Table of Contents
What is Migraine?
A migraine is a common disabling primary headache disorder characterized by attacks of throbbing, unilateral headaches which are exacerbated by physical activity.1 The most common migraine symptoms are photophobia, phonophobia, nausea, and vomiting (and sometimes cutaneous allodynia – pain provoked by non-noxious tactile stimuli).2
What Is Migraine Aura?
A “migraine aura” is a group of unilateral, fully reversible central nervous system symptoms that develop gradually, either before (around sixty minutes prior), accompanying, or after the headache phase of migraine. Aura symptoms may be visual, sensory, speech and/or language, motor, brainstem, and/or retinal. Visual aura is the most common type of aura, followed by sensory aura.3
Aura is likely produced by cortical spreading depression of Leão, a “depolarization wave in cerebral gray matter than propagates across the brain” resulting in “a wave of reduced cerebral blood flow.”4
Pain in migraine headaches is experienced as a throbbing or pulsing sensation. The pain can be so severe that it is debilitating, meaning that the pain prevents people from carrying out their typical daily activities. People may have to skip school or work until they feel better.
Types of Migraines
The International Classification of Headache Disorders, 3rd edition (ICHD-3) divides all known headache disorders into primary headache disorders and symptomatic headaches (headaches that are a symptom of a different disorder).5
Although a migraine without aura has no sub-types, menstrual migraine is included as one in the ICHD-3 Appendix, indicating that more research (validation) is needed before the entity can be included in the main body of classification. Menstrual migraines are migraines, mostly without aura, that occur in menstruating women on at least one of five days (from two days preceding menstruation to three days of active menstruation) in at least two out of three menstrual cycles.
Migraines with aura have many sub-types, including migraines with brainstem aura and hemiplegic migraines. Migraines with brainstem aura consist of symptoms originating from the brainstem, including slurred speech, vertigo, tinnitus, hearing loss, double vision, slurred speech, and decreased level of consciousness and not including motor or retinal symptoms. A hemiplegic migraine is similar, but the aura consists specifically of motor weakness and visual, sensory, and/or speech/language symptoms.
Chronic migraines also have no sub-types. Chronic migraines are headaches occurring on fifteen or more days per month, for more than three months, which has the features of migraine headache on at least eight days per month.
“Episodic syndromes that may be associated with migraine” are disorders that occur in people who also have a migraine without aura or migraine with aura. “Recurrent gastrointestinal disturbance” refers to recurrent episodic attacks of abdominal pain and/or discomfort, nausea, and/or vomiting that may be associated with migraines. Thus, abdominal migraines are an idiopathic disorder, not a headache. They occur mainly in children, and most such children will develop headache migraines in adulthood.
Also found in the ICHD-3 Appendix is the vestibular migraine. People with this disorder experience vestibular symptoms, including spontaneous vertigo, positional vertigo, visually induced vertigo, head motion-induced vertigo, and head motion-induced dizziness with nausea, of moderate to severe intensity.
Typical migraines progress through four phases: prodrome, aura, headache, and postdrome.6
Prodrome is a symptomatic phase, lasting up to forty-eight hours, occurring before the onset of pain in migraines without aura or before the aura in migraine with aura. Common prodromal symptoms include:
- Difficulty in concentrating
- Neck stiffness
- Sensitivity to light and/or sound
- Blurred vision
- Elated or depressed mood
- Unusual hunger
- Cravings for certain foods
Auras have positive and negative symptoms. Positive symptoms are produced by central nervous system neuron activity and include:
- Bright lines or shapes
- Abnormal sensations (like “pins and needles”)
- Pain due to stimuli that don’t normally produce pain (like combing one’s hair)
- Rhythmic movements
Negative symptoms indicate a loss of function, such as the loss of vision, hearing, sensation, or motion. For example, visual auras include scintillating scotoma (an area of absent vision with a shimmering or glittering zigzag border) as the most common positive symptom and visual field defects as the most common negative symptom. Sensory auras usually consist of tingling sensations on one side of the face or body. Motor auras are rare and consist of either complete or partial hemiplegia (paralysis of one side of the body).
Aura in basilar migraine emerges from the brainstem and includes:
- Loss of vision in one half of the visual field of both eyes
- Double vision
- Vertigo (spinning sensation)
- Impaired balance or coordination
- Slurred speech
- Sensitivity to sound
- Pins and needles on both sides of the body
The most frequent accompanying migraine symptoms (occurring with, rather than before or following) are:
- Photophobia (hypersensitivity to light, even at normal levels, usually causing avoidance)
- Phonophobia (hypersensitivity to sound, even at normal levels, usually causing avoidance).
Postdrome is a symptomatic phase, lasting up to forty-eight hours, following the resolution (complete remission) of pain in migraine attacks with or without aura. Common postdrome symptoms include:
- Feeling tired or weary
- Difficulty with concentration
- Neck stiffness
Migraine vs. Headache
A migraine is a type of headache. Other common types of headaches include tension headaches and cluster headaches.
The causes of migraines are actively being researched. For instance, as of five years ago, it was evident that activation of meningeal afferents, neuropeptide release, and neurogenic inflammation plays a role in pain generation, but events leading to activation of meningeal afferents were unclear.7 8
The current understanding of the pathophysiology of a migraine is based on the anatomy and physiology of pain-producing structures of the cranium as well as knowledge of central nervous system modulation of these pathways.9
More than one mechanism (e.g., blood flow, chemicals, electrical signals) and multiple locations are involved, and the abnormal brain activity that occurs during a migraine can be triggered by a variety of factors. However, the exact basis for the initiation and cessation of migraine attacks isn’t known.10
Migraine headaches have a genetic component; people with migraine-prone relatives are three times more likely to experience migraines themselves than people who do not have migraine-prone relatives. In addition, women are more likely than men to have migraines because of hormonal changes involved in the menstrual cycle.
Several migraine triggers contribute to the development of this issue:11
- Hormonal changes
- Insufficient sleep
- Change in schedule
- Hunger (skipped meals)
- Powerful smells
- Grinding teeth at night
The American Headache Society recommends documenting triggers in a headache diary and taking the diary with you when you visit your healthcare provider. This information can help identify headache management strategies.12
Biofeedback for Migraines
There are a variety of options for migraine treatment. If you prefer to avoid the pharmacological options, you may be interested in biofeedback, a form of behavioral therapy. Biofeedback is a mind-body technique used to teach people how to manage physical processes that are normally automatically controlled by the body (e.g., blood pressure, heart rate, body temperature, breath control, muscle tension, and sweating).13
In practice, a trained and certified biofeedback technician will use electronic instruments and specific equipment to measure blood pressure, brain waves, breathing rate, volume, and rhythm, heart rate and heart rate variability, muscle tension, skin conductivity, and skin temperature. The technician can then recommend physical and mental exercises the patient can practice to learn to control these processes. Such control allows patients to remain relaxed and avoid the processes that cause tension and pain, particularly if the migraine has a gradual onset.14
Find the Right Treatment Center for Migraines
The American Migraine Foundation, National Headache Foundation, and Migraine Research Foundation websites have resources to find migraine treatment resources and/or certified headache specialists.15 The right treatment center will help create an individualized course of treatment that will help manage your migraine symptoms.