What Is a Migraine?

A migraine is a common neurological disorder characterized by recurrent, often unilateral (one-sided), throbbing headaches. These headaches can last from 4 to 72 hours and are frequently accompanied by sensitivity to light (photophobia), sound (phonophobia), nausea, or vomiting. Migraines are more than just bad headaches—they involve complex processes in the brain and nervous system.

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Classification (ICHD-3)

According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), migraines fall into three main categories:

• Migraine without aura
  • Most common type (about 75% of migraines)
  • Headache attacks lasting 4–72 hours
  • At least two of: unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by routine activity
  • At least one of: nausea/vomiting, photophobia, phonophobia

• Migraine with aura
  • Transient focal neurological symptoms (the “aura”) that usually precede headache
  • Aura features: visual disturbances (flashing lights, blind spots), sensory changes (tingling), or speech difficulties
  • Aura develops over ≥5 minutes and lasts <60 minutes

• Chronic migraine
  • Headache on ≥15 days per month for >3 months
  • At least 8 days/month meet criteria for migraine without aura

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Who Gets Migraines?

• Affects about 12% of the population worldwide
• More common in women than men (approximately 3:1 after puberty)
• Often begins in adolescence or early adulthood
• Family history present in up to 70% of cases (genetic predisposition)

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Underlying Mechanisms

Research (Burstein et al., 2015) shows migraines involve multiple interconnected processes:

1. Cortical Spreading Depression (CSD)

   • A wave of neuronal and glial depolarization moving across the brain’s cortex
   • Associated with aura symptoms

2. Trigeminovascular System Activation

   • Sensory nerves (trigeminal ganglia) around blood vessels release neuropeptides (e.g., CGRP)
   • Leads to blood vessel dilation and inflammation

3. Central Sensitization

   • Heightened sensitivity in the spinal trigeminal nucleus and brainstem
   • Explains allodynia (pain from normally non-painful stimuli)

4. Neurogenic Inflammation

   • Release of inflammatory substances around blood vessels
   • Contributes to persistent pain

5. Genetic and Environmental Factors

   • Multiple genes involved (ion channels, neurotransmitter systems)
   • Triggers such as stress, hormones, or diet play a role

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Common Symptoms

Migraine attacks can vary but often include:

• Moderate-to-severe, throbbing or pulsating head pain
• Unilateral location (one side of the head)
• Sensitivity to light and sound
• Nausea and/or vomiting
• Aura in some cases (visual or sensory disturbances)
• Neck stiffness or scalp tenderness
• Mood changes (irritability, depression)
• Difficulty concentrating

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Triggers and Risk Factors

While each person’s triggers differ, common ones include:

• Hormonal fluctuations (menstrual cycle, pregnancy, menopause)
• Stress and emotional upset
• Sleep disturbances (too little or too much sleep)
• Certain foods and additives (aged cheeses, MSG, nitrates)
• Alcohol (especially red wine)
• Dehydration or skipping meals
• Environmental factors (bright lights, strong smells, weather changes)

Keeping a headache diary can help identify personal triggers.

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Diagnosis

Migraine is diagnosed clinically based on patient history and ICHD-3 criteria:

1. At least five headache attacks fulfilling criteria for migraine without aura, or at least two with aura.
2. Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated).
3. Headache has ≥2 of: unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by routine physical activity.
4. During headache, ≥1 of: nausea/vomiting, photophobia, phonophobia.
5. No better explanation by another diagnosis.

Doctors may order tests (MRI, CT) to rule out other causes if red-flag signs are present.

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Treatment Options

Acute (Abortive) Therapies

Aim to relieve symptoms once an attack starts:

• Over-the-counter pain relievers (NSAIDs: ibuprofen, naproxen)
• Triptans (serotonin receptor agonists)
• Anti-nausea medications (metoclopramide, prochlorperazine)
• Ditans and gepants (newer options)

Preventive (Prophylactic) Therapies

Consider if migraines are frequent, severe, or disabling:

• Beta-blockers (propranolol, metoprolol)
• Antidepressants (amitriptyline, venlafaxine)
• Antiepileptics (topiramate, valproate)
• CGRP monoclonal antibodies (erenumab, fremanezumab)
• OnabotulinumtoxinA injections (for chronic migraine)

Non-Drug Approaches

• Sleep hygiene and regular sleep patterns
• Stress management (biofeedback, cognitive behavioral therapy)
• Regular exercise and hydration
• Avoiding identified dietary triggers
• Relaxation techniques (meditation, yoga)

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Self-Assessment and When to Seek Help

If you suspect your headaches could be migraines, you might consider doing a free, online symptom check for to gather more information before seeing a professional.

See a doctor promptly if you experience:

• “Worst headache of my life” or sudden onset
• Headache with fever, stiff neck, rash, or confusion
• New headache after age 50
• Progressive worsening over weeks or months
• Seizures or neurological deficits (weakness, vision loss)
• Headache after head injury

For anything life-threatening or serious, always speak to a doctor immediately.

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Living with Migraines

• Understanding your personal pattern and triggers helps reduce attack frequency.
• Consistent treatment plans, including both acute and preventive options, improve quality of life.
• Joining support groups or seeing a headache specialist can provide additional strategies and reassurance.

By recognizing the signs, knowing your triggers, and working closely with a healthcare provider, most people with migraines can achieve better control and fewer disruptions to daily life.