Migraine

A migraine is a type of headache characterized by intense throbbing and pulsating pain that can last for a few hours or several days. Migraines are usually more painful on one side of your head, but can occur throughout the head, neck, or face. It’s a genetic neurological disorder that can affect people of all ages—children, teenagers, and adults. 

A migraine is treated by a doctor who specializes in neurological disorders called a neurologist. Penn Medicine's neurologists are among the leading headache and migraine care providers in the Philadelphia region. 

The most common migraine symptom is a painful headache anywhere in the head or face. However, migraines typically have four stages, and patients experience different symptoms at each stage. 

• Prodrome: Sometimes called a preheadache, this stage can last for a few hours or several days. Symptoms include changes in your mood, constipation, fatigue, food cravings, increased urination, increased yawning, nausea, stiff neck, or swelling due to fluid retention. 
• Aura: In this stage, you may experience problems speaking, tingling in an arm or leg, weakness or numbness in the face or one side of the body, and vision changes including blurred vision, bright spots, flashes of light, shapes, or vision loss. This stage usually lasts up to an hour before the headache begins. 
• Headache: During this stage, you may experience throbbing pain, chills or sweating, dizziness, loss of appetite, nausea, vomiting, and sensitivity to light, smells, sound, and touch. Migraine pain can last a few hours or several days without treatment. 
• Post-drome: Sometimes referred to as a migraine hangover, you may feel confused, drained, happy, or energized. This stage can last a day or two. 

Note that not everyone will experience every stage the same way. 

Experts don’t fully understand what causes migraines. When you feel pain from a headache, it’s the result of nerves in your blood vessels sending pain signals to your brain. These signals cause inflammation, but it’s unknown why the nerves react that way. 

Migraine triggers 

There might not always be a trigger for your migraine. However, there are several factors that can trigger them, including: 

• Alcohol 
• Bright or flashing lights 
• Caffeine  
• Dehydration 
• Estrogen fluctuations 
• Grinding your teeth 
• Hormonal medications 
• Hunger 
• Menstruation 
• Physical exertion 
• Sleep changes 
• Stressful events 
• Strong smells 
• Weather changes 

There are several types of migraines. Some of the most common include: 

• Classic migraine: A migraine with aura, it's accompanied by disruptions in vision that can include wavy, flashing lights and vision loss. It may also include sensory symptoms like tingling in a limb.
• Common migraine: A migraine without aura, patients experience moderate to severe pain that gets worse with physical activity. In addition, some people have nausea and vomiting and may feel worse around light and sound. This type of migraine can last between four and 72 hours if it’s not treated.
• Abdominal migraine: Occurring more often in children, the symptoms of this type of migraine include moderate to severe pain in the abdomen, vomiting, and dizziness, and may occur about once a month. Typically, patients don’t experience a headache.
• Hemiplegic migraine: A severe form of migraine, it can cause temporary paralysis that may last several days. Other symptoms include problems seeing, speaking, or swallowing, and vertigo. This condition can run in families, called familial hemiplegic migraine.
• Menstrual migraine: Some women have migraines around their menstrual cycle. These occur a few days before, during, or right after their period. The symptoms are the same as those of common or classic migraines.
• Migraine equivalent: A migraine aura that isn’t followed by a headache, it often happens after age 50 to people who had migraines when they were younger. The symptoms include streaks or points of light moving across your field of vision.
• Ocular migraine: Also known as retinal migraine, it creates visual issues in one eye, such as an aura that changes from light to dark or a blind spot. The issue is temporary and will go away when the headache recedes.
• Silent migraine: A migraine without head pain, it may include aura symptoms but without the headache that usually accompanies it.
• Vestibular migraine: In addition to headache symptoms like throbbing on one side of the head, nausea, and vomiting, it also includes dizziness, loss of balance, and sensitivity to motion. 

Taking proactive steps in managing your migraines can potentially decrease their frequency and help in controlling their severity. For example: 

• Aim for 8 hours of sleep every night 
• Drink water regularly 
• Eat on a regular schedule 
• Exercise most days of the week 
• Keep a migraine diary 
• Learn techniques to manage stress 
• Maintain a healthy weight 
• Take medications as prescribed 

At Penn Medicine, our mission is to guide our migraine patients through every phase of their medical journey. We’re dedicated to relieving your pain with treatment that is right for you.