Migraine is a complex neurological disease. While there are many different types of headache disorders, migraine is not just another headache. What makes migraine complex is its connection to genetics, environment, and the social stigma that surrounds this type of headache.
According to the American Migraine Foundation, migraine is a neurological disease that impacts approximately 39 million people in the United States. The current best estimates are that migraine accounts for 4.9% of the global population's ill health (Steiner & Stovner). The American Headache Society estimates the current burden of migraine likely exceeds $28 billion healthcare dollars in the United States.
The Cleveland Clinic defines migraine as a type of headache that "causes throbbing, pulsing head pain on one side of your head. The headache phase of a migraine usually lasts at least four hours, but it can also last for days."
Migraine impacts females three times more than males.
Signs & Symptoms
While migraine affects everyone differently, some common descriptions are associated with a migraine headache. These are some of the more common signs and symptoms of a migraine attack:
Pounding or pulsating on one side of the head ("hemiplegia")
Photophobia (sensitivity to light)
Hyperacusis (sensitivity to sounds)
Osmophobia (sensitivity to smells)
Nausea and/or vomiting
Phases of a Migraine Headache
There are four phases to a migraine attack. But take note that not every person experiences every phase.
Prodrome - The first phase of a migraine. This phase can occur up to 24 hours prior to the migraine attack. You may experience subtle changes that warn of an upcoming migraine. "Warning signs"' include, but are not limited to constipation, mood changes (ranging from depression to euphoria), food cravings, neck stiffness, increased thirst and urination, or frequent yawning.
Aura - a visual or sensory disturbance acting as a warning signal.
Attack - the active phase of the migraine that lasts 4 to 72 hours.
Post-drome - the final stage after the attack, lasting 4 to 48 hours. This is also the recovery phase where the individual may feel energetically drained with brain-fog. This phase is also known as a "migraine hangover."
Migraine With or Without Aura
With aura is a classic migraine. An aura is a visual or other sensory disturbance that occurs before a migraine attack. It's the body's warning signal that a migraine is pending. Sometimes the aura and the migraine occur simultaneously.
Without aura is a common migraine. Not everyone experiences an aura or sensory disturbance.
Types of Migraine Headaches
Hemiplegic migraine - a rare type of migraine that happens with one-sided muscle weakness (which can mimic a stroke).
Menstrual migraine - a common migraine in women that starts at the onset of the menstrual cycle (during PMS), and typically ends when the menstrual cycle begins and hormone levels begin to rise.
Silent migraines (migraine without headache) - having the signs and symptoms of a migraine without the head pain.
Ocular migraine - attacks of visual disturbances affecting only one eye with a migraine headache. You may experience pain or pressure in the center of the eyeball.
Status Migranosis - A migraine attack lasting longer than 72 hours (also intractable migraine)
Abdominal Migraines (often associated with migraine in children) - experiencing moderate to severe abdominal (belly) pain lasting anywhere from one to 72 hours. The condition is related to migraine a headache, but is absent of head pain. This type of migraine is commonly seen in children.
Vestibular migraine - a person may experience a combination of vestibular attacks, visual aura, or sensitivity to visual stimulation and motion at different times, and they can occur with or without an actual headache. The person experiencing a vestibular migraine has dizziness, sensitivity to motion, and unsteadiness or loss of coordination and balance.
3 Different Classifications of Migraine
Episodic - when a person experiences up to fourteen migraine attacks per month
Chronic - when a person experiences fifteen or more migraine attacks per month
Intractable - a migraine lasting longer than 72 hours, with no relief from any therapeutic or pharmacologic interventions.
If you have experienced anything mentioned in this article, talk to a healthcare provider to determine if you are having migraine headaches, and what treatment options are available to you.
References:
Steiner, T.J., Stovner, L.J. Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol 19, 109–117 (2023). https://doi.org/10.1038/s41582-022-00763-1
https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/migraine-headaches
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