Migraines
Composed By Muhammad Aqeel Khan
Date 12/12/2025
Composed By Muhammad Aqeel Khan
Date 12/12/2025
Migraines are more than just severe headaches, they are a neurological migraine disorder that affects more than one billion people worldwide. Characterized by intense, throbbing migraine pain, sensory disturbances, nausea, and cognitive impairment, migraines can significantly disrupt daily life and productivity. Understanding what a migraine is, what causes it, and how to treat it is essential for effective long-term migraine management.
What Is a Migraine? How Migraines Differ from Regular Headaches
A migraine is a recurrent neurological condition involving abnormal brain activity that affects nerve pathways, blood vessels, and chemical signaling. Unlike regular tension headaches, migraines are typically:
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Throbbing or pulsating
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Unilateral (affecting one side of the head)
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Moderate to severe in intensity
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Worsened by physical activity
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Accompanied by nausea, vomiting, light/sound sensitivity, or sensory changes
Researchers suggest that migraines stem from cortical spreading depression (a wave of electrical activity in the brain), along with imbalances in neurotransmitters such as serotonin and activation of the trigeminal nerve, which triggers inflammatory responses and vascular changes.
Types of Migraines
Understanding the types of migraines helps with diagnosis and treatment.
1. Migraine Without Aura
The most common type. Symptoms include:
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Throbbing head pain
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Nausea
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Sensitivity to light and sound
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Hours to days of disability
2. Migraine With Aura
Aura consists of reversible neurological symptoms that occur before or during the attack, such as:
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Zigzag lines or flashing lights
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Blind spots (scotomas)
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Tingling in the face or hands
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Temporary speech difficulties
3. Chronic Migraine
Defined as:
Headache occurring ≥15 days per month for at least 3 months, with at least 8 days of migraine symptoms.
Chronic migraine severely affects workplace productivity, emotional well-being, and daily functioning.
4. Vestibular Migraine
These involve dizziness, vertigo, and balance issues, often without head pain.
5. Hemiplegic Migraine
A rare form causing temporary paralysis or weakness on one side of the body, mimicking a stroke. Medical evaluation is essential.
Common Migraine Symptoms
Migraine symptoms can vary but often include:
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Intense, throbbing headache
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Nausea or vomiting
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Visual disturbances
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Fatigue or confusion
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Sensitivity to light, sound, smell, or touch
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Neck stiffness or pressure
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Difficulty concentrating
Symptoms typically progress through four phases: prodrome, aura, attack, and postdrome. Many patients feel “drained” for up to 24 hours afterward.
Migraine Causes: Why Do People Get Migraines?
The exact cause is complex and multifactorial. Research shows migraines are influenced by genetic, hormonal, environmental, dietary, and lifestyle factors.
1. Genetic Factors
Over 38 genetic variants have been linked to migraines. If one parent has migraines, the child has a 50% chance of developing them.
2. Brain Chemistry and Serotonin
Fluctuations in serotonin affect pain pathways and may trigger cortical spreading depression.
3. Hormonal Changes
Migraines are more common in women, especially around:
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Menstruation
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Ovulation
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Pregnancy
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Perimenopause
This is linked to changes in estrogen levels.
4. Environmental and Sensory Triggers
Common migraine triggers include:
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Bright or flickering lights
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Loud noises
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Weather changes or barometric pressure drops
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Strong odors (perfumes, chemicals)
5. Dietary Triggers
Some individuals are sensitive to:
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Aged cheeses
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Chocolate
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Red wine or alcohol
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MSG
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Processed meats with nitrates
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Artificial sweeteners
6. Lifestyle Factors
Irregular habits are major contributors:
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Sleep deprivation or oversleeping
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High stress
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Skipping meals
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Dehydration
How Migraines Affect Daily Life and Well-Being
Migraines can severely affect:
1. Daily Functioning
Attacks may impair:
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Driving
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Reading
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Screen use
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Household tasks
2. Workplace Productivity
Migraine is a leading cause of lost workdays. The World Health Organization ranks migraines among the top causes of disability globally.
3. Mental and Emotional Health
Chronic migraine is associated with:
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Sleep disorders
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Social withdrawal
4. Long-Term Health
While migraines themselves do not usually cause neurological damage, migraine with aura slightly increases the risk of:
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Stroke (especially in women who smoke or use estrogen-based contraceptives)
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Cardiovascular disease
References: World Health Organization; Burch et al., Headache, 2019.
How Migraines Are Diagnosed
Diagnosis is based on:
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Patient history
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Symptom patterns
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Physical and neurological examinations
Doctors may use the ICHD-3 criteria. Imaging (CT or MRI) is recommended only when symptoms suggest other conditions, such as stroke or tumors.
Migraine Treatment: How to Treat Migraines
Migraine treatment includes acute treatments, preventive therapies, and lifestyle modifications. Combining methods often yields the best results.
1. Acute Migraine Treatment (for stopping an attack)
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NSAIDs (ibuprofen, naproxen)
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Triptans (sumatriptan, rizatriptan)
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Gepants (ubrogepant, rimegepant)
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Ditans (lasmiditan)
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Antiemetics for nausea
Resting in a dark, quiet room can also help.
2. Preventive Medications (to reduce frequency)
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Beta-blockers: propranolol, metoprolol
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Anticonvulsants: topiramate, valproate
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Antidepressants: amitriptyline, venlafaxine
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Botox injections (effective for chronic migraine)
3. CGRP Inhibitors — A Breakthrough in Migraine Prevention
CGRP (Calcitonin Gene-Related Peptide) plays a major role in migraine pain. New drugs target this pathway:
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Erenumab
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Fremanezumab
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Galcanezumab
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Eptinezumab
These may significantly reduce monthly migraine days with fewer side effects.
Migraine Prevention: Lifestyle Changes, Natural Remedies, and Trigger Management
Lifestyle-based migraine prevention is often as important as medication.
1. Sleep Hygiene
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Go to bed and wake up at the same time daily.
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Avoid screens 1 hour before sleep.
2. Hydration and Nutrition
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Drink enough water throughout the day.
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Keep a food diary to identify personal triggers.
3. Stress Reduction
Stress is one of the most common migraine triggers. Helpful strategies include:
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Progressive muscle relaxation
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Yoga or tai chi
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Meditation or mindfulness apps
4. Natural Remedies for Migraines (Evidence-Supported)
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Magnesium supplements
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CoQ10
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Butterbur (PA-free extracts only)
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Feverfew (mixed evidence)
5. Regular Exercise
Moderate, consistent exercise reduces attack frequency but sudden strenuous exercise may trigger migraines in some individuals.
6. Trigger Management
Using a migraine diary helps identify:
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Foods
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Stressors
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Environmental changes
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Sleep patterns
7. Digital Tools
Migraine tracking apps can assist with pattern recognition and prevention strategies.
Conclusion
Migraines are a complex neurological disorder with far-reaching effects on health, productivity, and quality of life. While there is no permanent cure yet, modern medicine offers powerful treatments from triptans and gepants to CGRP inhibitors alongside natural and lifestyle-based strategies that reduce frequency and severity.
Understanding migraine symptoms, causes, triggers, and types empowers individuals to take control of their condition. With the right combination of medication, prevention strategies, stress management, and healthy habits, most people can significantly improve migraine control and daily well-being.
References
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Charles, A. (2018). The pathophysiology of migraine. New England Journal of Medicine.
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Goadsby, P. et al. (2017). Migraine—current understanding and treatment. NEJM.
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International Classification of Headache Disorders (ICHD-3), 2018.
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Lipton, R., et al. (2020). Migraine epidemiology and burden. Lancet Neurology.
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Silberstein, S. (2018). Migraine pathophysiology. Brain.
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Dodick, D. (2018). CGRP inhibitors in migraine prevention. Lancet.
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American Migraine Foundation (AMF).
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Sun-Edelstein, C., & Mauskop, A. (2009). Dietary supplements in migraine prevention. Headache.