Migraines

Migraines are headaches that involve recurring attacks of moderate to severe pain. The pain is usually a throbbing or pulsing pain, and it is often on one side of the head. During migraines, people are very sensitive to light and sound. They may also become nauseated and vomit.

Many things can trigger a migraine, including stress, anxiety, lack of sleep, hunger, diet changes, exposure to light, or hormonal changes. There may also be a genetic cause of migraine. Migraine headaches often begin in childhood, adolescence, or early adulthood.

Migraine is 3 times more common in women than in men. It affects approximately 1 in 10 people worldwide. Some people can tell when they are about to have a migraine because they see flashing lights or zigzag lines or they temporarily lose their vision. Migraines can last hours to days. Medicines can reduce the severity and frequency of migraines, and lifestyle changes can help avoid triggers that cause migraines.

The exact cause of migraines is not clear, but genetics and environmental factors appear to play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in chemicals found naturally in the brain, including serotonin, which helps regulate pain in your nervous system, may also be involved.

Regardless of the exact mechanism of migraine, many factors may trigger them. Common migraine triggers include:

• hormonal changes, especially in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Other women have an increased tendency to develop migraines during pregnancy or menopause.
• foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
• food additives. The sweetener aspartame and the preservative monosodium glutamate, found in many foods, may trigger migraines.
• drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
• stress. Stress at work or home can cause migraines.
• sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells, including perfume, paint thinner, and secondhand smoke, can trigger migraines in some people.
• changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
• physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• changes in the environment. A change of weather or barometric pressure can prompt a migraine.
• medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Several risk factors increase the likelihood of having migraines.

• family history. Most people with migraines have a family history of migraine attacks.
• age. Migraines can begin at any age, though most people experience their first migraine during adolescence. Most people who have migraines have had their first attack by the age of 40 years old.
• sex. Women are 3 times more likely to have migraines than men. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.
• hormonal changes. In women, migraines may begin just before or shortly after onset of menstruation. Migraine patterns may also change during pregnancy or menopause. Generally, migraines improve after menopause.

See your doctor if headaches are frequent or severe or do not respond to usual treatment. Get emergency help for the 'worst headache of your life,' or a headache with weakness, trouble speaking, vision loss, fever, or a stiff neck.