The Basics of Migraines


Migraine HeadacheMigraine headache causes intense throbbing or pulsing pain in one area of the head. This type of headache is usually accompanied by nausea, vomiting, and sensitivity to sound and light. Migraine attacks often lead to pain that persists for hours and even days. Some migraine patients experience aura, which is sensory warning symptoms that occur immediately before the onset of pain. These symptoms include blind spots, flashes of light, and/or tingling sensations of the arm and/or leg.


In the U.S., more than 30 million people report one or more migraine headaches per year. Females suffer with migraines more than males, with a rate of 18% for women compared to 6% for men. In addition, migraine appears to affect whites more than African Americans and Asian Americans. According to the World Health Organization, global prevalence of migraine is around 10%, with higher rates occurring in North America.


Symptoms of Migraine Headache


Symptoms are broken down into four categories, which occur in phases: prodrome, aura, attack, and postdrome.


  • Prodrome – These occur one or two days before the migraine and include irritability, constipation, depression, hyperactivity, food cravings, yawning, and neck stiffness.Migraine headaches
  • Aura – These include vision loss, visual phenomena, speech problems, and tingling of the arm or leg.
  • Attack – This involves the actual pain, which can last from 4 to 72 hours. Symptoms include pulsating/throbbing pain on one or both sides of the head, sensitivity to light and sound, blurred vision, nausea, vomiting, lightheadedness, and/or fainting.
  • Postdrome – After the migraine attack, the patient feels drained, fatigued, and mildly euphoric.


Cause of Migraines


The exact cause of migraine is not known, but experts believe these headaches are related to changes in the brainstem and interaction of the brainstem with the trigeminal nerve. In addition, there is often an imbalance of serotonin, which is the brain chemical that regulates pain in the nervous system.


Migraine Triggers


Several things appear to trigger the onset of a migraine headache. These triggers vary from patient to patient and include:


  • Hormonal changes – Fluctuations in estrogen, with women reporting headaches right before or during the menstrual period. Some women have migraines during pregnancy or menopause. Additionally, oral contraceptives and hormone replacement therapy often worsen migraines.
  • Certain foods – These include aged cheeses, processed foods, and salty foods. In addition, food additives (aspartame and monosodium glutamate).
  • Certain drinks – This includes alcohol (wine and beer), as well as caffeinated beverages.
  • Stress – Work or home-related stress increases the risk of migraines.
    Sleep-wake pattern changes – Getting too much or too little sleep.
  • Sensory stimuli – Sun glare, bright lights, unusual smells, and loud noises.

Medications for Migraine Headaches


There is no cure for migraine headaches for people who suffer with them chronically. The goal of treatment is to reduce the frequency of the headaches and to alleviate symptoms. The types of medicines used include:


  • Preventive medicine – These drugs prevent the occurrence of the migraine headaches.
  • Pain medicine – These drugs eliminate or reduce pain when a migraine occurs.
  • Migraine medicine – These drugs prevent the migraine if taken as soon as the headache begins.
  • Anti-nausea medicine – These drugs prevent vomiting and ease away nausea.


Treatment Options


  • Occipital nerve blocks – A nerve block is the injection of an anesthetic and steroid medication into the posterior region of the mouth, as the base of the nerve. These injections result in immediate relief of pain and can be performed two times a week for three weeks.Occipital Nerve Block


  • Sphenopalatine ganglion block – This involves an injection done through a catheter, which is inserted into the nose. The medication is inserted into the region of the sphenopalatine ganglion, which is a group of nerves.


  • Trigger point injections – To reduce the pain associated with migraine, an injection of an anesthetic is given into the facial fascia, the soft connective tissue that surrounds the muscle. This injection is safe and effective.


  • Botox – This medication has been approved for the treatment of chronic migraines. The injections are given to the forehead and temple region to paralyze the muscles which contract and are associated with migraine.




Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology. Mar 26 2002;58(6):885-94.

Mayo Clinic (2014). Migraine. Retrieved from:

Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D. Age- and sex-specific incidence rates of migraine with and without visual aura. Am J Epidemiol. Nov 15 1991;134(10):1111-20.