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Understanding Migraines: Types, Symptoms, Phases, Diagnosis, Management, and More

Dr. Craig Smith, MD

4 Min read

Migraines, complex neurological disorders affecting approximately 1 in 7 people globally, are characterized by recurrent, intense headaches often accompanied by nausea, sensitivity to light and sound, and, in some cases, neurological symptoms known as auras. This article delves into the intricate details of migraines, encompassing their various types, symptoms, forms, phases, considerations for pediatric cases, the diagnostic process, and comprehensive insights into treatment approaches, including both acute relief during migraine attacks and preventive measures.

Types of Migraines:

  • Migraine without Aura: This common type, experienced by 70-90% of migraine sufferers, involves moderate to severe pulsating headaches. Triggers can include stress, lack of sleep, and specific foods, necessitating lifestyle adjustments for management.

  • Migraine with Aura: Affecting some individuals, auras precede headaches and can manifest as visual disturbances, sensory changes, or motor abnormalities. These auras typically last between 20 minutes to an hour and offer a warning sign of an impending migraine.

  • Chronic Migraine: More prevalent in women, chronic migraines are diagnosed when headaches occur on 15 or more days per month. Managing chronic migraines often involves a multifaceted approach, combining medications and lifestyle modifications.

  • Menstrual Migraine: Hormonal fluctuations, particularly changes in estrogen levels, trigger migraines. These migraines can be more severe and longer-lasting than non-menstrual migraines.

Symptoms of Migraines:

  • Headache: Throbbing or pulsating pain, often on one side of the head. Physical activity can worsen the pain during an episode.

  • Aura Symptoms: Visual disturbances such as flashing lights or blind spots. Sensory auras involving tingling or numbness. Motor auras resulting in difficulty speaking or temporary paralysis.

  • Nausea and Vomiting: Nausea is a common symptom, and vomiting can occur in severe cases during a migraine episode.

  • Sensitivity to Light and Sound: Photophobia (light sensitivity) and phonophobia (sound sensitivity) are prevalent during migraines.

Forms and Phases of Migraines:

  • Prodrome Phase: Mood swings, food cravings, and increased thirst can signal an impending migraine. Recognizing prodromal symptoms can aid in early intervention.

  • Aura Phase: Lasting 20 minutes to an hour, auras offer unique neurological symptoms before the headache begins. Understanding auras aids in distinguishing migraines from other headaches.

  • Attack Phase: The actual headache occurs, accompanied by nausea, sensitivity to stimuli, and potential aura symptoms. Can last from a few hours to several days.

  • Postdrome Phase: Exhaustion, confusion, or elation may follow the headache, known as the "migraine hangover." This phase highlights the importance of post-attack self-care.

Pediatric Considerations:

Migraines can affect children, often presenting with abdominal pain or dizziness. Identifying triggers in children may require close observation and communication due to differences in expression.


  • Medical History: A detailed account of symptoms, including their frequency and triggers. Recognition of patterns aids in accurate diagnosis and personalized treatment plans.

  • Neurological Examinations: Essential to rule out other neurological conditions. Evaluates reflexes, coordination, and sensory perception.

  • Imaging Studies and Blood Tests: Conducted to rule out underlying causes such as tumors or vascular issues.

Treatment Approaches for Migraines:

Acute Treatment:

  • Over-the-Counter Pain Relievers: Non-prescription pain relievers like acetaminophen, ibuprofen, or aspirin can provide relief for mild to moderate migraines. These medications are most effective when taken at the onset of symptoms.

  • Triptans: Triptans are prescription medications designed to alleviate moderate to severe migraines by narrowing blood vessels and reducing inflammation. They are available in various forms, including oral tablets, nasal sprays, and injections.

  • Anti-Nausea Medications: Medications like metoclopramide or prochlorperazine can help alleviate nausea and vomiting associated with migraines. These are often used in conjunction with other acute treatments.

  • Caffeine: In some cases, combining pain relievers with caffeine can enhance their effectiveness. However, excessive caffeine intake should be avoided to prevent rebound headaches.

Preventive Treatment:

  • Prescription Medications: For individuals experiencing frequent or severe migraines, preventive medications may be prescribed. Options include beta-blockers, anticonvulsants, tricyclic antidepressants, and CGRP inhibitors.

  • Botox Injections: Botulinum toxin injections, commonly known as Botox, have been approved as a preventive treatment for chronic migraines. Injections are administered every 12 weeks around the head and neck.

  • Calcitonin Gene-Related Peptide (CGRP) Inhibitors: These relatively newer medications target the CGRP pathway involved in migraine attacks. Administered through self-injections, they have shown efficacy in reducing migraine frequency.

Lifestyle Modifications:

Identifying and managing triggers through lifestyle changes is crucial for preventing migraines. This may include maintaining regular sleep patterns, managing stress through relaxation techniques, and avoiding specific foods or environmental factors.

Alternative and Complementary Therapies:

  • Acupuncture: Acupuncture involves the insertion of thin needles into specific points on the body to promote energy flow and alleviate pain. Some migraine sufferers find relief and reduced frequency through acupuncture.

  • Biofeedback: Biofeedback uses electronic monitoring to help individuals gain better control over physiological processes, such as muscle tension and heart rate. Learning to control these factors can reduce the frequency and intensity of migraines.

  • Herbal Supplements: Butterbur and feverfew are herbal supplements that have shown promise in migraine prevention. However, it's crucial to consult with a healthcare professional before incorporating herbal remedies due to potential interactions and side effects.

Emerging Treatments and Therapies:

  • Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It has shown promise in reducing the frequency of migraines.

  • Monoclonal Antibodies: These antibodies, targeting specific molecules involved in migraine attacks, are under investigation for their preventive potential. Monoclonal antibodies like erenumab have been approved for chronic migraine prevention.

In conclusion, managing migraines is a dynamic process that often requires a combination of acute and preventive approaches tailored to the individual. Collaboration with healthcare professionals is crucial to determine the most effective treatment plan. As ongoing research continues to unravel the complexities of migraines, new and more targeted treatments may emerge, offering hope for enhanced relief and improved quality of life for those affected by this challenging condition. If you are experiencing migraines, consult with a healthcare provider to explore the most suitable treatment options for your specific situation.

About the Author

In 1984, Dr. Craig Smith founded Lifesource. As a coach, he's worked with world-class athletes and guided thousands towards successful weight loss. Driven by a desire to elevate his understanding of the human body, he returned to the rigors of medical school in his 50s, achieving his goal of becoming a physician at 56. Now in his 60s, Dr. Smith leads by personal example, continuing to inspire, educate and empower individuals from all walks of life to achieve their health and fitness goals. If you wish to train and diet online with Dr. Smith, hear his message and schedule a 45-minute consultation on the New You page.