- Migraine Headache FAQs
- The Timeline of a Migraine Attack
- Understanding Migraine Progression Can Help You Anticipate & Manage Your Symptoms
- Migraine – a common and distressing disorder
- Stages of Migraine
- Types of Migraine
- Lower-half Headache or Facial Migraine
- Migraine Aura without Headache
- Status Migrainosus
- Abdominal Migraine (recurrent stomach pains in childhood)
- Basilar Artery Migraine (with loss of balance and fainting)
- Hemiplegic Migraine (with weakness on one side of the body)
- Ophthalmoplegic Migraine (with double vision)
- Retinal Migraine (with loss of vision in one eye)
- Migrainous Infarction
- Treatment of Migraine
- Migraine and Other Health Conditions
- Headache and major depression – Is the association specific to migraine?
- Headache Types and Panic Disorder – Directionality and Specificity
- Comorbidity in Migraine – Causes and Effects
- Is there an association between migraine headache and open-angle glaucoma? Findings from the Blue Mountains Eye Study
- Migraine and Stroke
- Migraine and Asthma
- Migraine and MS
- Your Doctor and Your Migraine
- When to Go to the Emergency Room for a Headache or Migraine
- Chronic migraine
- Taking control if you have chronic migraine
- Headache: what makes a headache serious?
- Tension headaches
- Sinus headaches
- Migraine headaches
- Chronic daily headache
- Hormone headache
- Exertional headache including ‘sexual’ headache
- Eye strain headache
- Temporomandibular joint headache
- Ice cream headache
- Other headaches
- When to see your doctor
Migraine Headache FAQs
How Are Migraine Headaches Treated?
Self-care at home
Most migraineurs can deal with mild-to-moderate migraine attacks at home. The following measures may help relieve migraine headache pain:
- Using a cold compress to the area of pain
- Resting with pillows comfortably supporting the head or neck
- Resting in a dark, quiet place
- Avoiding odors
- Withdrawing from stressful surroundings
- Drinking a moderate amount of caffeine
Taking certain over-the-counter headache remedies: Note that none of the following (with the exception of acetaminophen, aspirin, and caffeine combinations) has been clearly shown to relieve migraine headache pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Examples of NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and ketoprofen (Orudis). These medicines sometimes cause stomach ulcers and bleeding; therefore, anyone with a history of stomach bleeding should not take them. Even people without such history should not take NSAIDs over a long period. The doctor or pharmacist should be asked about possible drug interactions if other medications are also being taken.
- Acetaminophen (Tylenol): Acetaminophen may be safely taken with an NSAID or other pain medicine for an additive effect. Taking acetaminophen by itself is usually safe, even for people with a history of stomach ulcers or bleeding, but it should not be taken if a person has liver problems. Taking large amounts of acetaminophen is associated with liver and kidney damage. Patients should always tell their doctor how much acetaminophen they take each day.
- Combination medications: Some over-the-counter pain relievers have been approved for use with migraine, including Excedrin Migraine, which contains acetaminophen, aspirin, and caffeine.
Despite advances, migraines can be difficult to treat. About half of migraineurs stop seeking medical care for their headaches because they are dissatisfied with treatment results. This is unfortunate because the right drug or combination of drugs may eventually be found if the migraineur keeps visiting his or her doctor for follow-up visits.
Migraines can be treated with 2 approaches: abortive and preventive.
- Abortive: The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. The prescribed medications stop a headache during its prodrome stage or once it has begun and may be taken as needed. Some can be administered as a self-injection into the thigh; others, as a wafer that melts on the tongue. These forms of medication are especially useful for people who vomit during a migraine, and they work quickly.
Abortive treatment medications include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions.
The following drugs are also specific and affect serotonin, but they affect other brain chemicals. Occasionally, one of these drugs works when a triptan does not.
- Ergotamine tartrate (Cafergot)
- Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
- Acetaminophen-isometheptene-dichloralphenazone (Midrin)
The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
The next drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable than the specific headache drugs listed above. These drugs should be used primarily as a “backup” for the occasions when a specific drug does not work.
- Butalbital compound (Fioricet, Fiorinal)
- Acetaminophen and codeine (Tylenol With Codeine)
Preventive: This type of treatment is considered if a migraineur has more than 1 migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:
A new class of monoclonal antibody drugs was approved by the FDA to prevent migraine headaches. These medications work by targeting calcitonin gene-related peptide (CGRP), which is elevated in the blood during a migraine attack. The new FDA-approved drugs are:
- erenumab-aooe (Aimovig)
- fremanezumab-vfrm (Ajovy)
- galcanezumab-gnlm (Emgality)
Botulinum toxin (Botox) also has been approved by the FDA to treat chronic migraine in adults and is used as a migraine preventive. The health care professional gives Botox injections at specific points in the head and neck muscles, and the effects last up to 3 months.
Migraineurs must see their doctor regularly. Keeping a “pain journal” is often helpful to track how often attacks happen and what drugs were used to treat them. Sometimes it takes several doctor visits before an effective treatment plan is found.
Some migraineurs have been helped by alternative or complementary therapies such as chiropractic, acupuncture, osteopathic manipulation, and herbal remedies, though none of these treatments is supported by reliable scientific evidence.
The Timeline of a Migraine Attack
Understanding Migraine Progression Can Help You Anticipate & Manage Your Symptoms
Migraine attacks have distinct phases, and understanding them can help people manage their disease. Symptoms associated with the earliest stages of a migraine attack, like the fatigue and blurred vision that can accompany the prodrome and aura stages, can serve as warning signs and signal the need for abortive medication. Identifying and treating a migraine early can even help prevent the symptoms for some people. Additionally, identifying risk factors that can contribute to postdrome “hangovers” may help individuals anticipate the duration of their attack and its aftereffects.
The Phases of Migraine
Also known as “preheadache” or the premonitory phase, prodrome can mark the beginning of a migraine attack. This phase can last several hours or may even occur over several days.
Most people with migraine will experience prodrome, but not necessarily before every migraine attack. If a person with migraine is experiencing prodrome, his or her care team can study their symptoms and patterns to guide a treatment plan that may lessen the severity of the oncoming headache. During this phase, taking medication, minimizing/avoiding other trigger factors (e.g. foods, alcohol) and practicing mindfulness meditation, relaxation therapy or other biobehavioral techniques, can even prevent headache in some cases. Prodrome symptoms vary from person to person, but can include changes in mood, from feelings of depression or irritability to difficulty focusing. Other symptoms may include fatigue, sensitivity to light and sound, insomnia, nausea, constipation or diarrhea, and muscle stiffness, especially in the neck and shoulders. Symptoms that are especially unique to the prodrome phase of migraine include yawning, cravings for certain foods, and frequent urination.
Up to one-third of people with migraine experience aura as a distinct phase in the progression of their migraine attack. Like other phases, aura doesn’t necessarily occur during every migraine attack in those who experience them. People experiencing aura might endure periods of blurry vision or vision loss, or the appearance of geometric patterns, flashing or shimmering lights, or blind spots in one or both eyes. These symptoms usually gradually evolve over at least 5 minutes and can last for up to 60 minutes. Not all auras are followed by headaches, but since they typically precede the headache phase, they can serve as another warning of a potential headache. In about 20% of individuals, the aura may last longer than 60 minutes and in some, the aura may not precede the headache phase but occur after the headache has already started.
The headache phase of a migraine attack is characterized by pain on one or both sides of the head. This phase typically lasts from several hours to up to three days. Headache phase pain can vary from person to person and from incident to incident, with some migraine attacks causing mild pain, while others are debilitating. The pain can shift from one side of a person’s head to the other over the course of the headache, or more commonly, may begin on one side and then gradually involve the other side. Besides pain, headache phase symptoms can include nausea, inability to sleep, anxiety, and sensitivity to sound, light and smell. Even everyday activities — like turning on the lights or participating in physical activity — can aggravate people with migraines during this phase.
Postdrome, also called the “migraine hangover,” typically occurs after the end of the headache phase. Like prodrome and aura, not every person with migraine suffers from postdrome, but it does occur in most (approximately 80%). For those that do, postdrome may not follow every migraine attack they experience, and the length of this phase can vary. Postdrome can be just as debilitating as headache, according to some people with migraine. Symptoms of postdrome include fatigue, body aches, trouble concentrating, dizziness and sensitivity to light. Even though the headache is over, people in postdrome are still experiencing a migraine attack and can benefit from avoiding triggers that aggravate headache, like bright lights and strong smells. Some people have reported finding relief during this phase by engaging in relaxing activities like meditation or yoga, drinking water and avoiding stress.
Understanding your individual phases of migraine can be an essential cornerstone in finding the right treatment option. Maintaining a headache diary can help people with migraine recognize their symptoms and the phases they experience before and after each headache. Identifying these symptoms, and using them to catch and treat a migraine attack early, is key to lessening the severity of headache—or in some cases, even stopping them.
More than 36 million Americans suffer from migraine, but only one of every three patients talk with their a doctor about their headaches. If you experience migraine attacks and haven’t yet partnered with a healthcare team, use the American Migraine Foundation search tool to find someone in your area who can help manage your pain today.
Migraine – a common and distressing disorder
Migraine is a common and distressing disorder. It is not likely to take life but can destroy the quality of life at what might have been its most rewarding moments1.’
Studies have shown that migraine affects over 3 million Australians. It is thought that more women suffer migraine than men due to hormonal factors.
Migraine can begin from childhood but often it appears in a patient in their 20s or 30s. It is relatively ‘infrequent after the age of 40; therefore, prevalence increases from the first to fourth decades and thereafter declines. Migraine may nevertheless be a significant health issue among children2.’
The International Headache Society classifies a headache as a migraine when:
(a) the pain can be classified by at least two of the following;
- one sided
- moderate to severe
- aggravated by movement
(b) there is at least one of the following associated symptoms:
- photophobia (sensitivity to light)
- phonophobia (sensitivity to noise)
(c) the headache lasts for between 4 and 72 hours.
Other symptoms that may be experienced include
- osmophobia (sensitivity to smell)
- aura (visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots lasting 20-45 minutes)
- difficulty in concentrating, confusion
- a feeling of being generally extremely unwell
- problems with articulation or co-ordination
- stiffness of the neck and shoulders
- tingling, pins and needles or numbness or even one-sided limb weakness
- speech disturbance
- paralysis or loss of consciousness (rare).
Migraine may occur recurrently over many years or even decades. Frequency may vary greatly in the same person over time, from a few a year up to several a week.
Stages of Migraine
Migraine can be divided into five distinct phases:
1. Early Warning Symptoms (prodromol)
A significant number of migraineurs experience warning symptoms for up to 24 hours before the attacks start but may not recognise these signs until they know what to look for. These symptoms include:
- changes in mood, varying from feeling elated, on top of the world and full of energy, flying through the day’s work and accomplishing twice as much as usual, to feeling depressed and irritable
- gut symptoms, nausea, changes in appetite (intense hunger or sugar craving: may consume a whole packet of biscuits or chocolates), lack of appetite, constipation, diarrhoea
- neurological changes, drowsiness, incessant yawning, difficulty finding the right words (dysphasia), dislike of light and sound, difficulty in eye focus
- changes in behaviour, hyperactive, obsessional, clumsy, lethargic
- muscular symptoms, general aches and pains
- fluid balance changes, thirst, passing more fluid, fluid retention.
All these symptoms arise in the hypothalamus, the deep-seated part of the brain.
Aura accompanies migraine attacks for about 20 – 30% of migraineurs. The most common aura symptoms are visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots. Aura affects the visual field of both eyes despite often seeming to affect one only and lasts 5-60 minutes then the vision normally restores itself. Less commonly aura affects sensation or speech. When several aura symptoms are present, they usually follow in succession.
Those experiencing classical migraine (migraine with aura) may or may not have a gap of up to an hour between the end of the aura and the onset of the head pain and may feel a bit ‘spaced out’ during the gap. Regardless of whether one experiences migraine with aura, or common migraine (migraine without aura), the headaches are similar. The headache phase can last up to three days. It is often throbbing and on one side of the head, but can affect both. It can be on the same or opposite side to the aura. Movement makes it worse. The most common accompanying symptoms in this phase are nausea, vomiting and sensitivity to light, sound and smell. Eating can help especially starchy foods. The symptoms can be more distressing than the headache itself.
The way an attack ends varies greatly. Sleep is restorative for some. Being sick can make children feel much better. For others effective medication can improve attacks. For a few nothing works except the headache burning itself out.
5. Recovery (postdromol)
A feeling of being drained may exist for about 24 hours, others may feel energetic or even euphoric.
‘Susceptibility to migraine is normally inherited. Certain parts of the brain employing monoamines, such as serotonin and noradrenaline, appear to be in a hypersensitive state, reacting promptly and excessively to stimuli such as emotion, bombardment with sensory impulses, or any sudden change in the internal or external environment. If the brainstem systems controlling the cerebral cortex become active, the brain starts to shut down, a process starting at the back of the brain in the visual cortex and working slowly forward. The pain nucleus of the trigeminal nerve becomes spontaneously active; pain is felt in the head or upper neck and blood flow in the face and scalp increases reflexly. Noradrenaline is released from the adrenal gland and causes the platelets to release serotonin. Serotonin in the circulation is thought to reflect levels of this neurotransmitter in the brain.
The brainstem nuclei of one side have a reciprocal effect on those of the other side; their effects may alternate, causing cortical changes on one side and headache on the other, or causing the headache itself to change from side to side.
Essentially, migraine is caused by the interaction between the brain and the cranial blood vessels. Treatment can be aimed at constriction of dilated arteries to abort each headache as it comes or at the brain itself in an attempt to prevent the headaches altogether.
This is the present hypothesis for the mechanism by which migrainous symptoms are produced3.
Types of Migraine
Apart from common migraine and migraine with aura, other types of migraine are:
Lower-half Headache or Facial Migraine
The term applies to common migraine that covers one-half of the face involving the nostril, cheek and jaw.
Migraine Aura without Headache
Where the headache of migraine with aura may become less severe over the years or may not occur at all, the attacks are referred to as migraine aura without headache. It is rare for attacks to have always occurred without a headache and a doctor should be consulted if this develops for the first time when over 50.
This term describes migraine that may last longer than 72 hours. Symptoms of nausea and light sensitivity resolve after a couple of days but the headache persists.
Abdominal Migraine (recurrent stomach pains in childhood)
Symptoms are periodic abdominal pains (experienced by about 20% of migrainous children compared with about 4% of children who do not suffer from headache).
Rare types of migraine include:
Basilar Artery Migraine (with loss of balance and fainting)
Symptoms include visual disturbances, giddiness, loss of balance, slurred speech followed by aching mainly in the back of the head. Fainting can occur at the height of the attack.
Hemiplegic Migraine (with weakness on one side of the body)
Symptoms resemble a stroke and may progress until the arm and leg on one side are completely paralysed for a few hours. Repeated attacks may leave a residual weakness. Familial hemiplegic migraine occurs where there is a family history of hemiplegic migraine.
Ophthalmoplegic Migraine (with double vision)
Symptom is paralysis of one or more of the muscles moving the eyes resulting in the eyes moving out of alignment and the person seeing double.
Retinal Migraine (with loss of vision in one eye)
Symptom is loss of sight in one eye and normal vision in the other. The sight clears leaving an ache behind the eye or a generalised headache.
Symptoms range from permanent blind spots to a full stroke occurring during a typical migraine attack. An infarct is the death of tissue due to an inadequate blood supply.
See also: Management of Headache / Precipitating factors
Triggers are many and varied, not the same for everyone and not necessarily the same for different attacks in the same person. Identifying triggers may be complicated by the fact that it often takes a combination of triggers to set off a headache.
Common, well-recognised dietary triggers include:
- missed, delayed or inadequate meals
- caffeine (coffee and tea) withdrawal
- certain wines, beers and spirits
- chocolate, citrus fruits, aged cheeses and cultured products (chocolate and other sugar cravings may be prodomal not triggers)
- monosodium glutamate (MSG)
Environmental triggers include:
- bright or flickering lights, bright sunlight
- strong smells, e.g. perfume, gasoline, chemicals, smoke-filled rooms, various food odours
- travel, travel-related stress, high altitude, flying
- weather changes, changes in barometric pressure (likewise, decompression after deep-sea diving)
- loud sounds
- going to the movies
- computers (overuse, incorrect use).
Hormonal fluctuations are implicated as a significant trigger for women as three times as many women suffer from migraine headaches as men, this difference being most apparent during the reproductive years,. Hormonal triggers may be:
- Climacteric (final menstrual period)
- Menstruation (a UK study found 50% of women more likely to have migraine around menstruation)
- Oral contraceptives
- Pregnancy (may worsen for first few months but in two thirds of women improves in latter part)
- Hormone replacement therapy (HRT)
Physical and Emotional Triggers
Physical and emotional factors include:
- lack of sleep or oversleeping (even as little as half hour difference in routine, e.g. sleeping in on weekends)
- illness such as a viral infection or a cold (if taken cold and migraine medication, remember that many cold remedies contain pain-killers)
- back and neck pain, stiff and painful muscles, especially in scalp, jaw, neck, shoulders, and upper back
- sudden, excessive or vigorous exercise (regular exercise can however prevent migraine, if migraine is triggered by a blow to the head a doctor should be consulted)
- emotional triggers such as arguments, excitement, stress and muscle tension
- relaxation after stress (weekend headache).
Treatment of Migraine
Much can be done about migraine. Treatment is not just a matter of taking a tablet but a case of each individual developing a migraine management plan that will probably involve lifestyle modifications, medication and complementary therapies.
See: Management of Headache
Some people can manage their migraines with medications available from a pharmacy. For many others, these are not sufficiently effective. If this is the case, or you are unsure about the cause or nature of your headache, or if your headaches change, it is important you consult a doctor. Studies show that 50% of migraine sufferers have not been diagnosed. Even if you have previously consulted a doctor and the prescribed treatment has not been successful it is worth going again. Migraines can be managed, effective migraine management involves a partnership between you and your doctor. Some medications are given once the headache has begun (acute treatment) and others taken daily to reduce the frequency of attacks (preventative treatment).
Infrequent, less severe migraine may respond to over-the counter medications such as
- aspirin (not recommended for young children, some adults respond well to three tablets)
- non-steroidal anti-inflammatory drugs such as ibuprofen (Nurofen, Brufen), naproxen (Naprosyn).
Medications that may be prescribed for more severe migraine include
- triptans such as sumatriptan (Imigran), naratriptan (Naramig), zolmitriptan (Zomig) that are based on the serotonin molecule
- ergotamine compounds (Cafergot) that appear to provide relief by constricting cranial blood vessels
- stronger non-steroidal anti-inflammatory drugs
- stronger narcotic-type analgesics.
Anti-emetic medications often prescribed with other forms of acute therapy to minimise the nausea that often accompanies migraine include
- metoclopramide (Maxolon), prochlorperazine (Stemetil) or domperidone (Motilium) to increase absorption and reduce nausea.
Prophylactic/preventive medication is taken daily, monthly or at regular intervals, regardless of whether a headache is present, to reduce the incidence of severe or frequent headaches. These include:
- beta blockers such as propranolol (Inderal), timolol (Blocadren), atenolol (Tenormin) and metoprolol (Lopresor, Betaloc) that block the beta-receptors on which adrenaline works in the nervous system as well as on blood vessels
- serotonin antagonists such as methysergide (Deseril), pizotifen (Sandomigran) and cyproheptadine (Periactin)
- sodium valproate or valproic acid (eg Epilim), an anti-epileptic drug shown to reduce the intensity of migraine
- calcium-channel blockers such as verapamil (Isoptin) that stop the constriction of blood vessels by preventing the use of calcium necessary for this reaction
- antidepressants such as amitriptyline (eg. Tryptanol) have an action on headache that is independent of their antidepressant action
- onabotulinumtoxin A (eg. Botox) is not just a beauty treatment. It has been proven to help those with chronic migraine and is listed on the PBS.
- feverfew, a herbal remedy
- riboflavin 200mg twice daily has been reported as useful.
All are effective. All have side effects and, except feverfew and riboflavin, are prescription drugs. Many were initially introduced for some other problem and were also observed to reduce headache.
Acupuncture: Stimulating acupoints may ease pain by encouraging production of endorphins (natural painkillers). Alexander technique: Can help prevent tension headaches by relieving poor posture and pressure that results from it. Aromatherapy: Combines various scented oils and promotes relaxation and eases tension. Biofeedback: Can be used to treat tension-type and migraine headaches – patient learns to control blood pressure, heart rate, and spasms in the arteries supplying the brain through a sensory device. Chiropractic Therapy: Based on the theory that most diseases of the body are a result of a misalignment of the vertebral column with pressure on the adjacent nerves that may affect blood vessel and muscle function. Manual techniques purport to adjust the misalignment. Homeopathy: Uses active substances found in certain medications highly diluted.
Hydrotherapy: Splashing your face with cold water before lying down for an hour can ease headache. Alternating hot and cold showers dilates then constricts the blood vessels, stimulating circulation. Ice pack on head is another option. Hypnotherapy: Can help sufferer deal with headache by altering the way the body interprets messages of pain. Massage: Can reduce muscle tension throughout the body, thereby reducing headache. Meditation: A recent study on migraine prevention through meditation has had very promising results, all participants reported less severe migraines. Naturopathy: Uses only natural substances in small amounts and aims to provide a healthier balance of bodily processes. Osteopathy: Manipulation of the neck or cranial, osteopathy may be used to correct misalignments of the vertebrae that can cause migraines. Physiotherapy: Treating muscle tension can release pressure that may lead to headache. Relaxation Techniques: Geared towards reducing pressure in the body and the level of stress chemicals that may worsen headache. Shiatsu: Combination of massage and pressure can restore the “energy balance” and induce relaxation. Yoga: Can relieve muscle tension in the back of the neck and correct posture.
Migraine and Other Health Conditions
Studies show that the prevalence of other health conditions, including depression, panic disorder, epilepsy, stroke, anxiety disorders, manic depressive illness, mitral valve prolapse, Raynaud’s syndrome, glaucoma is higher amongst persons with migraine and severe headache than control groups. Extracts from some of these studies are included below in addition to information about studies indicating a higher prevalence of asthma among migraine sufferers and a link between migraine and multiple sclerosis
Headache and major depression – Is the association specific to migraine?
N. Breslau, L.R. Schultz, W.F. Stewart, R. Lipton, V.C. Lucia, and K.M.A. Welch.
This U.S study found that lifetime prevalence of major depression was approximately three times higher in persons with migraine and in persons with severe headaches compared with controls. Significant bi-directional relationships were observed between major depression and migraine, with migraine predicting first-onset depression and depression predicting first onset migraine in contrast, persons with severe headache had a higher incidence of first-onset major depression (hazard ratio = 3.6) but major depression did not predict a significantly increased incidence of other severe headaches (hazard ratio = 1.6). The study concludes that the contrasting results regarding the relationship of major depression with migraine versus other severe headaches suggests that different causes may underlie the co-occurrence of major depression in persons with migraine compared with persons with other severe headaches. Neurology 2000; 54: 308-313
Headache Types and Panic Disorder – Directionality and Specificity
N. Breslau, L.R. Schultz, W.F. Stewart, R. Lipton, and K.M.A. Welch.
The U.S study found that lifetime prevalence of panic disorder was significantly higher in persons with migraine and in persons with other severe headaches, compared with controls. Migraine and other severe headaches were associated with increased risk for the first onset of panic disorder (hazard ratios = 3.55 and 5.75). Panic disorder was associated with an increased risk for first onset of migraine and for onset of other severe headaches, although the influences in the direction were lower (hazards ratios = 2.10 and 1.85). The study concludes that comorbidity of panic disorder is not specific to migraine and applies also to other severe headaches. The influence is primarily from headaches to panic disorders, with a weaker influence in the reverse direction. The bi-directional associations, despite the difference in the strength of the associations, suggest that shared environmental or genetic factors might be involved in the comorbidity of panic disorder with migraine and other severe headaches.
Neurology 2001; 56: 350-354
Comorbidity in Migraine – Causes and Effects
This U.S study notes that there is strong evidence that migraine is comorbid with a number of different conditions: epilepsy, stroke, depression, anxiety disorders, and manic depressive illness. There is strong evidence that migraine is comorbid with mitral valve prolapse and Raynaud’s syndrome. Cephalalgia 1998: 18 Suppl 22: 8-14 Oslo Issn 0800-1952
Is there an association between migraine headache and open-angle glaucoma? Findings from the Blue Mountains Eye Study
JJ Wang, P Mitchell and W Smith
In this Australian study, ‘increased odds for OAG (open-angle glaucoma) were found for people giving a history of typical migraine headache and aged 70-79 years after adjusting for variables found associated with glaucoma’. The study concludes that ‘these data suggest the possibility of an association between history of typical migraine headache and OAG, which could be modified by age’. Ophthalmology, Vol 104, 1714-1719 Copyright © 1997
Migraine and Stroke
The complex relationship between migraine and stroke has been studied intensively.
A recent study, “Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age” (M. Donaghy, C.L Chang, N. Poulter, on behalf of the European collaborators of The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception- J Neurol Neurosorg Psychiatry 2002;73:747-750) notes that ‘Migraine is recognised increasingly as a risk factor for ischaemic stroke in women of childbearing age. Migraine with aura poses a higher risk than migraine without aura.’ The study provides an additional analysis ‘of a previously reported multicentre case-control study of the relation between stroke and migraine in women aged 20-44 years and concludes that ‘the risk seems particularly high in those whose initial migraine type involved aura occurring more than 12 times per year’.
A previous study by Tzourio et al (1995) reported that the risk of stroke was greatly increased for migrainous patients who smoked more than 20 cigarettes a day (odds ratio 10.2) and for those using oral contraceptives (odds ratio 13.9) and that the absolute risk of young women with migraine suffering a stroke was 19 per 100,000 per year4.
Migraine and Asthma
A recent British study, carried out by Professor David Strachan and colleagues at St George’s Hospital Medical School London, compared the prevalence of asthma in nearly 65,000 migraine patients with an equal number of control patients without migraine and found that the relative risk in patients with migraine was 1.59.
Br J Gen Pract 2002; 52:723-728
Migraine and MS
The MS Society of Australia report on their website www.mssociety.com.au : ‘although headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache. One report noted that migraine headaches were more than twice a common in a group of MS patients than in a group of people with similar characteristics, but without MS. Another study noted that up to one-third of an MS population studied had a prior diagnosis of migraine. It has been reported that vascular or migraine type headaches may occasionally be the first symptom of MS. One published report that 20% of a sample group of people with MS had a family history of migraine, compared to 10% of controls, suggests that there may be a common predisposing factor to both MS and migraine.
SOURCE: NMSS Information Resource Center and Library. Compendium of Multiple Sclerosis Information (CMSI). ©1997, National Multiple Sclerosis Society. Rev. 10/97.
Your Doctor and Your Migraine
If you are unsure about the cause or nature of your headache, need assistance in managing your migraines or if the pattern of your headaches change, it is important you consult a doctor. Studies show that 50% of migraine sufferers have not been diagnosed. Even if you have previously consulted a doctor and the prescribed treatment has not been successful it is worth going again. Migraines can be managed, effective migraine management involves a partnership between you and your doctor.
See: Management of headache/ Your Doctor and Your Headache
- Migraine and Other Headaches 2000 Professor James Lance Simon and Schuster
- Headache Disorders and Public Health, Education and Management Implications
- World Health Organisation, Geneva, WHO/MSD/MBD/00.9, Sept 2000
- Understanding Migraine and Other Headaches 2002 Dr Anne MacGregor
- Littlewood et al., 1998 from Mechanism and Management of Headache 6th Ed James W. Lance and Peter J.Goadsby
- Headaches Paul Spira 2000 Health Essentials
- Wolff’s Headache and Other Head Pain 7th Ed Silberstein, Lipton & Dalessio
Prepared by Louise Alexander, PhC, Grad Dip Comm Mngt, Former National Director of the Brain Foundation. Reviewed by Professor James Lance, AO, CBE, MD, Hon DSc, FRCP, FRACP, FAA, Consulting Neurologist, and author, “Migraine and Other Headaches”
1 Migraine and Other Headaches 2000, Professor James Lance
2 Headache Disorders and Public Health, Education and Management Implications, World Health Organisation, Geneva, WHO/MSD/MBD/00.9, Sept 2000
3 Migraine and Other Headaches 2000, Professor James Lance, Simon & Schuster
4 Mechanism and Management of Headache 1998 J.W Lance Butterworth Heinemann
When to Go to the Emergency Room for a Headache or Migraine
When going to the ER, be sure to mention:
- your symptoms, including any that are new or unusual for you;
- any medications you have taken, especially in the last few days; and
- if you have had good results from a particular medication regimen, that can be helpful to the ER.
Often ER doctors will want to order tests such as a CT scan of the head or spinal tap to make sure there is no bleeding in the brain, large stroke or meningitis. If you are having your typical severe headache or Migraine, and no new symptoms, the chance these tests will be helpful are extremely low and you have the right to refuse them (see 5 Things Migraine and Headache Patients and Doctors Should Question).
The majority of persons coming to an ER for severe headache or Migraine do not get lasting results from the medications given in the ER, so having a good long-term plan and relationship with an outpatient doctor who treats your headache disorder is very important. If you have even occasional long-lasting headaches or Migraines, a good migraine preventive plan is very important, and you should have at least one rescue medication to prevent future ER visits.
Taking control if you have chronic migraine
Chronic migraine is a distinct type of migraine that is sometimes progressive. It is therefore important to recognise how often everyday life is disrupted by migraine and keep a record of how many days per month you have a headache. If this is more than half the month, you may well have chronic migraine and should see a neurologist, as he or she may be able to offer you a wider range of treatments to help reduce your symptoms.
- Olesen J et al. Cephalalgia 2006; 26:742–746.
- Natoli JL, Manack A, Dean B et al. Cephalalgia 2009;1–12
- Munataka J, Hazard E, Serrano D et al. Headache 2009;49:498–508
- Buse DC et al. Mayo Clin Proc 2009;84:422–435.
- Buse DC, Lipton RB, Kawata AK et al. Poster presented at 14th International Headache Congress, September 10–13,2009, PA, USA
- Harwood RH et al. Bull World Health Org 2004;82:251–8.
- Steiner TJ. Lecture to the All Party Parliamentary Group on Primary Headache Disorders. 19 November 2008.
- Lipton RB. Neurology 2009;72 (Suppl 1):S3–7.
- Berger A, Varon SF, Bramley TJ et al. Poster presentation at the 14th International Headache Congress, September 10–13, 2009, PA, USA.
- Diener et al. Cephalagia 2010;30;3:1-11
- Goadsby PJ, Sprebger T. BMC Medicine 2009, 7:71
- Varon SF, Shah MV, Kawata AK et al. Poster presentation at the 14th International Headache Congress, September10–13, 2009, PA, USA.
Your support could help make sure everyone with migraine gets the information they need. .
Headache: what makes a headache serious?
Headaches are very common and have many causes. Although they are a frequent source of stress and anxiety, headaches are only very rarely a sign of serious illness.
Many headache sufferers worry about having a brain tumour, but this is a very uncommon event. There are many different types of headaches, including tension headaches, sinus headaches, migraine headaches and cluster headaches. Knowing what type of headache you have is important so that you get the right treatment.
The most common cause of pain in the head is tension headache. Most adults will have experienced a tension headache at some time. According to the World Health Organization, this type of headache affects more than one-third of all men and more than half of all women.
Tension headaches are usually felt as a dull pain on both sides of the head, or as a feeling of having a tight band around the forehead. Sometimes the pain extends to the neck and shoulders.
Tension headaches usually appear around times of stress. They may come on with tiredness and sometimes after prolonged reading. Poor posture can also trigger these headaches. Taking exercise or drinking alcohol does not usually make these headaches any worse.
Tension headaches were previously thought to be due to contraction (tightening) of the neck muscles, but research now suggests this is not the cause. In fact, the exact cause is not known.
For tension headache treatment, simple over-the-counter painkillers such as ibuprofen, paracetamol or aspirin usually provide relief. (Aspirin should not be used in children aged 16 years and younger).
Hot showers, stretching and massage may also help. Chronic sufferers should beware of becoming too reliant on painkillers and look for ways of relaxing and avoiding stress.
Sinus headache is a common problem, which many people will recognise, particularly when they have a bad cold or flu. A ‘stuffy’ head and pain above or behind the eyes, or on either side of the nose, are the usual symptoms. Pain is often worse when the head is bent forward or when lying down.
Migraine is a common cause of headache, affecting at least one in 7 people. Migraines are about 3 times more common in women than in men.
Migraine headaches are often throbbing, one-sided, associated with nausea (feeling sick) and vomiting, and worse with bright light and noise. They may be preceded by an ‘aura’ of symptoms such as seeing a moving pattern or blinking lights in front of you.
Migraines can be brought on by stress, certain foods, changes in the weather, lack of food, lack of sleep, as well as a range of other factors.
Specific migraine treatment options are available. Many attacks can be relieved by taking medicines as soon as symptoms start and lying down in a dark, quiet place.
Cluster headaches are a rare type of headache, affecting men much more than women. Cluster headaches can affect people of all ages, but onset is most common between the ages of 20 and 40.
Cluster headaches are one sided, and are usually felt around the eye. The pain is usually intense and stabbing in nature. There may be a feeling of a blocked or runny nose and a watery eye on the affected side. They tend to last between 15 minutes and 3 hours.
Cluster headaches occur once or several times per day for weeks or months at a time (in a ‘cluster’), and then disappear for months or even years. The headaches usually happen at the same time every day during a cluster, often at night.
Cluster headaches can be brought on by alcohol.
Chronic daily headache
Chronic daily headaches can occur on and off, every day. They can be associated with anxiety or depression, or due to ‘rebound’ headache, which results from overuse of pain medicines. Symptoms may be similar to tension headache or migraine, or a mixture of both.
Some women experience severe headaches including migraines at times when their hormones fluctuate, for example, around the time of their period each month or around the time of ovulation.
Exertional headache including ‘sexual’ headache
Some people get a headache associated with exercise, sport or sexual activity. A ‘sexual headache’ can occur before or after orgasm; it can be severe and last for several minutes to several hours. Some people experience a sudden, severe headache at the point of orgasm.
Eye strain headache
If you have visual problems that have not been addressed by prescription glasses or contact lenses, you can get an eye strain headache, which typically causes pain and a heavy feeling around the eyes.
Temporomandibular joint headache
Some people may get muscle tension and pain related to a disorder of the temporomandibular joint (TMJ), the joint just in front of each ear, where your jaw bone connects to your skull.
Ice cream headache
Eating something very cold can cause a sharp pain in the middle of your forehead or over one temple. People who get migraines may be more likely to get an ice cream headache — so-named because the pain comes on immediately after eating ice cream.
Many other headaches are a secondary effect of another disorder, such as:
- a neck problem;
- irritation of nerve fibres, e.g. trigeminal nerve neuralgia;
- eye, ear, sinus, tooth and jaw problems;
- inflammation of an artery in the head (temporal arteritis);
- a head injury;
- a hangover from drinking excessive alcohol; or
- withdrawing from drugs such as caffeine or narcotics.
When to see your doctor
Sometimes headaches may be due to a serious problem, like a brain tumour, a brain haemorrhage or a brain infection such as meningitis. While these are uncommon causes of headache, it’s important to know the warning signs.
Seek medical attention if you:
- have a headache that’s ‘the worst you’ve ever had’;
- start getting regular headaches, especially if you are aged 50 years or over;
- have a change in the pattern of your headaches, for example, from mild and occasional headaches to severe and frequent headaches;
- get a sudden severe headache ‘out of the blue’ that may be accompanied by a stiff neck;
- have a constant headache that is gradually getting worse over days or weeks;
- develop a severe headache accompanied by fever, neck pain or stiffness, nausea or vomiting;
- have a headache together with drowsiness, confusion, or memory loss;
- have a headache following a head injury;
- have a headache together with loss of sensation or weakness in any part of your body, coordination problems, blurred or double vision, slurred speech or difficulty speaking;
- have a headache associated with coughing, physical exertion or sexual activity;
- have a headache associated with being short of breath; or
- develop a headache that is associated with convulsions (fits).
Drowsiness, visual symptoms, vomiting and dislike of bright light may all be symptoms associated with migraine. However, in other situations, particularly after head injury, they may indicate an underlying brain disorder. If you are experiencing these symptoms for the first time or are in any doubt, seek medical attention.
You should also see your doctor if you have headaches that are different from or worse than other headaches you have experienced. Indeed, any headache that is worrying you warrants a visit to your doctor.
Last Reviewed: 31/05/2017