A migraine is not just headache pain. Migraine is thought to be a genetic neurological disease characterized by flare-ups often called "migraine attacks" or "migraine episodes." A headache can be one symptom of a migraine attack. Some individuals with migraine disease often have migraine attacks without having a headache.
Migraine attacks, or episodes, occur in phases or parts. A typical migraine attack consists of four phases. Not every individual experiencing a migraine has all four phases. The four phases of a migraine attack are prodrome, aura, headache, and postdrome (see Signs and Symptoms).
Individuals suffering from migraines tend to have recurring attacks triggered by a lack of food or sleep, certain food allergies, exposure to light, or hormonal changes in women, including puberty, menopause, and premenstrual syndrome (PMS). Anxiety, stress, or relaxation after stress can also be triggers. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.
Attacks tend to become less severe as the migraine sufferer ages. The uncertainty of when attacks may occur leads to additional patient anxiety. Symptoms, incidence, and severity of migraine headaches vary by individual.
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches at one time in their lives.
In the United States, migraine headaches often go undiagnosed or are misdiagnosed as tension or sinus headaches. As a result, many migraine sufferers do not receive effective treatment.
Treatments for migraine attacks involve prevention of the attack and treatment of acute (immediate) symptoms such as the headache.
Types Of Headaches
A headache is pain in occurring in the head. There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not associated with (caused by) other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by associated disease, such as brain tumors. The associated disease may be minor or serious and life threatening. Seven in ten people have at least one type of headache a year.
Migraine with aura: Migraine with aura is a migraine headache characterized by a neurological (nervous system) experience originating in the brain called an aura. Most auras appear as bright shimmering lights around objects (halos) or at the edges of the field of vision (called scintillating scotomas), zigzag lines, wavy images, or other visual hallucinations. Other individuals may experience temporary vision loss. An aura is usually experienced 10-30 minutes before the headache.
Non-visual auras include muscle weakness, speech or language abnormalities, dizziness, and paresthesia (tingling or numbness) of the face, tongue, or extremities.
Migraine without aura: Migraine without aura, or "silent" migraine, is the most prevalent type of migraine headache and may occur on one or both sides of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (also called photophobia) often accompany migraine without aura.
Basilar migraine: Basilar migraine or basilar artery migraine, involves a disturbance of the basilar artery (blood vessel) in the brainstem. Symptoms include severe headache, vertigo (dizziness), double vision, slurred speech, and poor muscle coordination. Basilar migraines pain is usually bilateral, or on both sides of the head. This type occurs in any age, but mostly occurs in females.
Carotidynia: Carotidynia is also called lower-half headache or facial migraine. It produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. There is usually tenderness and swelling over the carotid artery (blood vessel) in the neck. Episodes can occur several times weekly and last a few minutes to hours. This type occurs more commonly in older people.
Headache-free migraine: A headache-free migraine is characterized by the presence of aura without a headache. This occurs in patients with a history of migraine with aura.
Ophthalmoplegic migraine: Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis), and the nerves responsible for eye movement become paralyzed. Eyelid dropping may persist for days or weeks.
Status migraine: Status migraine is a rare type involving intense pain that usually lasts longer than 72 hours. The patient may require hospitalization.