Migraine: Triggers, Phases and Treatment

A migraine is a recurring kind of headache. The pain is moderate to severe, throbbing or pulsing, and often on one side of the head. Nausea, weakness and sensitivity to light and sound can come with it.

Causes and triggers

Researchers believe migraine has a genetic cause. Many things can also set one off, and they differ from person to person:

• stress and anxiety
• hormonal changes in women
• bright or flashing lights, loud noises, strong smells
• medicines, and taking migraine medicine too often (medication overuse)
• too much or too little sleep
• sudden changes in weather or surroundings
• overexertion
• tobacco, caffeine, or caffeine withdrawal
• skipped meals

Some people find that certain foods or ingredients bring on headaches, especially combined with other triggers: alcohol, chocolate, aged cheeses, monosodium glutamate (MSG), some fruits and nuts, fermented or pickled foods, yeast, and cured or processed meats.

Who gets them

About 12% of Americans get migraines. Anyone can, but the risk is higher for:

• women, who are three times more likely than men to get migraines;
• people with a family history: most people with migraines have relatives who have them;
• people with other conditions such as depression, anxiety, bipolar disorder, sleep disorders and epilepsy.

The four phases

Not every migraine goes through every phase.

Migraines are more common in the morning, and people often wake up with one. Some people get them at predictable times, such as before menstruation or on weekends after a stressful work week.

Diagnosis

A health care provider takes a medical history, asks about symptoms, and does a physical and neurological exam. Ruling out other conditions that could cause the symptoms is an important part of diagnosis, so blood tests, an MRI or CT scan, or other tests may follow.

Treatment

There is no cure. Treatment aims to relieve symptoms and prevent further attacks.

During an attack

• Medicines that relieve symptoms include triptans, ergotamines and pain relievers. The sooner they are taken, the better they work.
• Rest with eyes closed in a quiet, dark room.
• Put a cool cloth or ice pack on the forehead.
• Drink fluids.

Prevention

• Stress management such as exercise, relaxation techniques and biofeedback may cut how often and how badly migraines strike. Biofeedback uses electronic devices to teach control of body functions such as heartbeat, blood pressure and muscle tension.
• A trigger log shows what to avoid, such as certain foods and medicines, and what helps, such as a regular sleep schedule and regular meals.
• Hormone therapy may help some women whose migraines seem tied to their menstrual cycle.
• Weight loss may help people with obesity.
• Preventive medicines may be needed for frequent or severe migraines; a health care provider can help choose one.
• Supplements: riboflavin (vitamin B2) and coenzyme Q10 may help prevent migraines, and magnesium may be worth trying if levels are low. Some people take the herb butterbur, but it may not be safe for long-term use. Check with a health care provider before taking any supplement.

Sources

• MedlinePlus, produced by the U.S. National Library of Medicine, "Migraine": https://medlineplus.gov/migraine.html — drawing on the National Institute of Neurological Disorders and Stroke (NIH).
• The source spells the first phase "Prodome"; corrected here to "Prodrome".