About Migraine

What is Migraine?

Just about everyone has headaches. But migraine is not just a bad headache. It is an extremely debilitating collection of neurological symptoms that usually includes a severe recurring intense throbbing pain on one side of the head (although in 1/3 of migraine attacks, both sides are affected). Attacks last between 4 and 72 hours and are often accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. In 15-20% of attacks, other neurological symptoms occur in advance of the actual head pain. These symptoms, which last 20-60 minutes, are referred to as the aura phase of the headache. Of course, everyone is different, and symptoms vary by person and sometimes by attack.

Migraine is a syndrome, a collection of symptoms which arise from a common cause. A syndrome may occur in a complete form, with all of the typical symptoms, in a less complete form, with some symptoms, or in specific groupings of symptoms. Migraine is classified according to the grouping of its symptoms. Since symptoms vary widely, migraine is often misdiagnosed.

Many people who suffer from migraine begin by treating themselves with over-the-counter medications. Sufferers sometimes consult their doctor as symptoms become more severe and disabling. Doctors diagnose migraine by analyzing the symptoms, conducting medical tests and eliminating other possible causes of the headache. Diagnosis is not always easy, however. Migraine is a moving target: symptoms are hard to evaluate and can change from one attack to the next.
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Migraine is a Real Illness

Many people fail to realize that migraine is a real illness, like asthma or diabetes. Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine. Migraine sufferers visit the emergency room because of the severity of the pain or the fear of unremitting pain, drug reactions or side effects from headache medications, severe nausea or vomiting, dehydration, and/or stroke-like neurological symptoms that might accompany the headache.

Migraine ranks in the top 20 of the world's most disabling medical illnesses. Amazingly, over 10% of the population, including children, suffer from migraine. Nearly 1 in 4 U.S. households include someone with migraine. In addition to the attack-related disability, many sufferers live in fear knowing that at any time an attack could disrupt their ability to work or go to school, care for their families, or enjoy social activities. Less than 10% of sufferers are able to work or function normally during their migraine attacks. While most sufferers experience attacks once or twice a month, about 12 million people experience attacks on a near-daily basis.

About 18% of American women and 6% of men suffer from migraine. This translates to about 36 million people in the United States alone! American employers lose more than $13 billion each year as a result of 113 million lost work days.
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Children and Migraine

Unfortunately, migraine is also very common in children. It has been reported in children as young as 18 months old. About 10% of school-age children suffer from migraine. Half of all migraine sufferers have their first attack before the age of 12. Before puberty, boys suffer from migraine more often than girls. As adolescence approaches, the incidence increases more rapidly in girls than in boys.

Migraine often goes undiagnosed in children and adolescents. In childhood migraine, head pain is often less dramatic or severe than other symptoms, such as unexplained nausea or vomiting, abdominal pain, or dizziness. Moreover, it is not uncommon for attacks to occur with only minor or even no head pain, making it hard to diagnose. Motion sickness is an early warning of the predisposition to childhood migraine. In childhood, the non-headache symptoms are often referred to as migraine equivalents.

While symptoms of childhood and adolescent migraine may be different from those typically found in adults, children are just as disabled. Children who suffer from migraine are absent an average of 7.8 days from school each year, compared to 3.7 days of absence for children without migraine. Treatment for childhood and adolescent migraine depends on the age of the child and the frequency and severity of the attacks. Although there are well over 100 drugs used to prevent or treat migraine symptoms, none have been approved for use in children. However, they have been studied by researchers and are prescribed. Expert help from migraine doctors or centers specializing in migraine may be indicated for children for whom diagnosis is difficult or who don’t respond to typical first-line treatments.

For a list of centers that treat children click here.

Women and Migraine

Over 27 million women are affected by migraine in the United States today. Three times as many women as men suffer from migraine in adulthood. In childhood, boys are affected more than girls, but after adolescence, when estrogen influence begins in young girls, the risk of migraine and its severity rises in females. Estrogen adversely influences the brain receptors that play a role in migraine development. About half of affected women have more than one attack each month, and a quarter experience 4 or more severe attacks per month. More severe and more frequent attacks often result from fluctuations in estrogen levels.
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Treatment

Migraine treatment has changed dramatically over the years. In the past, doctors often diagnosed patients with disabling head pain as neurotic and dismissed their complaints as psychiatric in nature. Later, researchers believed that the dilation and constriction of blood vessels in the head were the primary source of the pain. Early migraine medications focused on the blood vessels as the principal target for treatment. The current theory of the source of migraine pain reflects the advances in technology that help us understand how the brain works. Researchers now believe that migraine is a disorder involving nerve pathways and brain chemicals. There is also evidence that links a number of genes to migraine, so that genetics is undoubtedly involved.

Migraine can often be managed with proper diagnosis and treatment. There are three principle approaches to treatment: acute, preventive, and complementary. Acute treatment uses drugs to relieve the symptoms of attacks when they occur. Preventive treatment uses drugs taken daily to reduce the number of attacks and lessen the intensity of pain. In some patients, life-style changes, biofeedback and other non-drug treatments can help avoid the triggering of attacks. Complementary treatment, which does not use drugs, includes biofeedback, relaxation techniques, acupuncture, exercise, and proper rest and diet.

Even with the correct diagnosis, treating migraine can be very difficult. There are well over 100 drugs, surgical treatments and devices used to prevent or treat migraine symptoms and choosing one or a combination that might work is time consuming and frequently requires expert help from doctors or centers specializing in the treatment of migraine.

For a list of doctors certified in headache medicine click here.
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Chronic Migraine (Chronic Daily Headache)

For about 12 million people episodic migraine progresses to chronic migraine (sometimes referred to as chronic daily headache) when attacks come nearly daily and are severe. Those who suffer from chronic migraine use a combination of acute, preventive, and complementary treatments to try to control or lessen the disabling pain. Depression, anxiety, and sleep disturbances are common for those with chronic migraine. These sufferers are often significantly disabled, and their overall quality of life is greatly diminished.

Although there are many contributing factors to the progression from episodic migraine to chronic migraine, medication overuse is the most common. Over-the-counter as well as prescription drugs can cause overuse headaches. Overuse is defined as using pain killers, triptans, or certain other medications more than 2-3 days per week, week after week and month after month. This can create a headache-worsening pattern that results in more headaches and the resulting need to take more medicine. Not only is the pattern itself harmful, but while in this cycle, other effective treatments often do not work. The only way out of this cycle is to stop the pattern of overuse, which should be done under a doctor’s care. Researchers are currently investigating the role of opiates and pain-killers in the progression to chronic migraine.
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Unanswered Questions

Migraine remains poorly understood and frequently mistreated. Researchers still do not understand many things about the causes of migraine, the role of genetics, the nature of pain, and the reasons why medications work only on some people and in some situations. As a result, sufferers often endure a lengthy process of trial and error to discover an effective treatment. Once a treatment is determined, it may not alleviate every attack, and it may prove ineffective over time. Some people suffer from several different types of migraine, making diagnosis and treatment that much more difficult.
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Role of the Migraine Research Foundation

Migraine is an enormous public health problem that has an impact on society, business, families, and, most importantly, on the individual sufferer. MRF raises funds for research to further the understanding of the causes and mechanisms of migraine, to develop improvements in treatment, and to find the cure. Read more about the cutting edge research we support.

Join our efforts to end the debilitating pain of migraine. Donate now

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Glossary of Terms

Click here for definitions of common terms about migraine and headache.

For more information

Visit our Resources & Links page for additional resources that provide further information about migraine, including organizations and publications.

View lists of doctors certified in headache medicine and headache centers for adults and children.

To read more about treatment options click here.

Disclaimer

The information provided here should not be used for the diagnosis, treatment, or evaluation of any medical condition. The Migraine Research Foundation has made every effort to ensure that the information is accurate; however, we cannot warranty its reliability, completeness, or timeliness.