9 Facts to Know About Migraines

Have you ever felt like a herd of elephants was parading through your head? You may have experienced a migraine.

Migraine is a neurological disease that can be disabling, says UNC Health neurologist Gary W. Jay, MD. It often runs in families and usually starts in adolescence. Between 45 million and 49 million people in the U.S. are estimated to have migraine headaches, he says.

Whether you’ve been diagnosed with migraine or you suspect you might have experienced one, read on for nine key facts about migraines.

1. Migraines can cause pain in all parts of the head.

Although the pain accompanying migraines has traditionally been thought to be on one side of the head or the other, it also may be felt in the front or back of the head, around the eyes or behind the cheeks, which is why migraines are sometimes misdiagnosed as sinus headache, Dr. Jay says. Migraine pain can be moderate to severe, and it often throbs or pounds.

2. Migraine symptoms go beyond pain.

Migraines typically last from four to 72 hours, Dr. Jay says. Nausea, vomiting, and sensitivity to light, smells and sound are common. Any type of exertion makes the pain worse.

“People with migraine often will lie in a cool, dark room to seek relief,” he says.

3. Some migraine sufferers experience aura.

About 1 in 5 people with migraines will get aura (certain symptoms or sensations) before the pain starts, Dr. Jay says. It may be visual aura (seeing dark, light or zigzag spots, or losing vision in the center or sides) or sensory aura (feeling like pins are being stuck into your arms, legs or sides). Sometimes people won’t understand what others are asking them, or they may understand but not be able to find words to answer.

“It can be very frightening, especially the first time it happens,” Dr. Jay says.

Aura usually lasts between five and 55 minutes, he says. The headache pain usually starts within an hour after the aura is over.

4. There is no single cause of migraines.

Migraines have different triggers and are unique to each person. For some, certain foods or smells, skipped meals, changes in weather or barometric pressure, sleeping too much or too little, physical exertion and low blood sugar can lead to migraines. Stress can also trigger migraines, but often the pain starts after the stress is resolved.

Among the most common causes are hormonal changes, especially in women, Dr. Jay says. Although both men and women have migraines, three times more women than men experience them. Often, the headaches start when a girl gets her first period and are most common during her childbearing years. Hormones also can play a role in migraines in men, Dr. Jay says.

5. Treatments may stop the pain or prevent the migraine.

Doctors treat migraines with different prescription medications, depending on how the patient experiences migraines.

Acute medications help stop attacks after they have started. They are most effective when taken at the first signs of an attack. These medicines may be pills, nasal sprays or shots. One class of medication—triptans—is taken for migraines and cluster headaches. A newer class of medicines, called CGRP antagonists, are often prescribed if patients don’t respond to triptans.

Preventive medications help reduce the frequency, severity and duration of attacks. They may be used for people who experience four or more migraines a month or whose pain is particularly severe. Some of these medicines are used for other conditions, including seizures, anxiety and high blood pressure.

Depending on which factors trigger your migraine attacks, certain lifestyle changes can help, such as maintaining a regular sleep schedule and exercise routine, staying well hydrated, not skipping meals (especially breakfast) and cutting back on caffeine.

Preventive treatments are especially helpful for people with chronic migraine, which is defined as having a headache at least 15 days a month and having migraine symptoms on at least eight of those days, Dr. Jay says.

6. If your migraine lasts longer than three days, there may be more going on.

Migraines can morph into different types of headaches.

“Sometimes patients tell me they’ve had a migraine for three weeks,” Dr. Jay says. “Any pain that lasts beyond 72 hours may actually be a tension headache or rebound headache.”

People often tense their shoulders when they have a migraine, which may cause muscle spasms that lead to a tension headache, he says. Also, people sometimes take too much medicine trying to get relief, which may make the pain worse and cause rebound headaches.

If you have a migraine and can’t eat or drink for three days or more, go to the emergency department, Dr. Jay says. You could be experiencing a rare condition called status migrainosus.

7. Children get migraines, too.

One in 10 children live with migraines. Children can have severe migraine headache pain, especially if one or both of their parents get migraines. However, children’s symptoms may be different from adult symptoms.

For example, their pain may be steady (not throbbing) and on both sides of the head, often above the eyes. Children commonly experience nausea, vomiting and sensitivity to light and sound. They may also have difficulty focusing, blurred vision, and lightheadedness or dizziness.

Children under 10 may experience abdominal migraine, Dr. Jay says, and may not have head pain at all. “They can have abdominal pain or continuous nausea and vomiting for two or three days. They might also have torticollis, the turning of the head to one side.”

Migraines usually start at puberty for the majority of people who get them, and typically slow down or stop as they get older, especially if hormones are the triggers. However, Dr. Jay says, he’s had patients in their 60s and older have migraines for the first time.

8. Less-common migraine types can cause unusual symptoms.

Some people get retinal migraine, which can cause temporary blindness in one eye, Dr. Jay says.

People having hemiplegic migraines may experience temporary weakness on one side of the body or in one joint. The weakness may be accompanied by visual disturbances and difficulty speaking.

A migraine with brainstem aura includes typical aura symptoms, such as vision problems, along with vertigo, tinnitus, slurred speech and unsteady movements. It is the only type of migraine associated with loss of consciousness.

Triptans—commonly used to treat migraines—can cause dangerous side effects in people with brainstem aura and those with hemiplegic migraine, Dr. Jay says.

9. Keeping a headache diary can help your migraines.

Dr. Jay recommends that people with migraines keep a headache diary that details when they had pain (day of the week, time of day, time of year), what they were doing, eating or experiencing before the pain began, and whether they experienced aura.

“This helps you and your doctor understand what your triggers might be and how to avoid them,” he says.

If you have frequent or painful headaches, talk to your doctor, or find one near you.