Migraine

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Symptoms & Causes Diagnosis & Treatment

What is a Migraine?

Migraines are more than just headaches; they are a neurological condition that can significantly impact daily life. Characterised by intense, throbbing pain, usually on one side of the head, migraines often come with nausea, vomiting, and heightened sensitivity to light and sound.

For some, migraines are preceded by warning signs or an aura, which can include visual disturbances or tingling sensations. Understanding the causes and symptoms of migraines is crucial for effective management and prevention.

What Causes Migraines?

The exact cause of migraines remains unclear, but researchers believe a combination of genetic and environmental factors plays a role. Below are some of the key contributors:

Brainstem and Nerve Interactions

Changes in the brainstem and its interaction with the trigeminal nerve, a major pain pathway, are thought to be involved in migraine development. These changes may amplify pain signals, leading to migraine episodes.

Chemical Imbalances

Imbalances in brain chemicals, particularly serotonin, are linked to migraines. Serotonin helps regulate pain in the nervous system, and its fluctuation may trigger migraine attacks.

Additionally, calcitonin gene-related peptide (CGRP) is another chemical messenger implicated in migraine pain.

Common Migraine Triggers

  • Hormonal changes: Menstruation, pregnancy, menopause, or hormonal medications
  • Dietary triggers: Aged cheeses, processed foods, MSG, aspartame, skipping meals
  • Alcohol and caffeine: Especially red wine and excess caffeine
  • Stress: Work-related or emotional stress
  • Environmental stimuli: Bright lights, loud sounds, or strong smells (perfume, paint)
  • Sleep patterns: Too much or too little sleep
  • Physical exertion: Intense activity, including sexual activity
  • Weather changes: Barometric pressure fluctuations
  • Medications: Vasodilators like nitroglycerin

Migraine Symptoms: How to Recognise a Migraine

Migraines can affect people of all ages and often progress through four distinct stages: prodrome, aura, attack, and postdrome. However, not everyone experiences all stages.

Aura

Some people experience an aura before or during a migraine. Symptoms include:

  • Visual disturbances (flashes of light, blind spots, zigzag patterns)
  • Vision loss or blurring
  • Tingling or numbness (usually on one side)
  • Speech or language difficulties

Attack (The Migraine Itself)

The migraine phase can last from 4 to 72 hours if untreated. Key symptoms include:

  • Throbbing or pulsating pain (usually on one side)
  • Sensitivity to light, sound, or smells
  • Nausea and vomiting

Postdrome (After the Migraine)

Post-attack symptoms may last up to a day:

  • Fatigue or exhaustion
  • Mood changes (elation or depression)
  • Difficulty concentrating
  • Mild headache upon movement

When to Seek Medical Attention

Seek urgent care if you experience:

  • A sudden, severe headache (“thunderclap headache”)
  • Headache with fever, stiff neck, confusion, seizures, or double vision
  • Headaches following trauma or that worsen with coughing or exertion
  • New headache pain after age 50

At Subang Jaya Medical Centre (SJMC), our expert team includes experienced neurologists who can assess your condition, recommend diagnostic testing, and help develop a personalised management plan.

If you suffer from frequent or severe migraines that affect your daily life, seeing a neurologist can help uncover underlying causes and explore advanced treatment options.

Risk Factors for Migraines

  • Family history: Having a close relative with migraines increases your risk
  • Age: Most people experience their first migraine in adolescence, with frequency peaking in their 30s
  • Sex: Women are three times more likely than men to have migraines
  • Hormonal shifts: Changes during menstruation, pregnancy, or menopause can trigger or intensify migraines

Complications of Migraines

One significant complication is medication-overuse headaches. Frequent use of painkillers, such as aspirin, ibuprofen, or triptans, can lead to a cycle where medications stop relieving pain and instead cause headaches.

This condition underscores the importance of consulting a healthcare provider for proper migraine management.

FAQs About Migraine Symptoms and Causes

Early warning signs of a migraine that are often overlooked include frequent yawning, fluid retention, and subtle mood changes such as irritability or sudden elation. These symptoms may appear one or two days before the migraine begins.

Yes, migraines can occur without head pain. This is known as a silent migraine or acephalgic migraine. In such cases, individuals may experience other symptoms like aura, nausea, or sensitivity to light and sound without the typical headache. However, this is extremely rare, and other pathological causes need to be excluded, such as seizures.

Hormonal changes, particularly fluctuations in estrogen levels, can trigger migraines. This is why migraines are common during menstrual periods, pregnancy, or menopause. Hormonal medications like oral contraceptives may also influence migraine frequency.

Yes, migraines often run in families. If one or both of your parents have a history of migraines, you are more likely to experience them as well. This suggests a genetic predisposition to the condition.

Migraines are believed to involve changes in the brainstem and its interaction with the trigeminal nerve, which is a major pain pathway. This interaction often localises pain to one side of the head, although it can affect both sides in some cases.

Weather changes, particularly shifts in barometric pressure, can trigger migraines by affecting the brain's chemical balance and blood flow. People sensitive to weather changes may notice migraines during storms, high humidity, or sudden temperature fluctuations.

Migraines often peak in frequency and intensity during a person’s 30s and tend to become less frequent with age. However, for some individuals, migraines may persist or even worsen due to factors like hormonal changes, stress, or other health conditions.

Yes, dehydration is a common trigger for migraines. When the body lacks adequate hydration, it can lead to changes in blood volume and brain function, which may provoke a migraine episode.

Reference

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