Dehydration—A common cause of many headache types.
• Hormonal changes—Especially fluctuations in estrogen, which may explain why women have fewer migraines after menopause.
• Medications—Including oral contraceptives and vasodilators (e.g., nitroglycerin).

Treatment

Currently there is no known cure for migraines, but there are a variety of medications available to treat them, specifically for pain relief and prevention (to reduce frequency/severity). In order to determine the best course of action for you and the symptoms you are experiencing, you will need to consult your physician. He/she is likely to recommend non-prescription medications. If you see a naturopathic physician, they may be able to suggest several natural remedies for pain relief and to reduce the frequency and duration of migraines.

If you have exhausted non-prescription options with little relief, your doctor may recommend treatments that include Triptans, narcotic pain medications (opioids), anti-depressants, beta blockers and anti-seizure medications. With all medications, too much of even a good thing may become a problem. In fact, extended use, high dosages and sudden withdrawal of all medications can cause secondary headache conditions.

While migraines are not life threatening, they are extremely painful and often debilitating. If you experience episodic or chronic migraines, keep a journal of your attacks and suspected triggers. Together, you and your healthcare provider will use your record to set up a regimen of activities, treatments and therapies that may help reduce the intensity, duration and frequency of your attacks.

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