What's a Migraine?

Migraine explanation treatment overview

/ Author:  / Reviewed by: Robert Carlson, M.D

You're having trouble speaking, weird colors are blinking, your head throbs with every tiny noise, and any bright light sends a searing pain straight into your brain. All of a sudden, you start throwing up. Am I having a stroke? Is this what meningitis feels like?

With these symptoms, you might be forgiven for thinking you're about to die, but for thousands of people who have chronic migraines, this is just another day.

Migraines are somewhat misunderstood because they can be so different from person to person, making diagnosis hard and treatment difficult. But with a little work on your part, and together with a dedicated doctor, most people can at least halve their amount of migraines.

In a migraine aura, vision loss, numbness, tingling, and difficulty talking are not unusual symptoms. Nausea and throbbing pain that's more sensitive to light and noise than a normal headache follows. Migraines start slowly, and without fever.

For most people with migraines, the special aura effects aren't included. Migraines are just another word for a deep, sensitive headache. As many as 20 percent of women and 10 percent of men will experience at least one during their lifetime.


The fascinating process behind the many weird effects of a migraine lies behind their complex, poorly understood electrical changes that affect the whole brain, a process known in the scientific literature as cortical spreading depression. Figuring out a way to stop that process hasn't been easy.

Some neuroscientists draw an analogy to an electrical storm in the brain causing some of the seemingly random symptoms of a full blown migraine - vomiting, visual problems and speech problems. The electrical storm starts at the back of the brain, where vision processing occurs, causing the blinking lights, and moves forward. Blood flow changes, which is why some people benefit from taking caffeine, and why some drugs affecting serotonin, like antidepressants or triptans, help migraines.

Keeping track of your daily activities, and figuring out what you did differently on days you had migraines is the best start to understanding what's going on. This headache diary can help you and your doctor understand what particular migraine triggers you have. Chocolate, caffeine, commercial perfumes, dehydration, even mild allergies to things like pet dandruff or pollen are the usual suspects.

Triggers can also be things like job stress, sleep loss, change in the menstrual cycle, or strong emotions like grief, anxiety, or depression.


Lifestyle changes, stress management, massages, and relaxation therapy may help change what's causing your migraines. When those fail to resolve the problem, we turn to solutions that come in pill form. For most migraines, a large dose of aspirin, Tylenol, Aleve, or Advil does the job.

After that, proper migraine treatment has two sides to it. The general treatment for a patient with more than ten migraines a month is to try several classes of drugs as a preventative. Tricyclics, beta blockers, calcium channel blockers all work to counteract some of the causes of migraines, reducing the frequency of migraines.

There is some evidence that stress related migraines can be treated with injections of Botox, if it is done by a skilled professional. This chemical relaxation of the muscles of the neck and face works in some patients.

Other patients find success with vitamin supplements such as magnesium, or taking several kinds of B vitamins together.

Migraines might be a sign of serious chemical imbalance, and antidepressant medications work for some people, often in part due to the shared relationship between the chemical found in the brain known as serotonin, which is involved in both depression and migraines.

A Quick Fix

When it comes to needing an immediate solution for a severe migraine, treatments are more promising. Researchers in the 1950s noticed that patients given LSD experienced instantaneous relief of their headaches. The powerful triptan class of migraine medication, derived from the non-hallucinogenic parts of LSD, is available by prescription.

At 20-50 dollars a pill, triptans can be expensive, but are well worth it. Injectible forms are also available if you feel too sick to keep a pill down. Due to how they work, if you have high blood pressure, heart problems, or especially if you're pregnant, triptans are off the table.

Triptans work best if taken immediately and can almost magically stop a migraine in its tracks, but don't work very well if you wait too long after it starts.

While a visit to the ER may not be very helpful, if your first migraine is painful enough, you might be worried it's something else and peace of mind is invaluable. Muscle relaxants together with high doses of common headache and anti nausea drugs intravenously can be surprisingly effective in reducing emergency-level migraine pain to something more manageable and might be worth suggesting.

While painful, migraines do not have to change your life and can nearly always be managed. A thorough exam and history by a properly trained headache specialist or neurologist is invaluable, and may reveal something you didn't consider.

Review Date: 
April 16, 2012