Migraine: Symptoms, Diagnosis, Treatments

What is a migraine? 

A migraine is a severe headache with throbbing pain on one side of the head. A migraine attack typically lasts four hours or longer and sometimes lasts days.

The headache worsens with triggers such as physical activity, movement, bright lights, loud noises, strong odours, and coughing or sneezing.Migraines are relatively common, affecting approximately 12 to 15% of the global population.

What is the difference between a cluster headache and migraines?

Cluster headaches and migraines are classified as primary headache disorders, meaning their symptoms arise directly from the condition rather than being caused by another underlying issue. There is some overlap in symptoms between cluster headaches and migraines, which can lead to confusion between the two conditions.

Cluster headache is significantly less common than migraine, with only around one in 1,000 individuals being affected by it. In contrast, migraine is highly prevalent, impacting approximately one in seven people.

Cluster headache typically begins in individuals in their 30s and 40s, although they can occur at any age. On the other hand, migraine can occur at any age. However, most people experience the first attack during adolescence. Cluster headache affects more men than women, whereas migraine is more prevalent in women than men.

Migraine headaches typically present as throbbing or pulsating pain frequently localised to one side of the head. Conversely, a cluster headache can occur suddenly and be characterised by sharp, piercing, or burning sensations. Although both types of headaches often affect one side of the head, cluster headaches tend to concentrate around or behind one eye.

Are migraines dangerous?

Migraines are not often dangerous, but they can significantly impair a person’s quality of life.

What are the types of migraine?

The two major types of migraine are:

• Migraine with aura (classic migraine): Comprises of visual disturbances and other neurological symptoms that start 10 to 60 minutes before the actual headache and usually wane after an hour. Additional symptoms include difficulty speaking, an abnormal sensation, numbness or muscle weakness on one side of the body, a tingling sensation in the hands or face, and confusion.

• Migraine without aura (common migraine): This is the most common type of migraine. Symptoms include sudden headache, pain on one side of the head, nausea, confusion, blurred vision, mood swings, fatigue, and heightened sensitivity to light, sound, or noise.

Other types of migraines include:

• Abdominal migraine: Affects young children and is characterised by moderate to severe abdominal pain that lasts for 2 to 72 hours, with little to no headache.

• Basilar-type migraine: Most often found in teenage girls and may be associated with their menstrual cycle.

• Hemiplegic migraine: A rare and severe type of migraine that produces temporary paralysis on one side of the body before or during a headache.

• Menstrual migraine: Affects women around the time of their menstruation.

• Migraine without headache: Symptoms include visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.

• Ophthalmoplegic migraine: An uncommon type of migraine with symptoms such as head pain, droopy eyelid, large pupil, and double vision.

• Retinal migraine: Includes visual loss or disturbances in one eye.

• Status migrainosus: A rare and severe type of acute migraine that can cause disabling pain and nausea that can last for 72 hours or longer.

What are the stages of migraine and their symptoms?

There are four stages of migraine and symptoms of migraine vary according to the stages.

1. Prodrome: Starts 24 to 48 hours before the onset of a headache.

   Symptoms:

   • Depression 
   • Irritability 
   • A feeling of euphoria
   • Food cravings
   • Constipation
   • Neck stiffness
   • Trouble concentrating
   • Fatigue
2. Aura: The aura phase may last from 5 to 60 minutes.

   Symptoms:

   • Flashing lights or bright spots
   • Zigzag lines
   • Vision changes
   • Changes in vision
   • Numbness or tingling in the fingers of one hand, lips, tongue, or lower face
3. Headache: A migraine headache can persist from 4 to 72 hours. 

   Symptoms:

   • Intense headache affecting one side of the head or both
   • Nausea and vomiting
   • Light, sound, and odour sensitivity
   • Sensitive to touch
4. Postdrome: This phase often lasts between a few hours and 48 hours.

   Symptoms:

   • Fatigue
   • Stiff neck
   • Depressed or euphoric mood
   • Difficulty concentrating
   • Nausea

What are the causes of migraine?

The exact causes of migraines are not known. However, if a person has a family history of the disorder, he/she is more likely to be triggered.

Certain triggers can cause migraines, such as:

• Stress and tiredness.
• Hormonal changes (for example, at the start of a menstrual period).
• Certain medications.
• Changes to sleeping pattern.
• Anxiety and depression.
• Weather condition changes.
• Too much physical activity (overexertion) or not getting enough.
• Addictive substances (for example, caffeine or tobacco).
• Missing a meal or not eating regularly.
• Exposure to bright lights, loud noises or strong odours.

How is a migraine diagnosed?

A migraine is diagnosed based on medical history, physical exam, and neurological exam results.The following tests may be performed:

• Blood tests 
• Imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI)
• Electroencephalogram (EEG)

How is a migraine treated?

While there is no cure for migraines, you can manage its symptoms using the following:

Medications

• Acute treatment for migraines involves medications taken at the onset of an attack to alleviate pain and symptoms immediately. Preventive treatment involves medications taken regularly, typically daily, to reduce the frequency and severity of future migraine episodes.

• Medications to stop migraines such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, ergots, and antiemetics.

• Medications to prevent migraines such as antiseizure medications, beta-blockers, antidepressants and calcium channel blockers

Lifestyle changes 

• Avoidance of migraine triggers.
• Eating at regular times and consuming less caffeine.
• Relaxation activities such as yoga.
• Regular exercise.
• Good sleep hygiene.

When should I see a doctor for a migraine?

You should consult your doctor if your migraines are:

• Severe.
• Interfere with your daily activities.
• Frequent, especially if they occur more than a couple of times a month.
• Worsening over time or do not respond to over-the-counter medications.

Make an appointment at Pantai Hospitals

A migraine is not the same as a typical headache. Treatment options are available to manage migraines and improve your quality of life. Take the first step and consult a neurologist to explore treatment options tailored to your needs. 

A dedicated and expert team of neurologists at Pantai Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding your health.

Please contact the Health Screening Centre at your nearest Pantai Hospital for health screening appointments.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.