Severe and chronic headaches inevitably cause distress and affect daily life. One highly common condition is a migraine headache. While many people are familiar with the name, the actual migraine causes, warning signs, and proper coping methods remain misunderstood.
This article explains migraine symptoms, the factors that trigger them, and migraine treatments to help patients control their condition and return to a regular routine.
What Is a Migraine?
A migraine is a headache condition caused by neurological irregularities in the brain. The nervous system becomes highly sensitive to stimuli, leading to the release of neurotransmitters such as CGRP. These chemicals relate to pain signaling and blood vessel changes in the brain, resulting in a headache. Pain characteristics and accompanying symptoms vary, with the severity and frequency differing for each individual.
Migraine Types
Migraines are broadly divided into two groups:
- Migraine without aura: A highly frequent presentation among patients.
- Migraine with aura: Involves warning signs such as visual disturbances, seeing zigzag lines, shimmering lights with or without color, partial visual loss, blurred vision, distorted images, or visual artifacts that remain when the eyes are closed. Additional auras include numbness in the hands, arms, or around the mouth, or weakness on one side of the body.
Migraine Causes and Triggers
Environmental factors and daily behaviors frequently act as migraine causes. Observing and avoiding these triggers helps lower the risk of an attack. Common triggers include:
- Environmental stimuli like bright lights, camera flashes, loud noises, strong odors, smoke, or sudden weather changes
- Sleeping too little or sleeping excessively
- Fasting or eating inadequate amounts of food
- Specific foods and beverages, including red wine, processed meats, dairy products, wheat, chocolate, MSG, and artificial sweeteners
- Overexertion or highly strenuous physical activities
- Hormonal changes in women during menstruation
- Screen light from mobile phones or computers
- Hormonal shifts during pregnancy, particularly in the first trimester (though some patients see improvements during pregnancy)
- Stress
- Specific medications
- Smoking
Migraine Symptoms
Observing headache patterns helps differentiate the condition. Frequent migraine symptoms include:
- Unilateral headache (one-sided), which may alternate between the left and right side.
- Throbbing pain around the temples.
- Pain radiating into the eye sockets.
- Pain at the base of the skull.
- Nausea, vomiting, and dizziness.
- Aura symptoms occur 5 – 60 minutes before the headache, such as flashing lights, shimmering lights, or blurred vision.
Stages of a Migraine
Migraine attacks generally progress through four stages:
- Prodrome: Early signs occurring 1 – 2 days before the headache, such as neck stiffness, mood swings, irritability, food cravings, and frequent urination.
- Aura: Usually develops 5 – 60 minutes before the headache. Signs include visual disturbances, flashes of light, zigzag lines, blurred vision, distorted vision, numbness, or weakness.
- Headache: The pain phase lasts an average of 4 – 72 hours. Features include throbbing pain, one-sided pain, nausea, vomiting, and heightened sensitivity to external stimuli.
- Postdrome: After the headache subsides, patients may experience fatigue, exhaustion, dizziness, confusion, lack of focus, sensitivity to stimuli, and mood changes. These symptoms usually resolve within 24 – 48 hours.
Migraine Severity Levels
Migraine severity and its impact on daily life vary. Severity levels help determine the treatment approach:
- Mild: The pain is tolerable. Patients can continue working or performing daily activities. The condition usually responds well to rest or general pain relievers.
- Moderate: Pain disrupts focus and activities, reducing work or study performance. This may require a temporary break or specific migraine medicine for relief.
- Severe: Pain prevents any daily activities. Patients need to rest motionless in a dark, quiet room. This level is often accompanied by nausea, vomiting, or extreme sensitivity to light and sound, requiring a longer recovery period.
Additional Migraine Observations
In addition to the headache and the stages of the condition, there are further observations that help indicate the specific characteristics of a migraine, as follows:
- Performing general daily activities, such as walking or climbing stairs, will worsen the headache.
- Symptoms will improve if resting still in a dark and cool room.
- Other accompanying symptoms found alongside the headache include nausea, vomiting, sensitivity to light, aversion to bright lights, and aversion to loud noises.
- To determine if a headache is caused by a migraine, it must be diagnosed by a specialist doctor for accuracy.
How to Differentiate Migraines from Other Headaches
Knowing how migraine symptoms differ from other conditions helps in providing clear information to a doctor.
- Tension-type Headache: Characterized by a tight, squeezing, band-like sensation across the forehead, temples, or back of the head. Pain is usually bilateral and constant rather than throbbing. It does not include nausea, vomiting, or sensitivity to light and sound.
- Cluster Headache: Severe, sudden pain, typically radiating deep behind one eye. Pain develops rapidly and occurs at the same time repeatedly. It may be accompanied by a red eye, tearing, swollen eyelid, and a runny nose on the affected side.
- Migraine: Characterized by a throbbing, pulsating pain aligned with the heartbeat. Mostly one-sided but can switch sides. Pain worsens with physical movement and is clearly accompanied by sensitivity to bright light, loud noises, nausea, or vomiting.
Initial Guidelines for Migraine Relief
When warning signs appear, immediate action provides migraine relief and aids recovery.
- Stop current activities: Cease tasks requiring intense visual focus, especially looking at computer or mobile phone screens. Avoid strenuous physical exertion.
- Rest in a suitable environment: Find a quiet, dimly lit, and cool room to rest or sleep. Bright lights and loud noises often aggravate the condition.
- Apply cold compresses: Place a cold gel pack or a clean cloth soaked in cold water gently on the forehead, temples, or back of the neck for 15 – 20 minutes. Cold application helps ease the pain and promotes relaxation.
- Stay hydrated: Sipping water consistently reduces dehydration risk, which is a known trigger for headache exacerbation.
- Take basic pain relievers: If the pain has just started, general pain medications like paracetamol can help control the symptoms.
Medical Migraine Treatments
A migraine is a chronic condition manageable with proper lifestyle adjustments and appropriate medications. Headache frequency often decreases with age. Migraine treatments fall into three categories:
1. Oral Medication
For acute attacks, doctors prescribe medication to be taken strictly when pain occurs, ideally immediately upon onset. This includes:
- Pain relievers like paracetamol.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen.
- Specific migraine medicine such as Triptans or Ergotamine-based drugs, which act on the nervous system and brain blood vessels by blocking pain signals from the trigeminal nerve and regulating blood vessel function.
- Oral CGRP receptor antagonists (Gepants): These block CGRP proteins that trigger migraines. They are used for acute relief and prevention (taken every other day) under medical supervision.
- Medications to reduce nausea and vomiting.
- Anti-inflammatory drugs for menstrual migraines (Triptans or NSAIDs), taken 2 – 3 days before menstruation and continued until 4 – 5 days after.
- Pain relievers for pregnancy, strictly under medical supervision.
- Antidepressants.
Note: All medications must be taken under medical guidance to prevent adverse physical effects.
Preventive migraine medicine: For frequent or severe attacks, doctors may prescribe daily preventive medication. Common options include:
- Anticonvulsants.
- Calcium channel blockers.
- Beta-blockers.
2. Injection Therapy
For patients with frequent, severe attacks that disrupt daily life or do not respond well to oral drugs, injection therapies offer an alternative to reduce attack frequency.
Anti-CGRP Injections
CGRP (Calcitonin Gene – Related Peptide) is a protein involved in pain signaling. Elevated CGRP levels trigger migraines. Injectable inhibitors are available as subcutaneous injections (preventive effect for roughly 1 month per dose) or intravenous infusions (preventive effect for roughly 3 months). This approach reduces the frequency, severity, and reliance on pain relievers. Must be administered under medical guidance.
Note: The use of all types of anti-CGRP medications must be under medical supervision.
Botulinum Toxin Injections
For chronic migraines (headaches occurring 15 or more days per month for over 3 months), doctors may consider Botulinum Toxin injections as a preventive treatment. It inhibits the release of neurotransmitters involved in pain signaling at nerve endings, reducing long-term attack frequency and severity, and decreasing the need for regular pain relievers.
3. Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) utilizes a high-powered magnetic field generator to stimulate specific brain areas responsible for the condition. Combined with lifestyle adjustments to avoid triggers, it helps reduce the frequency and severity of migraine attacks.
Migraine Prevention Guidelines
Without intervention, a headache can last from 4 – 72 hours. Understanding prevention is vital for quality of life.
- Avoid environments that induce headaches, such as bright lights, loud noises, strong odors, or PM2.5 pollution.
- Identify and avoid personal triggers.
- Get adequate, consistent sleep daily.
- Exercise regularly without overexertion.
- Avoid smoking, as it increases the risk of ischemic stroke.
- Avoid caffeinated beverages like coffee, tea, sodas, and energy drinks.
- Individuals needing oral contraceptives must consult a doctor first.
- Consult a physician immediately if headache severity increases or characteristics change.
Specialists for Migraine Management
Dr. Chakorn Chansakul, Neurologist at Bangkok International Hospital.
Click here to schedule an appointment.
Hospital Care for Migraine in Thailand
Bangkok International Hospital is prepared to identify causes, treat, and prevent migraines. With neurologists, nurses, healthcare professionals, and current medical technologies, the facility focuses on reducing severity and helping patients return to their normal lives. Managing a migraine in Thailand is supported by structured medical protocols at our Brain and Bone Center.
Summary
Migraines are common headaches caused by neurological sensitivity, neurotransmitter release, and blood vessel changes, resulting in severe pain. Frequent symptoms include throbbing pain, unilateral pain, nausea, and vomiting. Triggers involve stress, certain foods, and inadequate rest. Management involves pain relievers, preventive medications, and lifestyle modifications like avoiding triggers, sleeping sufficiently, and exercising appropriately.
Frequently Asked Questions
1. How severe does a migraine need to be to see a doctor?
If you experience sudden severe pain, an unfamiliar type of headache, or accompanying neurological abnormalities like limb weakness, body numbness, or slurred speech, seek medical attention immediately.
2. Can migraines go away entirely?
Currently, migraines are a chronic condition and do not disappear completely. However, patients can control the severity and reduce the frequency of attacks with appropriate medication and by avoiding triggers.
3. What foods trigger migraines?
Common dietary triggers include caffeinated drinks, alcohol (such as red wine), cheese, processed meats, and foods containing MSG or artificial sweeteners.
4. Can pregnant women take migraine medication?
Pregnant women must not buy and take medications on their own. If experiencing a headache, they should consult a physician for assessment and to receive medications that will not negatively impact fetal development.
