What is a migraine?

Migraines are very complex conditions involving the immune system, the gastrointestinal (digestive) system, the endocrine (hormonal) system and the nervous system.

Headaches are just one of many symptoms someone can experience.

They affect women three times more than men, starting with the hormonal changes of puberty.

Triggers

Research is pointing to genetics as the cause of migraines, but attacks are caused by triggers. 

Triggers vary greatly, commonly including:

• foods high in tyramine
• fermented foods
• alcohol
• caffeine
• stress
• disturbed sleep
• and eating patterns. 

Triggers are contentious because some of them may simply be cravings in response to changes in blood sugars and hormones, but wrongfully blamed as a trigger. Research is also pointing to attacks being triggered by multiple triggers acting at the same time.

Symptoms

The prodrome that precedes an attack commonly involves:

• fatigue
• yawning
• difficulty concentrating
• mood changes
• neck pain

The above usually starts about 24 hours before an attack, but may persist during the attack. 

Some people also experience red eyes, tearing, congested sinuses or runny nose. This is because the face, eyes, nose, sinuses and jaw share innervation of the trigeminal nerve with the meninges around the brain, which becomes inflamed during an attack.

Migraine attacks

The migraine attack commonly includes a severe headache to one side of the head. The nervous system is hypersensitive during the attack, causing aversion to bright light and loud sounds. The severity will often cause someone to seek a quiet dark place to lie down, and stop them from daily activities such as work. There may also be intense nausea and vomiting.

The attack lasts up to 72 hours (or longer). Once the attack subsides there may be a postdrome, which feels like a hangover.

This is a common pattern for the most common migraine (migraine without aura). Some people experience aura symptoms during the prodrome, or even alongside the attack.

The aura symptoms persist longer than 5 minutes and can include visual disturbances, such as:

• flashing lights or blind spots
• sudden onset of numbness or tingling to the face or limbs
• speech or language disturbances.

Importantly, these symptoms are temporary and reversible.

Treatment options

Evidence-based treatment options include:

• pharmaceutical medications, but most are only moderately effective, at best;
• dietary and nutritional interventions;
• manual treatments, such as chiropractic, osteopathy, and myotherapy and massage;
• specific exercises;
• herbal medicine; and
• cognitive and mindfulness-based psychological interventions.