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Understanding Migraine

Migraine is a neurological condition, a primary headache disorder which is characterized by recurrent debilitating headaches scaling from moderate to severe. Extreme pain which is experienced in migraine may last for several hours and may extend up to days.

Migraine is a very common disorder. They generally follow after an aura of sensory disturbances which include nausea, speaking difficulty, hyperactivity, vomiting, sensitivity to light, sound or smell. The pain is known to worsen if the patient is involved in any type of physical exertion. Migraine tends to affect people aged between 15 to 55 years.

Types of Migraine

Migraine can be classified into two main types which depend on whether the patient suffers from sensory impairment. These disturbances are known as Aura.

Migraines with aura

These symptoms work as warnings for many patients which signals the onsets of migraines. Aura is characterized by sensory disturbances which include confusing thoughts, strange sparkling spots, zigzag lines, blind spots or even temporary loss of vision.

Migraines without aura

Between 70% to 90% of migraines occur without any sensory disturbance or Aura. However, the patient will still undergo the prodrome stage.

Other types of migraine

There are a few other types of migraine which are related to specific syndrome and triggers.

  • Chronic Migraine: When migraine attacks occur over 15 days of a month
  • Menstrual Migraine: When the migraine attack is somehow related to the pattern of the menstrual cycle
  • Hemiplegic Migraine: When migraine temporarily weakens one side of the body
  • Abdominal Migraine: This is a syndrome which connects Migraine attack to dysfunction of gut and abdomen
  • Migraine with Brainstem Aura: A very rare type of migraine which can causes severe neurological symptoms
  • Acephalgic Migraine: Also referred to as silent migraines. When a migraine occurs with headaches. However, symptoms like Aura still prevail.

It is highly recommended to see a doctor if the headaches follow a migraine pattern.


Symptoms that revolve around migraine can begin a day or two before the onset of the headache itself. These symptoms are called The Prodrome Stage. These include:

  • Food craving
  • Fatigue
  • Hyperactivity
  • Irritability
  • Depression
  • Frequent yawns
  • Neck stiffness

In migraine with aura, some sensory difficulties are experienced by the patient after the prodrome stage. During Aura sensory organs are affected with impairment in vision, movement, hearing, speech and/ or sensation. For example

  • Difficulty in speaking
  • The illusion of seeing shapes bright spots or flashes
  • Tingling sensation
  • Temporary loss of vision (severe symptom and should not be ignored)

The notorious headache of migraine occurs afterward. This stage is called the Attack phase. The most severe of all phases for which migraine is known. This phase can last up to hours or even days. Symptoms seen in this phase can vary from person to person. Some of the most common symptoms are

  • Nausea and dizziness
  • Increased sensitivity to light and sound
  • Pulsing head pain
  • Vomiting
  • Pain on one side of the head, either left, right, front, back or in temples

After the Attack, the patient generally experiences what is called the Postdrome phase. Changes in mood and feelings are experienced during this phase. This can range from euphoric and happy to fatigued and apathetic with a mild and dull headache.

The duration and degree of these phases vary from person to person. It is not unusual for a phase to skip and it is completely possible that attack may occur without any headache. 


The causes of migraine are not fully understood yet. But apparently, the cause is a mix of genetics and environmental factors that play a major role. Abnormal brain activities may result in a migraine. This affects the way nerves communicate and may cause a chemical imbalance. This includes a decrease in brain chemical known as serotonin. Researchers are also studying the role of Calcitonin gene-related peptide (CRGP) in causing migraines. Genetics and allergies also seem to play a big role. In above two-third of the cases, migraine runs through the family.


Many triggers are responsible for the occurrence of migraine which includes:

  • Hormonal changes: Seen in women, fluctuations in estrogen due to menstrual periods, pregnancy and/or menopause seem to trigger acute headaches. It may worsen due to the use of Hormonal medications, such as oral contraceptives and hormone replacement therapy
  • Drinks: Especially the one which contain alcohol or caffeine, like wine, coffee or energy drinks
  • Foods: Certain food items are known to trigger migraines like aged cheese and salty processed food. Sweeteners like aspartame and preservatives like monosodium glutamate (MSG) or even skipping meals can trigger migraines
  • Stress: One of the most popular triggers of migraines. Stress and tension at home or work can cause migraines
  • Medications: Oral contraceptives can cause hormonal imbalance and vasodilators
  • Physical Factors: involvement in intense physical exertion might trigger a headache. And so, can change in sleep patterns or missing sleep. Sometimes too much sleep and jet lag can also trigger migraines
  • Sensory stimuli: Exposure to bright light such as sun glare, loud sound or strong smell can trigger a migraine


It is highly recommended to see a doctor if you see any of the symptoms mentioned above or if your headache follows a migraine pattern because there is no single cure for migraines and the treatment may vary from person to person. Treatment helps in preventing a full-blown attack. Sometime migraine may alleviate with merely with some changes in lifestyle and daily habits but sometimes it may need surgery to cure. The best way to deal with migraines is to consult a doctor and get it diagnosed.

Lifestyle changes may help with a migraine which includes

  • Getting enough and good quality sleep
  • Reducing stress
  • Drinking plenty of water
  • Regular mild exercise
  • Eating gluten-free

Generally, migraine is treated with a course of medication which includes painkillers such as naproxen, aspirin with little caffeine, acetaminophen. Always consult a doctor before starting any kind of medication.

The doctor may prescribe botox injections to deal with migraines. In a 2014 review, it was shown that surgical decompression of nerves could alleviate the symptom and may even eliminate the migraine.

Dr Tushar Tayal
Author: Dr Tushar Tayal
With more than 14 years of experience, Dr Tushar Tayal is an Internal Medicine specialist and Intensivist/Critical care specialist. His expertise lies in managing patients with infectious diseases, diabetes, thyroid disorders, hypertension, respiratory and critical illnesses.