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Migraine lasting: Symptoms, Causes, Diagnosis, Treatment, and Prevention


How Long Will My Migraine Attack Last?

An estimated 39 million Americans have migraine, with symptoms that can range from mild to severe, according to the Migraine Research Foundation. Migraine attacks previously were thought to be a result of abnormal dilation of blood vessels in the brain, but scientists now believe that the cause may be more complex and involve inherited differences in brain chemistry.

Women are much more likely than men to have migraine, as are people with a family history of migraine, according to the Migraine Research Foundation.

But not all migraine attacks are alike, and not everyone has the same migraine symptoms, says neurologist Alexander Mauskop, MD, a founder and director of the New York Headache Center in Manhattan and White Plains, New York.

The length of time a migraine attack lasts can vary, too. The National Headache Foundation says most migraine attacks last 4 to 72 hours. “But some people have migraines for a shorter time and some people have them for longer — it’s very individual,” Dr. Mauskop says.

Phases of a Migraine Attack

Often a migraine attack involves distinct phases, though people can experience them differently, says Roderick Spears, MD, a neurologist and headache specialist at Penn Medicine in Philadelphia.

Prodrome Phase This first phase of migraine can occur hours to days prior to the attack, says Dr. Spears. “It typically involves a change in mood and energy; certain cravings or excessive yawning can be a sign of prodrome,” he says.

People sometimes confuse these prodrome, or “premonitory,” symptoms, with migraine triggers. That’s to say, a person who craves chocolate as a prodrome symptom may mistakenly believe that consuming chocolate triggered the migraine attack, according to MigraineAgain.

Aura About 25 to 35 percent of people with migraine have aura, says Spears. “The most common aura is a visual change with a kaleidoscope-like phenomenon that can last anywhere from five minutes to an hour but usually much less than an hour,” he says. Other aura symptoms may include tingling sensations, numbness, garbled speech, and clumsiness or weakness.

Headache Phase “This stage can last 4 to 72 hours, and in most patients, it’s marked by a headache on one side of the head that’s throbbing and pulsating in quality. Typically, the pain is described as moderate to severe,” says Spears.

The headache phase is also associated with becoming sensitive to the environment, he adds. “Light, sound, and odor sensitivity are common, as are nausea and vomiting,” he says.

A survey of 1,100 U.S. adults with migraine published online in May 2020 in Headache found that 44 percent of people reported that the headache or attack phase of migraine lasts for up to 24 hours, while one-third said it can persist for more than 24 hours.  

Postdrome or Recovery Phase This phase — where there’s no pain or very mild pain, but people don’t feel normal — can last 24 to 48 hours, says Spears. “They’re not as sharp cognitively, and they can feel ‘hungover,’” he says.

“There are also some people who feel elated — almost euphoric — because they don’t have the pain anymore, and they’re full of energy, even verging on hyper,” he says.

RELATED: Survey Shows Migraine Sneaks Up and Sticks Around for 95 Percent of People Who Have It

How to Shorten Your Migraine Attack

If you recognize the signs that a migraine attack may be coming on, you may be able to reduce the amount of time it lasts, says Spears. “Often the person with migraine doesn’t always recognize the prodrome phase, but someone close to them — a spouse or family member — may pick up on it,” he says.

Spears offers a few tips to potentially reduce the length of your migraine attack:

  • Aggressively hydrate. Drinking a lot of water is usually helpful.
  • Limit your physical activity. If possible, sit or lie down somewhere.
  • Avoid stimulating environments. Go to a dark, quiet place.

Some people find that relaxation techniques, such as meditation or massage, will help release the tension they feel in their face, jaw, or neck. If you can release tension with these techniques, your migraine attack may not be as severe or last as long. Others find that putting a cold compress on their temples will help relieve their migraine symptoms and keep their migraine from lasting as long, Mauskop says.

Acute Drug Treatment to Stop a Migraine Attack

There are several different medication options for treating a migraine attack once it’s begun. The type of migraine you have as well as the frequency and severity of your attacks is something you should discuss with your doctor when developing a treatment plan.

For people with mild to moderate symptoms, over-the-counter medications are often sufficient to relieve them, according to the American Migraine Foundation. These include:

Your doctor may also prescribe any of a number of drugs for acute treatment of migraine. Generally speaking, acute migraine treatments work better the earlier in the attack you take them, before the pain has gotten severe. Triptans are the most commonly used acute migraine medications, and gepants and ditans are two new classes of migraine drugs that may be helpful if you can’t take triptans or are not helped by them.


There are seven different triptan drugs, of which sumatriptan (sold as Alsuma, Imitrex, Onzetra, Zembrace, and Treximet, which is a combination of sumatriptan and naproxen) is probably the best known. All of the triptans are available as pills, two as nasal sprays or powders, and one as a self-administered injection.

Most triptans start relieving pain in 30 to 60 minutes, although two longer-acting triptans, Amerge (naratriptan) and Frova (frovatriptan), take one to three hours and about two hours, respectively, to start working. Many people report being pain-free within two hours of taking a faster-acting triptan, according to MigraineAgain.

If migraine pain recurs within 24 hours of taking a triptan, a second dose may be needed. But migraine recurrence may be an indication that a different triptan or different dose of the one you’re taking may work better for you, according to Eric Baron, DO, writing for Virtual Headache Specialist.

Because one of the effects of triptans is to narrow blood vessels in the brain, these medications should not be used by people with coronary artery disease, a history of stroke, peripheral vascular disease, or uncontrolled high blood pressure. Women who are pregnant or planning to become pregnant should discuss the relative risks and benefits of using triptans during pregnancy, according to John Rothrock, MD, and Deborah Friedman, MD, writing for the American Headache Society (PDF).


A new class of migraine drugs called calcitonin gene-related peptide (CGRP) receptor antagonists may be an alternative for people who can’t use triptans because of vascular disease, because they do not narrow the blood vessels. CGRP receptor antagonists are also sometimes called “gepants” because of how the drugs in this class are named: Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant).

According to Spears, “These medications target a different neurotransmitter pathway than triptans.”

Both Nurtec and Ubrelvy begin reducing migraine pain within 60 minutes. In studies, 20 percent of participants who took either drug reported being pain-free after two hours, and 35 percent of those who took Nurtec ODT and 34 percent of those who took Ubrelvy reported being free of their “most bothersome symptoms,” such as nausea, sensitivity to light, and sensitivity to sound, in that time.

However, the drugs can also cause nausea, as well as sleepiness, as a side effect.

Data on Nurtec ODT was published online on July 13, 2019, in The Lancet, while data on Ubrelvy was published online on November 19, 2019, in The Journal of the American Medical Association.


Reyvow (lasmiditan) belongs to a new class of headache medication called selective 5-HT(1F) receptor agonists, or ditans, for short. The drug binds to a particular type of serotonin receptor found on the trigeminal nerves, according to the American Headache Society. It does not constrict blood vessels and may therefore be another alternative for people who can’t use triptans because of vascular disease.

Reyvow is available as a tablet in three dose sizes. In research published on July 24, 2019, in The Journal of Headache and Pain, about 30 percent of people who took Reyvow reported that their pain and their most bothersome migraine symptom had resolved two hours after treatment.

No more than one dose of Reyvow should be taken in 24 hours, and people should not drive or operate machinery for eight hours after taking Reyvow. Common side effects include dizziness, fatigue, abnormal skin sensations (such as tingling or numbness), and sleepiness, according to RxList.

Other Acute Migraine Treatment Options

In addition to the drugs mentioned above, other options for acute migraine relief include the prescription NSAID Voltaren (diclofenac); a class of drugs called ergots, which are sometimes used in people who don’t respond to triptans; and a variety of neurostimulation devices that deliver magnetic or electric pulses to specific nerves involved in migraine.

If the combination of drugs and home remedies you’re using to stop migraine attacks isn’t working, speak to your doctor about other treatment possibilities.

RELATED: How to Get Rid of a Headache or Migraine Attack Fast

The Danger of Using Acute Migraine Medication Too Often

When people with migraine use acute medication too often, they can develop medication-overuse headache, according to the American Migraine Foundation. These headaches are also known as rebound headaches.

The risk of medication-overuse headaches can put people with migraine in a difficult position, says Spears. “Migraine is a condition where the sooner you treat it with medication, the more likely it is that you’ll be successful in stopping it. At the same time, if you take your rescue medication too frequently, it will lead to rebound,” he says.

Most of the medications commonly used to treat migraine attacks, such as aspirin, NSAIDs, acetaminophen, triptans, and others, have all been associated with rebound headaches, according to the American Migraine Foundation. It’s recommended that people don’t take these medications for acute treatment of migraine for more than two days a week.

The one class that hasn’t been shown to cause medication-overuse headache is gepants, says Spears. But “we still try to limit patients to using them two days a week,” he says.

What If a Migraine Attack Lasts 3 Days or More?

A debilitating migraine attack that lasts longer than 72 hours and doesn’t respond to normal treatment is called status migrainosus, or intractable migraine.

It can be more medically serious than a normal migraine attack, especially if symptoms such as vomiting are prolonged, due to the risk for severe dehydration, according to the National Headache Foundation.

Status migrainosus is what brings many people to the hospital emergency department, where a variety of IV drugs may be administered to break the pain cycle.

Could My Migraine Attack Be a Symptom of COVID-19?

“We are still learning about migraine and COVID-19,” says Spears. “We do know that the COVID-19 headache usually presents differently than a typical headache. It’s been described as intense pressure in the head that is made significantly worse with coughing and sneezing,” he says.

Is it true that people with migraine are more likely to experience headache as a symptom of COVID-19? There isn’t enough data to know if that’s the case with COVID-19, but it is true in many other conditions, says Spears.

“If someone has migraine and they develop a sinus infection, they’re more likely to develop a migraine-like headache. When people with migraine have anything going on that’s head- or neck-related, they’re more likely to experience a migraine-like headache,” he says.

This also applies in people with migraine who also have diabetes or high blood pressure, says Spears. “If something is going on in the entire body or systemically, they’re more likely to manifest that in migraine-like headache if they have a history of migraine,” he says.

Related: A Guide to Living With Migraine During the COVID-19 Pandemic

Preventing Future Migraine Attacks

In addition to there being medication that can stop a migraine attack in progress, there are also drugs that can be taken for migraine prophylaxis, or preventive therapy, as a way to reduce the frequency and severity of migraine attacks.

Preventive migraine treatments include prescription medications that were originally developed for epilepsy, depression, or high blood pressure — these can often prevent future attacks, Mauskop says. They also include a newer class of drugs called CGRP antibodies that were developed specifically to treat migraine.

Women whose migraines are associated with their menstrual cycles may find relief through taking certain types of hormonal birth control or hormone replacement therapy, although in some cases, these options can make migraine worse, according to the American Migraine Foundation.

Many people do get migraine relief from various treatments. “However, if your headaches persist or they last a long time, you should seek medical help from a neurologist or headache specialist,” says Mauskop. “You shouldn’t self-treat migraines if they are unusually long or you’re having them for the first time.”

Additional reporting by Beth Orenstein.

Migraine – Symptoms and causes


A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.

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Migraines, which affect children and teenagers as well as adults, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.


One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

  • Constipation
  • Mood changes, from depression to euphoria
  • Food cravings
  • Neck stiffness
  • Increased urination
  • Fluid retention
  • Frequent yawning


For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes.

Examples of migraine auras include:

  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Weakness or numbness in the face or one side of the body
  • Difficulty speaking


A migraine usually lasts from 4 to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

  • Pain usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound, and sometimes smell and touch
  • Nausea and vomiting


After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

When to see a doctor

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke
  • Headache after a head injury
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain after age 50


Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are a number of migraine triggers, including:

  • Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.

    Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.

  • Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
  • Stress. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
  • Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
  • Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
  • Weather changes. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
  • Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Risk factors

Several factors make you more prone to having migraines, including:

  • Family history. If you have a family member with migraines, then you have a good chance of developing them too.
  • Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
  • Sex. Women are three times more likely than men to have migraines.
  • Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.


Taking painkillers too often can trigger serious medication-overuse headaches. The risk seems to be highest with aspirin, acetaminophen and caffeine combinations. Overuse headaches may also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days a month.

Medication-overuse headaches occur when medications stop relieving pain and begin to cause headaches. You then use more pain medication, which continues the cycle.

What are the stages of a migraine?

Speaking of Health

The Migraine Research Foundation says that migraine is a neurological disease that affects 39 million people in the U.S. Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.

Learn more about each stage of a migraine:

1. Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including constipation, mood changes from depression to euphoria, food cravings, neck stiffness, increased thirst and urination or frequent yawning.

2. Aura

For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual, but they also can include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts 20 minutes to one hour.

Examples of auras include:
  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • “Pins-and-needles” sensations in an arm or leg
  • Weakness or numbness in the face, or one side of the body
  • Difficulty speaking
  • Hearing noises or music
  • Uncontrollable jerking or other movements
3. Attack

A migraine usually lasts from four to 72 hours if untreated, and the frequency varies by the person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:
  • Pain, usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound, and sometimes smell and touch
  • Nausea and vomiting


After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on pain again briefly.

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraines, keep a record of your attacks and how you treated them. Then make an appointment with your health care provider to discuss your headaches.

Learn more about headaches:

Nancy Erickson, M.D., is a Family Medicine physician in Onalaska, Wisconsin.

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

Migraine – NHS

A migraine is usually a moderate or severe headache felt as a throbbing pain on 1 side of the head.

Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood.

There are several types of migraine, including:

  • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
  • migraine without aura – the most common type, where the migraine happens without the specific warning signs
  • migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop

Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally.

It’s possible for years to pass between migraine attacks.

When to get medical advice

You should see a GP if you have frequent or severe migraine symptoms.

Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicines, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you’re with experiences:

  • paralysis or weakness in 1 or both arms or 1 side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a severe pain unlike anything experienced before
  • headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

Causes of migraines

The exact cause of migraines is unknown, although they’re thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain.

Around half of all people who experience migraines also have a close relative with the condition, suggesting that genes may play a role.

Some people find migraine attacks are associated with certain triggers, which can include:

  • starting their period
  • stress
  • tiredness
  • certain foods or drinks

Treating migraines

There’s no cure for migraines, but a number of treatments are available to help reduce the symptoms.

These include:

  • painkillers – including over-the-counter medicines like paracetamol and ibuprofen
  • triptans – medicines that can help reverse the changes in the brain that may cause migraines
  • anti-emetics – medicines often used to help relieve people’s feeling of sickness (nausea) or being sick

During an attack, many people find that sleeping or lying in a darkened room can also help.

Preventing migraines

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks.

Medicines used to prevent migraines include the anti-seizure medicine topiramate and a medicine called propranolol that’s usually used to treat high blood pressure. 

It may take several weeks before your migraine symptoms begin to improve.


Migraines can severely affect your quality of life and stop you carrying out your normal daily activities.

Some people find they need to stay in bed for days at a time.

But a number of effective treatments are available to reduce the symptoms and prevent further attacks.

Migraine attacks can sometimes get worse over time, but they tend to gradually improve over many years for most people.

Page last reviewed: 10 May 2019
Next review due: 10 May 2022

Migraine Headache – StatPearls – NCBI Bookshelf

Continuing Education Activity

Migraine is a genetically influenced complex disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. This activity reviews the evaluation and treatment of migraine and highlights the role of the interprofessional team in evaluating and treating patients with this condition.


  • Identify the etiology of migraine headache medical conditions and emergencies.

  • Review appropriate evaluation of a migraine headache.

  • Outline the management options available for migraine headaches.

  • Describe interprofessional team strategies for improving care coordination and communication to advance migraine headaches and improve outcomes.

Access free multiple choice questions on this topic.


Migraine is a genetically influenced complex disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and increased sensitivity to light and sound. The word migraine is derived from the Greek word “hemikrania,” which later was converted into Latin as “hemigranea.” The French translation of such a term is “migraine.”[1] Migraine is a common cause of disability and loss of work. Migraine attacks are a complex brain event that unfolds over hours to days, in a recurrent matter. The most common type of migraine is without aura (75% of cases).

Migraine can be classified into subtypes, according to the headache classification committee of the International Headache Society:[2]

  • Migraine without aura is a recurrent headache attack of 4 to 72 hours; typically unilateral in location, pulsating in quality, moderate to severe in intensity, aggravated by physical activity, and associated with nausea and light and sound sensitivity (photophobia and phonophobia).

  • Migraine with aura has recurrent fully reversible attacks, lasting minutes, typically one or more of these unilateral symptoms: visual, sensory, speech and language, motor, brainstem, and retinal, usually followed by headache and migraine symptoms.

  • Chronic migraine is a headache that occurs on 15 or more days in a month for more than three months and has migraine features on at least eight or more days in a month.

  • Complications of migraine

    • Status migrainosus is a debilitating migraine attack that lasts more than 72 hours.

    • Persistent aura without infarction is an aura that persists for more than one week without evidence of infarction on neuroimaging.

    • Migrainous infarction is one or more aura symptoms associated with brain ischemia on neuroimaging during a typical migraine attack.

    • Migraine aura-triggered seizure occurs during an attack of migraine with aura, and a seizure is triggered. 


Genetics and Inheritance

Migraine has a strong genetic component. The risk of migraines in ill relatives is three times greater than that of relatives of non-ill subjects, but there has not been any pattern of inheritance identified.[3][4] The genetic basis of migraine is complex, and it is uncertain which loci and genes are the ones implicated in the pathogenesis; it may be based on more than one genetic source at different genomic locations acting in tandem with environmental factors to bring susceptibility and the characteristics of the disease in such individuals.[5] The identification of these genes in an individual with migraines could predict the targeted prophylactic treatment.

Familial Hemiplegic Migraine


Melas is a syndrome of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes.

a multisystemic disorder by maternal inheritance that can present recurrent migraine headaches.[12]


Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) angiopathy by autosomal dominant inheritance, caused by mutations in the NOTCh4 gene (notch receptor 3) on chromosome 19 that can present migraine with aura (prodrome in 80%) in nearly 50% of carriers.[13]


Retinal vasculopathy with cerebral leukodystrophy is angiopathy by C-terminal frame-shift mutations in TREX1 (three prime repair exonuclease 1) presents almost 60% of the cases.[14]


Hereditary infantile hemiparesis, retinal arteriolar tortuosity, and leukoencephalopathy


Hereditary endotheliopathy with retinopathy, nephropathy, and stroke


Withdrawn or exposed to several factors contribute to the development of migraine headaches.[15] A retrospective study found that 76% of the patients reported triggers.[16] Some of them are probable factors that contribute, while others are only possible or unproven factors.

  • Stress in 80% (probable factor)

  • Hormonal changes in 65% during menstruation, ovulation, and pregnancy (probable factor)

  • Skipped meals 57% (probable factor)

  • Weather changes in 53% (probable factor)

  • Excessive or insufficient sleep in 50% (possible factor)

  • Odors in 40% (perfumes, colognes, petroleum distillates)

  • Neck pain in 38%

  • Exposure to lights in 38% (probable factor)

  • Alcohol ingestion in 38% (wine as a probable factor)

  • Smoking in 36% (unproven factor)

  • Late sleeping in 32%

  • Heat in 30%

  • Food in 27% (aspartame as a possible factor, and tyramine and chocolate as unproven factors)

  • Exercise in 22%

  • Sexual activity in 5%


Migraine is highly prevalent, affecting 12% of the population, attacking up to 17% of women and 6% of men each year.[17][18][19] The adjusted prevalence of migraine is highest in North America, followed by South America, Central America, Europe, Asia, and Africa. It is ranked as the second leading cause of disability worldwide.[20] Migraine tends to run in families.[17] It is consistently the fourth or fifth most common reason for emergency visits accounting for an annual 3% of all emergency visits.[21] Its prevalence increases in puberty but continues to increase until 35 to 39 years of age, decreasing later in life, especially after menopause.[18]


At first, there was a vascular theory of migraine, which explained that the headache was produced by vasodilation and aura by vasoconstriction, but this theory is not viable anymore.[22] Nowadays, the suggestions pose that multiple primary neuronal impairments lead to a series of intracranial and extracranial changes that cause migraines.[23]

The cortical spreading depression of Leão, a propagating wave of neuronal and glial depolarization that initiates a cascade, is hypothesized to cause the aura, activate trigeminal afferents, and alter the hematoencephalic barrier permeability by activating brain matrix metalloproteinases.[24] In migraine without aura, the suggestions are that cortical depression may occur in areas where depolarization is not consciously perceived, such as the cerebellum.[25] There is activation of trigeminal afferents by neuronal pannexin-1 megachannel opening and subsequent activation of Caspase-1, followed by the release of proinflammatory mediators, activation of NF-kB (nuclear factor kappa-B), and spreading of this inflammatory signal to trigeminal nerve fibers around vessels of the pia mater.[26] This causes a series of cortical, meningeal, and brainstem events, provoking inflammation in the pain-sensitive meninges that concludes in headaches through central and peripheral mechanisms.[27][28] This pathway can, therefore, explain the cortical depression (which establishes the aura) and the latter prolonged activation of trigeminal nociception (which leads to headache).

The anterior structures are most innervated by the ophthalmic division of the trigeminal nerve, which could explain the pain in the anterior region of the head. There is a convergence of fibers from the upper cervical roots, which originate the trigeminal nerve neurons along with the trigeminal ganglion and the trigeminal nerve at the trigeminal nucleus caudalis, which can explain the anterior to the posterior distribution of pain, from where the fibers ascend to the thalamus and the sensory cortex.[29]

Neurogenic inflammation, which is based on vasodilation, edema, and plasma protein extravasation, results from nociceptor activation, in this case, the trigeminal system. It is associated with the release of substance P, calcitonin gene-related peptide, and neurokinin a, all vasoactive neuropeptides liberated by trigeminal ganglion stimulation.[30] Elevated levels of these neuropeptides have been found in the spinal fluid of chronic migraine patients.[31][32] Neurogenic inflammation can lead to sensitization, which is the process in which neurons tend to become more responsive to stimulation. This can explain some clinical symptoms of the pain and the conversion from episodic migraine to chronic one.[33]

Serotonin, released from the brainstem serotonergic nuclei, may play a role in migraine; however, the exact role of its mechanisms remains a matter of controversy. Most likely, serotonin levels are low between attacks because it may cause a deficiency in the serotonin pain inhibition system, therefore helping the activation of the trigeminal system. It could mediate by acting directly over the cranial vessels, or in central pain control pathways, or by cortical projections of brainstem serotonergic nuclei.[34][35]

Calcitonin gene-related peptide is abundant in trigeminal ganglion neurons. It is released from the peripheral nerve and central nerve terminals as well as secreted within the trigeminal ganglion. When released from the peripheral terminals, it initiates an increased synthesis of nitric oxide and latter sensitization of trigeminal nerves.[36][37] It is a strong vasodilator of cerebral and dura mater vessels, therefore a component of neurogenic inflammation, and it also mediates trigeminal pain transmission from vessels to the central nervous system.

History and Physical

Migraine attacks occur through four phases:[38]

  • Prodrome: premonitory symptoms associated with hypothalamus activation (dopamine)[39][40]
    • Around 77% of patients suffer prodromic symptoms up to 24 to 48 hours before headache onset. It is more common in females than males (81 to 64%).

    • Frequent symptoms are yawning (34%), mood change, lethargy, neck symptoms, light sensitivity, restlessness, difficulties in focusing vision, feeling cold, craving, sound sensitivity, sweating, excess energy, thirst, edema.

  • Aura: changes in cortical function, blood circulation, and neurovascular integration. It occurs in about 25% of the cases.[2][13][41][42]
    • It can precede the headache, or it can present simultaneously.

    • They are typically gradual, with less than 60 minutes of duration, more often visual, and have positive and negative symptoms.

      • Positive symptoms are caused by active release from central nervous system neurons (bright lines or shapes, tinnitus, noises, paresthesias, allodynia, or rhythmic movements).

      • Negative symptoms point out a lack or loss of function (reduction or loss of vision, hearing, sensation, or motion).

    • They have to be fully reversible.

    • Visual auras are the most frequent ones.

      • The most common positive visual symptom is the scintillating scotoma (an area of absent vision with a shimmering or glittering zigzag border).

      • The most common negative visual symptom is the visual field defects.

    • Sensory auras are also common. They can follow visual symptoms or occur without them.

    • Language auras are not frequent. They consist of transient dysphasia.

    • Motor auras are rare. They consist of complete or partial hemiplegia that can involve limbs and the face.

  • Headache: additional changes in blood circulation and function of the brainstem, thalamus, hypothalamus, and cortex.

    • Often unilateral, generally with a pulsatile or throbbing feature and increasing intensity within the first hours.

    • The intensity can correlate to nausea, vomiting, photophobia, phonophobia, rhinorrhea, lachrymation, allodynia, and osmophobia.

    • It can take place over hours to days.

    • Patients may have to seek relief in dark places, as the pain usually resolves in sleep.

  • Postdrome: persistent blood changes with symptoms after headache termination.

    • This phase consists of a movement-vulnerable pain in the same location as the previous headache.

    • Common symptoms can be exhaustion, dizziness, difficulty concentrating, and euphoria.


The diagnosis of migraine is based on patient history, physical examination, and fulfillment of the diagnostic criteria. The necessary information that has to be gathered consists of these simple questions:

  • Demographic features of the patient: age, gender, race, profession

  • When did the headache start?

  • Where does it hurt? Location, irradiation.

  • What is the intensity of the pain?

  • How is the pain? Which are the qualitative characteristics of the pain?

  • How long does the pain last?

  • In which moment of the day does the pain appear?

  • How has it evolved since it started?

  • What is the frequency of appearance?

  • What are the triggering situations?

  • Simultaneous symptoms?

  • Is it related to sleep?

  • How does it get better or worse?

  • Which medications do you take to make it better? What is the frequency of this medication?

The International Classification of Headache Disorders (ICHD-3) describes these diagnostic criteria.[2]

B1. Migraine without aura:

B1a. Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)

B1b. Headache has at least two of the following characteristics:

B1c. During headache, at least one of the following:

B2. Migraine with aura:

B2a. One or more of the following fully reversible aura symptoms:

  • Visual

  • Sensory

  • Speech and language

  • Motor

  • Brainstem

  • Retinal

B2b. At least two of the following characteristics:

  • At least one aura symptom spreads gradually over 5 or more minutes

  • Two or more aura symptoms occur in succession

  • Each aura symptom lasts 5 to 60 minutes

  • At least one aura symptom is unilateral

  • At least one aura symptom is positive

  • The aura is accompanied, or followed within 60 minutes, by the headache.

C. On eight days or more per month for more than three months, fulfilling any of the following:

  • Criteria B1b and B1c for migraine without aura

  • Criteria B2a and B2b for migraine with aura

  • It is believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative.

D. Not better accounted for by another ICHD-3 diagnosis

The ICHD-3 criteria for migraine without aura are:

  1. At least five attacks fulfilling criteria B to D (see below)

  2. Headache attacks that last 4 to 72 hours, untreated or unsuccessfully treated

  3. Headache that has at least two of the following criteria:
  4. During headache, at least one of the following:
    • Nausea, vomiting, or both

    • Photophobia and phonophobia

  5. Not better accounted for by another ICHD-3 diagnosis

 The ICHD-3 criteria for migraine with aura are:

  1. At least two attacks fulfilling criteria B to D

  2. One or more of the following fully reversible aura symptoms:
    • Visual

    • Sensory

    • Speech and language

    • Motor

    • Brainstem

    • Retinal

  3. At least three of the following six characters:
    • At least one aura symptom spreads gradually over ≥5 minutes

    • Two or more symptoms occur in succession

    • Each aura symptom lasts 5 to 60 minutes

    • At least one aura symptom is unilateral

    • At least one aura symptom is positive

    • The aura is accompanied, or followed within 60 minutes, by the headache

  4. It is not better accounted for by another ICHD-3 diagnosis

  5. Hemiplegic migraine is diagnosed when the aura consists of motor weakness.

  6. Migraine with brainstem aura (previously known as basilar artery migraine or basilar migraine) is diagnosed if the aura symptoms emerge from the brainstem (bilateral hemianopic visual disturbance, diplopia, vertigo, ataxia, dysarthria, tinnitus, hyperacusis, bilateral paresthesia, or numbness)

  7. Retinal migraine is diagnosed when the aura involves a monocular visual field defect.

The ICHD-3 criteria for chronic migraine are:

  1. Headache (tension-type-like or migraine-like) on 15 or more days per month for more than three months and fulfilling criteria B and C

  2. It is occurring in a patient who has had at least five attacks fulfilling the following criteria for migraine without aura (B1) or migraine with aura (B2)

Neuroimaging (computed tomographic scan, magnetic resonance imaging, magnetic resonance angiography, or magnetic resonance venography) is indicated in the following cases:[43][44]

  • Acute severe headache, especially if it is the first or worst episode (discard subarachnoid hemorrhage).

  • Abnormal neurologic examination, especially if there are unexplained symptoms or signs (confusion, stiff neck, papilledema, epilepsy).

  • Non-typical characteristics.

  • Changes in the patient’s typical features or patterns

  • Resistance to treatment.

  • New episodes in older (>50 years of age) or immunosuppressed patients.

  • Systemic or meningeal signs or symptoms (fever, weight loss, fatigue)

The commonly used acronym “SNOOP” can be used to aid in the determination of neuroimaging indications:

  • “S” for systemic signs or symptoms and secondary risk factors

  • “N” for neurologic signs or symptoms

  • “O” for onset

  • “O” for older

  • “P” for position-dependent intensity changes, prior pattern changes, papilledema, and precipitated by Valsalva maneuvers.

Cerebrospinal fluid analysis and electroencephalogram are not typically performed unless seizure activity of infectious etiology has to be excluded.

Treatment / Management

Treatment options are based on the onset scenarios: acute or chronic.

Acute or Abortive treatment

  • Acute treatment aims to stop the progression of a headache. It has to be treated quickly, and with a large single dose. Oral agents can be ineffective in patients with migraine-induced gastric stasis. For that reason, parenteral medication could be the rule for some patients, especially the ones with nausea or vomiting. Therapy consists of stratified options:[45][46][47]
    • NSAIDs (nonsteroidal anti-inflammatory drugs): ibuprofen, naproxen, diclofenac, aspirin, or acetaminophen. Usually in mild to moderate attacks without nausea or vomiting.

    • Triptans (the first-line in patients with allodynia): sumatriptan, eletriptan, rizatriptan, almotriptan. With or without naproxen for moderate to severe attacks.
      • Triptans should be limited to less than ten days of use within a month to avoid medication overuse.

      • Because of the activation of the 5-HT(1B) and 5-HT(1D) receptors on coronary arteries and cerebral vessels, there are recommendations against its use in patients with ischemic stroke, ischemic heart disease, poor-controlled hypertension, angina, pregnancy, hemiplegic or basilar migraine. In these patients, with cardiovascular risks, the best-suited medication is a selective serotonin 1F receptor agonist that does not produce vasoconstriction; lasmiditan.

      • It is recommended to monitor therapy if the patient takes selective serotonin reuptake inhibitors or selective serotonin-noradrenaline reuptake inhibitors because of the risk of serotonin syndrome.

    • Antiemetics: metoclopramide, chlorpromazine, prochlorperazine. They are generally used as adjunctive therapy with NSAIDs or triptans to decrease nausea and vomiting, especially in the emergency department. Diphenhydramine can also be added to prevent dystonic reactions (mostly with metoclopramide).

    • Calcitonin-gene-related peptide antagonists: rimegepant, ubrogepant. It could be considered in patients that don’t respond to conventional treatment or in those with coronary artery disease.[48]
    • Ergots: ergotamine and dihydroergotamine, being this last one the only one recommended for acute attacks as a parenteral administration, and effective as bridge therapy for medication overuse headache and status migrainosus. Ergotamine has not demonstrated particular effectiveness yet, and it can present significant side effects.

    • Dexamethasone can reduce the recurrence of early headaches, but does not provide immediate relief of headaches.[49][50]
    • Transcutaneous supraorbital nerve stimulation can reduce intensity.[51]
    • Transcranial magnetic stimulation is proved effective as a second-line treatment, with no serious side effects. It can also be offered as an option to treat chronic migraines. It is contraindicated in patients with epilepsy.[52][53][54]
    • Nonpainful remote electric neurostimulation could be considered as a first-line treatment in some patients.[55][56]
    • Peripheral nerve blocking (occipital plexus and sphenopalatine ganglion).[57][58]

Prophylactic or Preventive Treatment

  • Preventive treatment aims to reduce attack frequency and to improve responsiveness to acute attacks’ severity and duration, and reduce disability.[59][60] Migraine triggers have to be documented by each individual to reduce them in the future.
    • Indications for preventive treatment are:
      • Frequent or long-lasting headaches

      • Attacks that cause significant disability and reduced quality of life

      • Contraindication or failure to acute therapies

      • Significant adverse effects of abortive therapies

      • Risk of medication overuse headache

      • Menstrual migraine (along with short-term premenstrual prophylaxis)

      • Hemiplegic migraine

      • Brainstem aura migraine

      • Persistent aura without infarction

      • Migrainous infarction

    • Preventive treatment agents are the following:
      • Beta-blockers: metoprolol and propranolol. Especially in hypertensive and non-smoker patients.

      • Antidepressants: amitriptyline and venlafaxine. Especially in patients with depression or anxiety disorders, and insomnia.

      • Anticonvulsants: valproate acid and topiramate. Especially in epileptic patients.

      • Calcium channel blockers: verapamil and flunarizine. Especially in women of childbearing age or patients with Raynaud’s phenomenon.

      • Calcitonin gene-related peptide antagonists: erenumab, fremanezumab, and galcanezumab.

Alternative Treatment 

  • Changes in lifestyle; must be a commitment from the patient; however, social support is of great importance to improve mental health to help the patient’s involvement.

  • Regular exercise

  • Yoga

  • Relaxation training

  • Cognitive-behavioral therapy

  • Biofeedback

  • Reduction of triggers

  • Detoxification

  • Butterbur

  • Melatonin

Differential Diagnosis

The following should be considered in a patient with migraine:

  • Tension-type headache

  • Cluster headache

  • Cerebral aneurysms

  • Chronic paroxysmal hemicrania

  • Dissection syndromes

  • Encephalitis

  • Subarachnoid/intracranial hemorrhage

  • Meningitis

  • Temporal/giant cell arteritis

Tension-type headache is usually bilateral, lasting 30 minutes to 7 days. The patient feels pressure or tightness but remains active. There are no associated symptoms.

Cluster headache is unilateral and had a sudden start around the eye or temple. It progresses in intensity within minutes to an excruciating continuous deep pain. It lasts 15 minutes to 3 hours. Associated symptoms include lacrimation and redness of the eye, rhinorrhea, pallor, sweating, Horner syndrome, agitation, and focal neurologic symptoms. It can easily be provoked by alcohol.


A migraine is a chronic condition that can revert to episodic migraine in 26 to 70% of patients. Prolonged remissions are common; however, some patients have a pattern of leaving and returning to chronic states. The severity and frequency of attacks can diminish with age.[61] Episodes increase during puberty but continue to climb until 35 to 39 years of age, decreasing later in life, especially after menopause.[18]


  • Seizures

  • Brain infarction

  • Work disability

  • Loss of work

Deterrence and Patient Education

Pearls and Other Issues

  • Cortical spreading depression is the probable cause of the aura. It can activate trigeminal nerve afferents and alter hematoencephalic barrier permeability. Trigeminovascular system activation can initiate neurogenic inflammation, which is related to migraine headaches.

  • The attacks are recurrent, and they occur through a cascade of events over hours to days.

  • Typical migraines progress through a prodrome, an aura, headache, and the postdrome.

  • There is no one approach to treating migraines. Each case must be individualized according to its comorbidities.

Enhancing Healthcare Team Outcomes

Management of a migraine patient will require the efforts of an interprofessional team. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities. Primary care physicians must be assessed by an internist, a neurologist, or a headache specialist if there’s any doubt about the diagnosis. Nurses and psychologists can be helpful in lifestyle changes, mental health supervision, drug overuse detoxification, and medication use recommendations.

Pharmacists can aid in determining drug interactions, especially if the patient is treated for chronic migraines. An interprofessional team that provides an integrated approach to patient care can help achieve the best possible outcomes. Collaboration, shared decision-making, and communication are crucial elements for a good result.


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Bhola R, Kinsella E, Giffin N, Lipscombe S, Ahmed F, Weatherall M, Goadsby PJ. Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015;16:535. [PMC free article: PMC4463955] [PubMed: 26055242]
Starling AJ, Tepper SJ, Marmura MJ, Shamim EA, Robbins MS, Hindiyeh N, Charles AC, Goadsby PJ, Lipton RB, Silberstein SD, Gelfand AA, Chiacchierini RP, Dodick DW. A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE Study). Cephalalgia. 2018 May;38(6):1038-1048. [PMC free article: PMC5944078] [PubMed: 29504483]
Yarnitsky D, Dodick DW, Grosberg BM, Burstein R, Ironi A, Harris D, Lin T, Silberstein SD. Remote Electrical Neuromodulation (REN) Relieves Acute Migraine: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Headache. 2019 Sep;59(8):1240-1252. [PMC free article: PMC6767146] [PubMed: 31074005]
Rapoport AM, Bonner JH, Lin T, Harris D, Gruper Y, Ironi A, Cowan RP. Remote electrical neuromodulation (REN) in the acute treatment of migraine: a comparison with usual care and acute migraine medications. J Headache Pain. 2019 Jul 22;20(1):83. [PMC free article: PMC6734294] [PubMed: 31331265]
Korucu O, Dagar S, Çorbacioglu ŞK, Emektar E, Cevik Y. The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments. Acta Neurol Scand. 2018 Sep;138(3):212-218. [PubMed: 29744871]
Crespi J, Bratbak D, Dodick DW, Matharu M, Jamtøy KA, Tronvik E. Pilot Study of Injection of OnabotulinumtoxinA Toward the Sphenopalatine Ganglion for the Treatment of Classical Trigeminal Neuralgia. Headache. 2019 Sep;59(8):1229-1239. [PMC free article: PMC6771650] [PubMed: 31342515]
Tfelt-Hansen PC. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2013 Feb 26;80(9):869-70. [PubMed: 23439705]
Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ., Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 Suppl 3):S1-S80. [PubMed: 23968886]
Serrano D, Lipton RB, Scher AI, Reed ML, Stewart WBF, Adams AM, Buse DC. Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design. J Headache Pain. 2017 Oct 04;18(1):101. [PMC free article: PMC5628086] [PubMed: 28980171]

Approach to Acute Headache in Adults

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How Long Can a Migraine Last? (Because It Feels Like FOREVER)

When you have a migraine, every
minute can seem like an eternity. It would be really great if your brain would wrap up the whole thing ASAP, but migraines can unfortunately last for much longer than they should have any right to do. We had experts explain why this is, plus if there’s anything you can do to get rid of your migraines more quickly. (Good news: There are definitely some options out there.)

Migraines are one of those weird health conditions that doctors know exists but still can’t fully figure out, especially when it comes to the cause.

It could be that there are aberrations how in your brainstem communicates with your trigeminal nerve, an important pain messenger in your body, the Mayo Clinic says. Or maybe some of your brain chemicals that help regulate pain, like serotonin, are out of whack, again looping in that good ol’ trigeminal nerve to cause discomfort. Scientists still aren’t sure.

Although the cause of migraines may be hazy, this much is clear: They can be excruciating, causing a severe throbbing sensation in your head along with issues like nausea, vomiting, and an extreme sensitivity to light and sound. Some people also experience aura, which are sensory disturbances often having to do with your vision, so you might see mirages of wavy lines, flashes of light, and other weirdness.

While classic migraines cause intense pain, some may only crash into your life with symptoms such as visual changes or intense dizziness. Whether or not your migraines come with pain, common triggers include stress, caffeine, hormonal fluctuations, and the weather.

Migraines can last for up to six days, which is appalling but not a guarantee. It depends on how many of the four migraine stages you experience.

Every potential migraine phase tends to last for a certain amount of time, and you may not deal with all of them. Here’s a quick run-down of each:

Prodrome: This is basically your body’s way of sounding the impending-migraine alarm. You might notice subtle warning signs one or two days before a migraine hits, like constipation, mood changes (ranging from depression to euphoria), food cravings, a stiff neck, being thirsty and peeing more than usual, and yawning a lot, the Mayo Clinic says.

Aura: Aura can happen before a migraine or while you’re actually having one, but the point is that they often cause those visual disturbances that can make your eyesight go bonkers. Sometimes, though, they can impact your other senses, so you might hear things that aren’t there or feel like someone’s touching you, for example.

This typically lasts for up to 60 minutes, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Attack: Well, you can probably guess what happens here, in arguably the worst part of the migraine. During this stage, you can experience why-won’t-it-end pain and those other troublesome symptoms, like nausea, vomiting, sensitivity to light, sound, smell, or touch, blurry vision, and lightheadedness and fainting. Basically, it’s really, really terrible, and it can last anywhere from four to 72 hours. “Usually, the pain [starts and] stops on the same day, but I’ve had some patients who say that the pain put them down for several days,” Medhat Mikhael, M.D., a pain management specialist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SELF.

Post-drome: This is known as the “migraine hangover” for a good reason: You’ve made it out on the other side of the attack and might feel completely drained, weak, dizzy, moody or confused, and still have some remaining sensitivity to light and sound. Or, if your brain really wants to do you a solid, you might feel a surge of elation as your
migraine recedes. Either way, this stage usually lasts for up to 24 hours, according to the NINDS.

Aura migraine

These are certain neurological disorders that occur before the onset of a migraine headache attack.

  • Visual disturbances – various visual “special effects” – these are the most typical manifestations of the aura.
  • Less commonly, there are changes in sensations: numbness or tingling in the lips, tongue, half of the face. Sensations move: spread to the neck and arm, or rise from the fingertips to the neck.

Symptoms of the aura are divided into positive – when something appears: flashes of light, a flickering zigzag line in front of the eyes, tingling.And negative – when something, on the contrary, disappears. For example, the field of vision falls out or the hand becomes numb.

Another property of the aura is dynamism. Symptoms increase in 5-20 minutes and then subside. The aura lasts no more than an hour. As a rule, a headache comes to replace.

But in some cases, the aura can appear on its own, without connection with pain [1]. This is especially true for older people who have suffered from migraines all their lives. With age, pain becomes easier or disappears altogether, and attacks may consist only of an aura.Then the disease is called headless migraine [3].

What causes the aura of migraine

The aura is based on changes in the electrical and biochemical activity of neurons (nerve cells) in certain areas of the brain. For example, a visual aura occurs when neurons in the occipital cortex are fired – because this part of the brain processes visual information.

Other symptoms of an approaching attack – prodrome
Most people with migraines (with or without aura) have symptoms that indicate that they are about to have an attack.They can occur even two days before a migraine attack. Each person with migraine can identify their own symptoms that “predict” an attack. For some, this is euphoria or, conversely, a decrease in mood. For others, hyperactivity or drowsiness. Desire to eat sweet or salty foods, increased yawning. [4] These are just some of the forerunners of migraine, and over time, you can learn to recognize them in order to prevent attacks in time.

Misconceptions about aura and migraine

Even many doctors believe that migraines necessarily involve an aura.And the aura should be replaced by an intense one-sided throbbing headache with nausea, vomiting, intolerance to light and sound – then the disease can be considered a migraine.

However, despite the fact that about 10% of people worldwide suffer from migraines, only a few have all these symptoms . A migraine attack can consist only of an aura without any headache. Or manifest as a severe headache without an aura. [2.5].

Aura of migraine is experienced by 20-25% of people with migraine, but only a few have an aura with every attack.


  1. Tabeeva G.R., Yakhno N.N. Migraine. // GEOTAR-media. – 2011 .– 624s.
  2. Eriksen M.K., Thomsen L.L., Olesen J. Implications of clinical subtypes of migraine with aura. // Headache. – 2006. – v.46. – p.286-297.
  3. Kelman L. Migraine changes with age: IMPACT on migraine classification. // Headache. – 2006. – v.46. – p. 1161-1171.
  4. Kelman L. The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. // Headache. – 2004. – v.44. – p.865-872.
  5. Rothrock J.F. Migraine aura // Headache. – 2009. – v.49. – p. 1123-1124.
  6. Zhang X., Levy D. Noseda R., et al. Activation of meningeal nociceptors by cortical spreading depression: implications for migraine with aura. // J Neurosci. – 2010. – v.30. – p. 8807-8814.

Migraine headaches: what to do if pain relievers don’t work?

14% * of the world’s population suffer from migraine attacks, the average duration of which is 18 hours.68% * of migraine sufferers are between 35 and 45 years old. Among them there are three times more women than men. Aigul Kudaibergenova, a practicing neuropathologist and candidate of medical sciences, announced these figures at an event dedicated to the launch of the Migraine Control application in Kazakhstan.

“No one can say for sure what exactly is causing my headache”

Our heroine Bota Suleimenova had her first migraine attack four years ago. Now it is a part of her life: migraines can remind of themselves once a month or several times a week.It interferes with work and life.

Bot Suleimenova:

– The first attack happened in the winter of 2015, when I flew to Almaty on vacation. It was a night flight, and when I got home, I immediately fell asleep. When I woke up, I still had a headache. I thought it was due to the change of time zones. The painkillers did not help, the pain did not stop for 2-3 days: I could not get up, I felt sick, it hurt to open my eyes. Then I was diagnosed with migraine.

As a child, I had a concussion, at the age of 10-11 I developed constant headaches.Then they diagnosed intracranial pressure, so all my conscious life these pains seemed to be something common. Everyday life was not particularly disturbed, but when I was in my first years of university, there was probably a period of exacerbation. I was again referred for MRI and examination, which again only confirmed intracranial pressure.

According to some doctors, the migraine occurred as a consequence of intracranial pressure, but no one can say for sure what exactly is causing my headache.Maybe because of intracranial pressure or migraine, or because of all together.

No one knows for sure what causes migraines

Migraine is a chronic disease, the main symptom of which is an attack of a throbbing headache. Sometimes migraines are accompanied by nausea, sensitivity to light and sounds: ordinary sounds and soft light intensify the already excruciating pain.

Neurological disorders can also speak of migraine: dizziness, temporary visual impairment, lethargy.At the same time, migraine is associated with external factors – nutrition, regimen, stress level.

The causes of migraine are not visible on MRI, and pain is a very subjective indicator that is extremely difficult to measure. In the intervals between attacks, the person looks quite healthy, which supports the spread of the myth about the illusory nature of the disease.

Often and severe headache, but the diagnosis “migraine” early

There are many types of headaches, but globally they can be divided into primary and secondary.Secondary pain occurs as a consequence of any deviation. Migraine, on the other hand, refers to the primary – for its occurrence, any previous injuries and deviations are not necessary.

Primary headache, as a rule, is not life threatening, but greatly impairs its quality.

Migraine is often confused with tension headache. The pain of tension can arise from the characteristics of upbringing, the psychological qualities of the personality, the level of stress or prolonged positional loads.

People describe this pain as pressing, mild or moderate, more often bilateral. It appears in the afternoon or after stress. If tension headache lasts for several days, it may be accompanied by photo- and phonophobia, as in migraine, but this rarely happens and is never accompanied by nausea or vomiting. At the same time, a person can move, eat, work, and physical activity does not increase the pain, and even sometimes relieves it. With migraines, physical activity is extremely difficult.

Psychotherapy can be effective for tension headaches, but not for migraines.

“Medicines do not always work quickly”

Bota Suleimenova: – I have had poor eyesight since childhood, so attacks often disappear with an aura. An aura is a short-term visual impairment that signals an impending attack.

Medicines do not always work quickly, so the best solution is to reduce the frequency of attacks. To do this, I try to exercise regularly and maintain a healthy regimen.With an overall improvement in health, the frequency of migraine attacks decreases.

Although often no reason is needed for an attack to occur. You can eat right, maintain an overall healthy body and brain, but seizures still appear. It gets in the way of doing business. I work in an international organization, we have additional sick leave, which can not be confirmed by papers. If I have sudden attacks, I can just lie down at home.

Those close to you try to treat with understanding, but the other person can do nothing to help.Do not disturb is already help.

Migraine has a scenario with certain stages

1. Prodrome – first phase. The symptoms of the prodromal phase include a wide range of phenomena: mood changes, irritability, depression or euphoria, fatigue, sensitivity to smells and sounds. This phase occurs with migraine with or without aura.

2. 30% of people then have an aura , which lasts no more than an hour, it looks like visual hallucinations.And the longer a person looks at colored or flickering objects or drawings, the worse his condition becomes, so he tries to focus on a white wall or a piece of paper.

Aura is a transient neurological phenomenon that occurs before or during a headache. Usually, the aura develops gradually over a few minutes and lasts no more than an hour. Symptoms can be visual, sensory, or motor, and many patients have more than one symptom at the same time.

During the first two phases, you must take the triptan life-saving tablet.This will not stop the pain, but it will significantly ease it and shorten the duration of the attack.

3. During of the third phase pain covers the entire head, nausea and vomiting appear, strong phobia of light and sound. Any movement increases the pain. This phase can last from several hours to several days.

4. Postdrome – the pain subsides, the person falls asleep. On the next day, a person experiences fatigue, he has poor hearing, blurred vision. Abilities are reduced.

If a person has more than 10 migraine attacks a month, he practically does not live.Fortunately, there are few of them, one in three experiences one or less one seizure per month. But it happens that people do not know about the existence of pills that can help stop a migraine attack, because up to 50% of migraine sufferers still practice self-medication.

Migraine tries to get people to live in the golden mean

People with migraines are more susceptible to fleeting factors called triggers that increase the risk of headache attacks.

Among the most common triggers:

  • Hormonal – menstruation, ovulation, use of oral contraceptives.
  • Food – the consumption of alcohol, glutamate, chocolate, cocoa, nuts, celery, cheese.
  • Weather – Weather changes can affect the balance of chemicals in the brain and trigger seizures.
  • Behavioral – not getting enough sleep or sleeping too long, feeling hungry or overeating.

If you keep a diary of the occurrence of migraine attacks and the circumstances in which these attacks manifested themselves, you can identify your individual characteristics.People who know their triggers and avoid them are less likely to experience seizures and significantly improve their quality of life. For convenience, you can keep a diary of migraine triggers in the mobile application. Such a Migraine Control application was recently announced by SANTO. Useful information about migraines on the Internet can be found under the hashtag #SUMMigraineReduces.

You can download the application using these links:

Migraine is controlled by special drugs – triptans

Neurologist Aigul Kudaibergenova spoke at the event dedicated to the launch of the Migraine Control application developed by SANTO.According to her, mild migraine attacks can sometimes be stopped with non-steroidal anti-inflammatory drugs, but still, in most cases, for mild, moderate and severe migraine attacks, doctors recommend using drugs with triptans.

According to Aigul Kudaibergenova, a properly selected drug helps to eliminate headache as quickly as possible – within two hours. In this case, the headache should not occur again after a few hours or 1-2 days. Preparations with triptans, according to the neurologist, must be taken before the onset of the third stage of migraine.The sooner you take the pill, the less migraine will manifest itself.

Triptans are antagonists of serotonin, which is also called the hormone of good mood. Triptans interact with the vessels of the brain and, roughly speaking, block pain impulses.

At the same time, up to 50% of people suffering from migraine ignore drugs with triptans – this is due to the widespread practice of self-medication.

Being carried away with analgesics, in addition to migraine, they risk earning a drug-related headache.

* Source : A.V. Amelin et al. Migraine (pathogenesis, clinical picture and treatment) St. Petersburg, 2001.

THIS Mysterious Migraine | Science and Life

The head hurts. One of the first symptoms of many diseases. But there is a disease for which a long, exhausting, sometimes almost unbearable headache is the main manifestation. It’s a migraine.


Doctors have known this disease for more than three thousand years, but its causes are still not fully understood.Of all living beings, only man suffers from migraine. Migraine is more common in people prone to anxiety-depressive states, emotionally excitable, not psychologically resistant to stress. The name “migraine”, which came to the Russian language from French, is a distorted Greek word “hemicrania”, which means “disease of half of the head” (from hemi – half, cranios – skull). This is exactly what the ancient Roman physician Galen (II century AD) called this disease. Indeed, with migraine, pain occurs mainly in one half of the head, although then it can spread to the other.

Nowadays, more than 80% of people suffer from headaches of various types, but not everyone considers it a disease and does not go to doctors. Of course, not all headaches are associated with migraines. Doctors distinguish two types of headaches: tension pain – bilateral, compressive, and migraine pain – pulsating, localized on one side.


Migraine, or rather, a predisposition to it, is genetically inherited. Most researchers believe that this disease has a dominant type of inheritance, and it is transmitted through the maternal line.Among men with migraines, four out of five cases have mothers who have the disease.

Usually, the first signs of the disease appear during puberty. In women, it occurs 3-4 times more often than in men, and migraine attacks are often associated with the menstrual cycle. In most cases, migraine occurs in young people – up to 30 years. Migraine also occurs in children (cases of the disease are known at the age of five). By old age, the disease fades away.

The intensity and frequency of headache attacks largely depend on the circumstances of a person’s life.If all goes well, seizures are rare. Stress, physical and emotional overload provokes migraines. Migraine, as a rule, does not cause complications, does not pose a threat to life, and does not lead to complete disability. She just interferes with life.


A simple migraine has three stages. Usually, several hours or even days before the onset of the painful phase, performance and mood deteriorate, and precursor symptoms appear: pallor, indifference, drowsiness, yawning, nausea.With the so-called “visual” migraine, immediately before the attack, flashes, flickering, zigzag stripes appear before the eyes. Then an acute headache occurs, which lasts from several to 15-20 hours. Usually, during an attack, a person does not tolerate bright light, loud sounds, loses his appetite, his nausea increases, sometimes to vomiting, his face turns red, chest pain, chills appear. And finally, after the attack comes the third stage – prolonged sleep.

Doctors note other clinical manifestations of migraine, for example, impaired motor activity of the limbs.Moreover, if the right half of the head hurts, then violations occur in the left leg or arm, and vice versa.

It is believed that in the first stage of a migraine, the blood vessels in the head become narrowed and as a result of this, there is a decrease in blood flow. Then, in the painful phase, the carotid artery expands.

Migraine is associated with such psychophysiological traits of nature as increased excitability and emotional lability, resentment, ambition, intolerance to the mistakes of others, love of excellence, initiative, ambition.Strong, strong-willed, active people suffer from this disease. Migraines often coexist with hysteria, epilepsy, and allergies. Migraine patients are usually stubborn, self-centered, easily irritated, internally tense. At the same time, they are conscientious, even prone to meticulousness and excessive detail. They often experience unreasonable anxiety, dissatisfaction, and disappointment.


A migraine attack can be triggered by a wide variety of circumstances – stress, release after emotional distress, negative emotions, changes in the weather, the onset of menstruation, lack of sleep or, on the contrary, excessive sleep with dreams, physical exertion.This range also includes food products: cocoa, chocolate, milk, cheese, nuts, eggs, soy sauce, sardines, tomatoes, celery, citrus fruits, red wine, fatty foods. Irregular eating (for example, long breaks between meals), constipation, alcohol are also risk factors. Sometimes medications, such as oral contraceptives or drugs that dilate blood vessels, are the cause of the attack. Bright light, flickering images on a TV or computer screen, loud noise can also trigger migraines.


The biochemical mechanisms of the onset of migraine attacks have been little studied, but it is known that this disrupts the metabolism of certain substances, primarily serotonin, as well as catecholamines and histamine. The peptide bradykinin (it has a strong vasodilating effect), prostaglandins and heparin are involved in the development of migraine.

It is possible that migraine is caused by congenital disorders of the hypothalamus – the part of the brain that regulates metabolism, body temperature, interacts with the nervous and endocrine systems – as well as the thalamus, which controls the sensory functions of the body.With these disorders, the level of serotonin in the brain decreases, which leads to symptoms such as nausea and vomiting, chills, sleep after a painful attack, and depression. The constant lack of serotonin “mobilizes” platelets, which contain a large amount of this substance. There is a sharp release of serotonin from platelets, which leads to an immediate narrowing of the vessels of the brain. Excess blood, which, due to vascular spasm, is forced to pass through the external carotid artery, press on the vascular wall, dilate the artery and cause a painful attack.The right hemisphere of the brain contains more platelets, so the right side of the head hurts more often in migraine sufferers. It is not surprising that drugs regulating serotonin metabolism, such as dihydroergotamine, triptans, are most effective for relieving headaches during a migraine attack. By the way, the provocative effect of some food products, especially chocolate, is due precisely to the fact that they contain substances that contribute to the formation of serotonin – tyramine and phenylethylamine.


Is it possible to find out about the approach of an attack not by subjective sensations, but with the help of medical devices? According to the Moscow neurologist, corresponding member of the Russian Academy of Medical Sciences A.Wayne, a patient with migraine gradually increases the bioelectric activity of the brain. When it reaches its maximum, an attack begins, and brain activity immediately returns to normal. Then it starts all over again. Boosting brain activity helps reduce aspirin. In some patients, long-term systemic use of aspirin in low doses for 6-7 months, regardless of whether there is a headache or not, effectively prevents the onset of seizures.

Yet migraines are difficult to treat.Common pain relievers and vasodilators are most commonly used during seizures. In the treatment of migraine, beta-adrenergic receptor blockers, monoamine oxidase inhibitors (an enzyme that destroys serotonin and other biogenic amines), clonidine, antiepileptic drugs, tranquilizers, heparin, 5-hydroxytryptophan are sometimes used. Treatment is complicated by the fact that with migraine, the absorption of drugs is impaired and the drugs are poorly absorbed.


Some researchers, for example V.P. Efroimson, author of the book “Genius and Genetics” (M., 1998), believe that gout, Marfan syndrome and other diseases act as companions of creative giftedness. It is known that in such diseases, the body produces excess amounts of substances that have a psychostimulating effect (with gout – uric acid). And it is possible that thanks to these substances, creative inclinations are realized more successfully.

Maybe the migraine is associated with genius? Indeed, the list of outstanding personalities who suffered from migraines is impressive: Julius Caesar, Alexander the Great, Pontius Pilate, E.Poe, Peter I, C. Darwin, L. Beethoven, P. Tchaikovsky, F. Chopin, R. Wagner, K. Marx, Z. Freud, A. Chekhov, K. Linnaeus, G. Heine, G. Maupassant, F. Nietzsche, Napoleon, F. Dostoevsky, N. Gogol, Calvin, B. Pascal, A. Nobel … From women – Charlotte Bronte, Elizabeth I Tudor, Virginia Woolf.

However, according to A. Wein, among geniuses, the percentage of migraine diseases is the same as among the entire population. But among migraine patients, there are many people who are ambitious and purposeful. So sometimes a migraine attack is a price to pay for being active.

See in the same issue

Something else about migraines.

Headache / Diseases / Clinic EXPERT

Headache is pain in the head and / or neck region. According to the latest scientific data, there are about 200 types of headache, many of which are well studied and can be both explicit and indirect signs of various diseases of the nervous system. By drinking a pill for a headache, you can only relieve the symptom, but not get rid of the cause of its occurrence.

Many people experience recurrent head and neck pain throughout their lives. According to statistics, about 90% of people experience a headache at least once during the year. Approximately 10-15% of the world’s population is susceptible to migraine attacks, of which women are 3 times more than men. In general, headache occurs 5-8 times more often in middle-aged men.

In most cases, such pain does not pose a threat to life, as it is a natural reaction of the body to overstrain or general overwork.But this does not mean at all that the problem can be “seized” with pills for years without taking any measures.

Acute head pain can be a serious symptom of stroke, traumatic brain injury, ruptured aneurysm, neoplasms in the brain, meningitis, arachnoiditis, etc.

In case of rarely recurring headaches of a mild nature, caused by understandable reasons and not causing much discomfort, a visit to a doctor is not required.

Types of headache

There is an international classification, according to which all types of headache are divided into primary and secondary (symptomatic):

  • primary – an independent disease.These include migraines, tension headaches, and cluster headaches.
  • secondary – a symptom of another organic disease.


The causes of primary headache are not fully understood, therefore, it is much more difficult to diagnose and treat them than secondary ones.

Causes of secondary headaches:

  • violation of the regulation of vascular tone by the autonomic nervous system (in practice, this means that the vessels cannot regulate their “adequate” diameter, i.e.i.e. they are either too narrowed or too expanded)
  • emotional or mental stress, neurosis-like and depressive states, inability to cope with stress
  • endocrine disorders, for example, hyperthyroidism (increased thyroid hormones) with severe autonomic disorders, including headache pain, or hypothyroidism
  • consequences of craniocerebral and neck injuries (for example, whiplash injuries of the neck that occur during sudden braking during an accident).
  • with osteochondrosis of the cervical spine and with violations of the tone of the muscles of the neck
  • dental problems – from dental disease to vascular reactions with dysfunctions of the temporomandibular joint due to improper bite or prosthetics, etc.
  • ENT pathology, for example, sinusitis, both acute and sluggish chronic, or inflammation of other sinuses
  • pathology on the part of the eyes, for example latent squint, refractive error, glaucoma
  • chronic diseases of internal organs, for example, stomach ulcer can proceed without pain in the abdomen, but it is a headache that can signal it
  • chronic viral infections, various intoxications, parasitic diseases
  • use of contraceptive pills, a period of hormonal changes, long-term hormonal therapy can also be a source of headaches
  • too frequent use drugs for headache (abusal headache)

Severe headaches, the cause of which may lie in the presence of rather serious pathologies not only of the nervous system, but also of other organs and systems, require qualified medical care.


Symptoms of tension headache include:

  • constant non-pulsating pain
  • sensation of tension and squeezing in the head and neck area
  • discomfort that does not increase with physical and mental exertion or increases slightly

Pain of this nature can be alleviated through meditation, hypnosis, and psychotherapy, as well as through work and rest.

Symptoms of cluster headache:

  • Acute pain in the eye of a constant nature, often repeated at the same time of the day
  • redness of the eyes and swelling of the eyelids
  • lacrimation
  • nasal congestion on one side



  • intense, pulsating increasing pain
  • more often localization on one side of the head
  • intensification with increasing physical and mental stress
  • sensitivity to light
  • nausea
  • sometimes vomiting

Before a migraine attack, about 20% of people see bright spots.This symptomatology is called aura. Some creative and active people may have a surge of vigor shortly before the onset of an attack.

Any headache requires qualified diagnosis and adequate treatment. With prolonged and uncontrolled use of painkillers, serious complications arise: drug hepatitis, damage to the gastrointestinal tract, kidneys, blood diseases, etc., which further aggravates the patient’s condition.

In addition, uncontrolled use of pain relievers can itself cause headaches.

In order to get rid of headaches without risk to health, we recommend that you consult a neurologist.


In some cases, for headaches, a sufficiently long observation of the patient is required, the use of various examination methods, which depend on the symptoms identified by the neurologist:

  • blood pressure measurement
  • Doppler sonography and duplex examination of the vessels of the head and neck
  • clinical, biochemical, immunological and other blood and urine tests
  • ECG
  • daily monitoring (Holter) ECG and blood pressure

In some cases, the doctor may prescribe:

  • examination of the heart and other internal organs
  • examination of endocrine organs, ENT organs, organs of vision
  • electroencephalography, electroneuromyography
  • X-ray examination of the spine and skull
  • MRI (magnetic resonance imaging) or CT (computed tomography) of the brain and / or spine 9000 6

It is especially important that in the conditions of the EXPERT Clinic it is possible to solve the patient’s problem with doctors of other specialties (endocrinologist, cardiologist, nephrologist, gastroenterologist, gynecologist, urologist, dentist, etc.).) This allows you to reduce the number of “unnecessary” examinations and speed up the correct diagnosis, and hence the appointment of adequate treatment.

Headache treatment

How to treat a headache – in this matter it is better to trust the specialists. Self-medication can numb the symptoms, but not eliminate the cause. Based on the tests and conclusions of the necessary diagnostic specialists, two options for headache treatment are possible – these are:

  • medication pain relief
  • individual selection of therapy based on long-term action

The effectiveness of headache treatment depends on the correct identification of the cause of the headache symptom.As a rule, if a patient seeks a neurologist as early as possible, then the likelihood of recovery is much greater.

Self-medication is not permitted!

The most effective is complex treatment using an individual approach to each patient during observation, when therapeutic factors are prescribed that affect not only the mechanisms of headache, but also maintain a good functional state of the nervous system and the body as a whole.

In the conditions of the EXPERT Clinic, the attending physician can help you by prescribing treatment in the comfortable conditions of a day hospital, using the capabilities of a psychotherapist.


With timely diagnosis, treatment and compliance with all recommendations, the prognosis is favorable.

Various types of headaches can be successfully treated. Often, after one course of treatment, the headache does not return.

Advice and Prevention

Never put off an appointment with a doctor until tomorrow. It is better to address complaints as early as possible than to allow complications to develop. You cannot ignore the headache, which can lead to irreversible consequences.

For the prevention and treatment of headaches, the following recommendations must be observed:

  • Be in the fresh air every day
  • Observe the daily regimen
  • Ensure good sleep
  • Exercise
  • Avoid stress and overstrain
  • Carry out a full massage course
  • eat
  • exclude alcohol, nicotine, synthetic carbonated drinks.

Frequently Asked Questions

I often have headaches.Is it a migraine?

Migraines are not the only causes of headaches. The most common are tension headaches. The diagnosis can be made by a neurologist after examination and examination.

Because of my headaches, I have to take a lot of pain medications. It is harmful?

Uncontrolled use of analgesics can cause various complications. In addition, the likelihood of side effects increases. But the uncontrolled intake of pain medications itself can be the cause of headaches – an abusal headache.

What if regular pain relievers don’t help with headaches?

Before prescribing a drug, it is necessary to establish the cause of the headache, i.e. make the correct diagnosis. In some cases, headaches require the appointment not of painkillers, but of vascular, anti-inflammatory drugs or drugs of other groups. It may be necessary to use several drugs in combination or non-drug treatment.

Treatment histories

Case No. 1

Patient A.35 years old, for 2 years suffered from frequent headaches. Repeatedly consulted with neurologists, was examined (MRI of the brain, USDG of the vessels of the head). Received courses of vascular, non-steroidal anti-inflammatory drugs, etc. The effect of the treatment was insignificant.

The patient consulted a neurologist at the EXPERT Clinic and was diagnosed with dianosis: Migraine, simple form (no aura). The patient underwent a course of intravenous drip injections in the day hospital of the EXPERT Clinic and the dose of an adequate etiotropic drug was selected.Pain syndrome significantly regressed: attacks became less frequent and less pronounced. Taking the prescribed drug at the beginning of the attack completely prevented its development.

Migraine with provoked stress and prolonged anxiety

You may have noticed that anxiety and stress can trigger a migraine attack. Sometimes an acute migraine overtakes during the relaxation period after stressful days. However, a few simple steps can ease tension and help prevent headaches.

Stress is associated with migraine attacks in almost 80% of people [1] . Many people report irritability, increased anxiety, depressed mood and stress in the days leading up to the onset of an attack [2] . Studies have investigated the effects of stress reduction or “reduction” as a trigger factor for migraines, often focusing on weekend headaches.

Professor Dawn Buse of Albert Einstein College of Medicine in New York says that “About 20% of people with episodic migraines (14 days or less a month) are depressed, and this percentage rises as the number of days of attacks per month increases.Concomitant anxiety disorder occurs in 20% of people with episodic migraine and 30-50% of people with chronic headache (more than 15 days of attacks per month) ” [3] .

The role of stress in migraine is multifaceted: stress can contribute to the onset of migraine, act as a trigger for headache attacks, increase their intensity and duration, and can also be a risk factor for the transition to a chronic form of migraine [4] .

Particular attention should be paid to the effects of stress reduction as a trigger of migraine headaches.This migraine is called weekend migraine because it can appear on Saturday or Sunday at home after a busy week [5] . For some people, stress is not the main trigger for migraines; it can amplify the effects of other triggers, such as foods or smells.

Stress is not always the main trigger for migraines; it can amplify the effects of other triggers such as food or odors.

Scientists around the world argue: does migraine provoke anxiety or anxiety migraine? The question is not simple, the exact answer to which has not yet been found.One thing is clear that this creates a vicious cycle: stress-migraine-chronic form [4] .

The mechanism of occurrence of a migraine attack triggered by stress is not fully understood, but there are some hypotheses explaining this relationship. The brain cells that control mood, sleep, and pain use a chemical called serotonin to regulate how they interact with each other. When a migraine attack occurs, these cells become more active than normal, resulting in altered serotonin levels and anxiety [6].Conversely, when stress occurs, a chain of reactions is triggered that affects serotonin levels. A sudden drop in serotonin levels in brain cells can cause headaches due to the release of neuropeptides or narrowing of blood vessels.

To find out how stress-related migraine attacks are, keep a migraine diary for several months. This can help you find patterns of headache and pinpoint what types of stress can increase the likelihood of migraine attacks.

Questionário ID-Migraine ™ e o adequado diagnóstico da migrânea

In addition to finding a doctor, keeping a headache diary, and finding effective therapy, one of the most important things you can do to combat a migraine is to relieve stress, which sounds easy, doesn’t it? Not right. In our busy lives, how can we better deal with the stress associated with migraines? Try to eat right, avoid fatty, salty, spicy foods. Get enough sleep.Use meditation techniques to relax. Add essential vitamins to your diet.

Use relaxation meditation techniques to combat migraines.

Research conducted by the American Migraine Foundation in conjunction with the American Headache Association [7] identified the most effective stress management steps for people with migraines:

  1. Determine your priorities.

Think about your priorities and write them down in two lists labeled “Life” and “Now”.What are the most important things on your list? What can you fix? Think about what really matters when you plan your time and prioritize. Being always on the move, focusing on tasks that don’t make you happy, is not the best option for a low-stress life.

  1. Save your time.

Learn to plan for yourself in your life. Use your calendar for protection and remember that your needs are important. Allocate yourself half an hour during the day, and use that to get up and move your body.Sometimes the word no can be your best friend. Use it to turn down offers that add chaos to your life.

  1. Take time for relationships and personal growth.

Research shows that socializing with other people relieves stress. Plan a “time together” with your loved ones, and consciously get off the couch and do something fun. By improving your relationships and prioritizing what makes you happy, stress is instantly minimized.

  1. Learn to be assertive and communicate.

If you prefer a passive manner of communication, chances are that you are not letting people know what you want out of life. Strong communication skills can help you build self-confidence, understand your feelings, communicate without anger, and reduce stress levels.

  1. Get enough sleep.

In a recent survey of more than two hundred people living with migraines, over 85% reported clinically significant poor sleep quality associated with headache, depression and anxiety.In his article entitled “Sleep, Insomnia, and Migraines,” Dr. Hulker, Vargas, and Dodik present a simple plan to improve sleep. Good sleep includes exercise every day, not eating or caffeine before bed, going to bed at the same time, and not using mobile or other gadgets for half an hour to an hour before bed.

Sleep is one of the best methods for dealing with migraines.

We cannot influence external factors beyond our control, however, it is in our power to control our emotions.Dealing with the stress of your migraine is enough to significantly improve your well-being and help reduce other migraine symptoms. Start taking steps in the right direction today.

  1. Kelman, L. The triggers or precipitants of the acute migraine attack. 2007; 27 (5), 394-402.
  2. Stress and psychological factors before a migraine attack: A time-based analysis Masahiro Hashizume, corresponding author1,1 Ui Yamada, 1 Asako Sato, 1 Karin Hayashi, 1 Yuichi Amano, 1 Mariko Makino, 1 Kazuhiro Yoshiuchi, 2 and Koji Tsuboi1 Biopsychosoc Med.2008; 2: 14. Published online 2008 Sep 18. doi: 10.1186 / 1751-0759-2-14
  3. The Link Between Migraine, Depression and Anxiety American Migraine Foundation
  4. The Stress and Migraine Interaction Khara M Sauro 1, Werner J Becker Headache 2009 Oct; 49 (9): 1378-86. doi: 10.1111 / j.1526-4610.2009.01486.x.
  5. Reduction in perceived stress as a migraine trigger Testing the “let-down headache” hypothesis Richard B. Lipton, MD Dawn C. Buse, PhD Charles B. Hall, PhD Howard Tennen, PhD Tiffani A.DeFreitas, MS Thomas M. Borkowski, PhD Brian M. Grosberg, MD Sheryl R. Haut, MD 2014 American Academy of Neurology
  6. Why are migraineurs more depressed? A review of the factors contributing to the comorbidity of migraine and depression Daniel Baksa1,2, Xenia Gonda2,3,4, Gabriella Juhasz Neuropsychopharmacol Hung 2017; 19 (1): 37–44)
  7. Stress and Migraine American Mugraine Foundation

Migraine in adults – Symptoms, diagnosis and treatment

Migraine is a chronic, genetically determined, episodic neurological disorder that usually manifests itself early or mid-life.It can seriously affect quality of life, but it is often underdiagnosed and under-treated.

Patients complain of intermittent headache and associated symptoms such as visual disturbances, nausea, vomiting, and sensitivity to light or noise (photophobia and sound phobia).

Some women experience a menstrual migraine, which most often occurs during the 2 days preceding menstruation and in the first 3 days of menstruation.

Diagnosis based on history and physical examination.No laboratory or imaging studies are required.

The treatment approach encompasses the identification and prevention of triggers and the use of drugs to treat an acute attack or prevent subsequent attacks. Triptans are preferred over nonspecific treatments.

Complications include: status migraine, migraine infarction, chronic migraine, persistent aura without heart attack and seizures, analgesic gastropathy, transformation of episodic migraine into chronic and drug-induced headache.

Migraine is a chronic, genetically determined, episodic neurological disorder that usually manifests itself early or mid-life. Key features of the history that support the diagnosis of migraine are nausea, photophobia and disability, and headache. A typical migraine aura (a set of reversible visual, sensory or speech symptoms) that occurs during or precedes a headache is pathognomonic for migraine, but occurs only in 15-30% of patients.[1] Hadjikhani N, Sanchez Del Rio M, Wu O, et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA. 2001 Apr 10; 98 (8): 4687-92.

[2] Bashir A, Lipton RB, Ashina S, et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1; 81 (14): 1260-8.
http: // www.ncbi.nlm.nih.gov/pmc/articles/PMC3795609/


BMJ talk medicine podcast: migraine
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How Depression Affects the Human Body – Society

The Lancet Psychiatry has published an article on an eight-year study of patients with severe clinical depression. This work reinforced the conjecture that the disease is associated with inflammatory processes in the brain.

Scientists from the University of Toronto divided the participants into three groups: some had depression lasting less than ten years, others – longer, and still others were healthy. They each got a CT scan to see if their gray matter was different.

On this topic

It turned out that those who had not treated depression for ten years or more had elevated levels of a particular inflammatory protein. This same protein is found in Alzheimer’s and Parkinson’s, which gradually destroy the brain.

Depression is not classified as a degenerative disease, but a study in Canadians showed that it also goes through several stages in the same way. This explains why, over time, depressive episodes are more frequent and last longer. But there is also a bright side: for those who took antidepressants, the amount of inflammatory protein did not increase over the years.

A study by Canadian scientists has once again confirmed that depression is not only a mental disorder, but actively affects physical health.Earlier, other studies have confirmed its links to diseases such as migraines, arthritis, and the effect of depression in pregnant women on the development of the brain in babies.


Migraine is similar to a common headache, like an uppercut to a click. During an attack, it seems as if a nail has been stuck in the eye, the hair grows into the head with needles, any sounds and light become intolerable. Unsurprisingly, one in four people with migraine has depression, a mental reaction to suffering.But it seems that the link between the two diseases is much more complex.

Back in 1994, American scientists calculated that depression increased the risk of the first migraine by more than three times. By the age of 33, almost every second person with clinical depression has a migraine. It turns out that the two diseases mutually increase the risks of each other.

True, this does not mean that depression causes migraines. Perhaps they just have a common nature. A 2010 study of distant relatives in the Netherlands indicates a possible genetic link between the two diseases.It has also been noticed that migraine sufferers have low serotonin levels, and one of the causes of depression is just a lack of serotonin. But unlike the statistical link between migraines and depression, these explanations are just speculation.

Disrupted connections in the brain of babies

Depression undermines health, but even worse – it can change the body of a person who has not even been born yet. This has been found in several studies of depressed pregnant women and their babies after birth.

On this topic

In 2017, scientists from the National Institute of Singapore performed CT scans on six-month-old babies who were born to sick mothers. It turned out that the amygdala of babies – the area responsible for memory, emotion and decision-making – is connected with other parts of the brain in the same way as in adolescents and adults with depression.

Someone would argue that the brain of babies could change due to care and upbringing in the first six months of life. But at the end of 2013, another work was published with the results of examining children 6-14 days old.Scientists have also found abnormalities in the amygdala that make babies prone to depression. Most likely, genetics affected, but the depression of mothers during pregnancy also played a role. Therefore, expectant mothers need to monitor their mental health and, if necessary, be treated.


Recent laboratory studies show that inflammation in depression spreads to the entire body, not just the brain. Knowing this, scientists from the University of Calgary decided to test whether depression is to blame for the fact that about one in 12 patients with psoriasis develops arthritis.

Psoriasis is a disease in which the skin becomes covered with raised red spots with scales. This is due to the fact that the immune system mistakenly attacks skin cells and inflammation begins. But the nature of psoriasis is not fully understood, and one of the mysteries is why sometimes inflammation spreads to the joints and psoriatic arthritis develops.

To check if there is a connection between the diseases, scientists processed more than 73 thousand medical records of people with psoriasis. It turned out that those who also had depression were 37% more likely to have arthritis.Two guesses follow from this. It is possible that psoriatic arthritis can be treated with psychotherapy and antidepressants. It is also possible that depression can provoke other inflammatory diseases.

On this topic

All these consequences of depression show how important it is to listen to yourself. According to the World Health Organization, by 2015, depression had become the leading cause of disability. At that time, more than 300 million people around the world suffered from it, that is, every 25th, and their number is growing from year to year.In Russia, there are even more patients with depression – every 18th resident of the country, and these are only diagnosed cases. Therefore, if the melancholy does not let go for more than two weeks, be sure to see a doctor: perhaps this is not just a breakdown and a bad mood. A specialist will help to cope with this.

Marat Kuzaev