Migraine 101 — Lets Start with the Basics

Have you recently been diagnosed with Migraine? Have you had Migraines for a while, but now they're getting serious enough that you need to learn more about them? Or maybe it's been a long time since you read anything about Migraines? If any of those apply to you, this article is for you.


This article will outline some basic information that we should all have and give you a good foundation for working with your doctor toward effective Migraine treatment and better Migraine management. There's more you'll want to know, but this will get you started.



What Is Migraine?


Migraine is a genetic neurological disease thought to be caused by genetic predisposition and a hyperexcitable brain. People searching for Migraine in their family history often encounter people in their family who have or had "sick headaches" or "sinus headaches." These are most likely Migraine. In previous generations, when less was known about Migraine, they were often referred to as "sick headaches." Many people think they have sinus headaches because of pain in the sinus area. Others are misdiagnosed with sinus headaches. Studies have show that approximately 90% of what patients think are sinus headaches are actually Migraines.



Who Gets Migraine?


Migraine can begin at any age — from preverbal children to the elderly. It affects 18% of women and 6-8% of men. Women are often told that their Migraines will stop after menopause. This isn't necessarily accurate. Many women's Migraines continue after menopause.



How Is Migraine Diagnosed?


There are no diagnostic tests to confirm a diagnosis of Migraine. It's what's called a "diagnosis of exclusion." Migraine is diagnosed by reviewing the patient's medical history and their family medical history, discussing and reviewing their symptoms, completing an examination, and ruling out other causes for their symptoms.


Migraine can present with some of the same symptoms as stroke, aneurysm, brain tumor, and other medical issues, so ruling out other issues before arriving at a diagnosis of Migraine is important. Imaging studies may or may not be necessary for diagnosis if the symptoms clearly fit Migraine, especially if there is a family history of Migraine.



A Complete and Accurate Migraine Diagnosis?


A simple diagnosis of Migraine is not complete. There are several different forms of Migraine, and knowing which form or forms we have can be important to choosing appropriate treatment options. Standardizing Migraine diagnoses simplifies matters by keeping everyone "on the same page." The gold standard for diagnosing Migraine and other Headache disorders is the International Headache Society's International Classification of Headache Disorders, Third edition (ICHD-3).


ICHD-3 recognizes the following forms of Migraine, syndromes that are common precursors of Migraine, and complications of Migraine:


1.1 Migraine without aura

1.2 Migraine with aura

1.2.1 Migraine with typical aura Typical aura with headache Typical aura without headache

1.2.2 Migraine with brainstem aura (formerly called basilar Migraine)

1.2.3 Hemiplegic Migraine Familial hemiplegic Migraine Sporadic hemiplegic migraine

1.2.4 Retinal Migraine

1.3 Chronic Migraine

1.4 Complications of Migraine

    1.4.1 Status migrainosus

    1.4.2 Persistent aura without infarction

    1.4.3 Migrainous infarction

    1.4.4 Migraine-triggered seizures

1.5 Probable migraine

    1.6.1 Probable migraine without aura

    1.6.2 Probable migraine with aura

1.6 Episodic syndromes that may be associated with Migraine

    1.6.1 Recurrent gastrointestinal disturbance vomiting

1.3.2 Abdominal migraine

1.6.2 Benign paroxysmal vertigo

1.6.3 Benign paroxysmal torticollis



In the appendix of ICHD-3, there is also listed vestibular Migraine. The purpose of the appendix is to present

research criteria for a number of novel entities that have not been sufficiently validated by research conducted so far. In many cases, diagnoses listed in the appendix of the ICHD-3 will be moved into the main portion of the document as an "official" diagnosis in the next edition. This was the case with chronic Migraine, which was in the appendix of ICHD-2.


A note on chronic migraine. A diagnosis of chronic Migraine should also include the form or forms of Migraine. For example — chronic Migraine without aura, chronic familial hemiplegic Migraine, etc.




How Is Migraine Treated?


There are three main types of Migraine treatment:


  1. Preventive Treatment. It's recommended that we explore preventive treatment if we have three or more Migraine attacks a month, or if our Migraines are especially severe or debilitating. For more information in prevention, see A Plethora of Migraine Prevention Options.
  2. Abortive Treatment. Abortive treatments stop the Migrainous process in the brain, thus ending the Migraine attack and its symptoms. Abortive treatments include:
    1. Triptans:
      1. sumatriptan (Imitrex),
      2. rizatriptan (Maxalt),
      3. zolmitriptan (Zomig),
      4. naratriptan (Amerge),
      5. almotriptan (Axert),
      6. eletriptan (Relpax), and
      7. frovatriptan (Frova).
      8. Treximet is a combination of sumatriptan and naproxen sodium.
    2. Dihydroergotamine
      1. DHE 45 injectable, and
      2. Migranal Nasal Spray.
    3. Midrin Equivalent Medications. Brand name Midrin has been taken off the market, and it will not be returning. There are, however, a couple of medications with the same ingredients that are still available.
    4. The Spring TMS Device. The Spring TMS device is a transcranial magnetic stimulation device that is FDA approved for the acute treatment of Migraine with aura. As with other treatments, it doesn't work for everyone, but when it works, it can abort Migraine attacks without the need for abortive medications.
  3. Rescue Treatment. Rescue treatments are those we use when our abortives fail, or if we cannot use abortives. Most of these treatments can't abort a Migraine, but are used to provide relief of pain and other symptoms. Commonly prescribed rescue medications for patients to use at home include:
    1. NSAIDs such as indomethacin, ibuprofen, and ketorolac;
    2. Muscle relaxants such as tizanidine and others;
    3. Antihistamines such as diphenhydramine (Benadryl);
    4. Pain medications; and
    5. Medications for relief of nausea and other symptoms.


Opioids and barbiturates are sometimes prescribed for rescue treatment, but should be reserved for rare rescue use since their use can increase the frequency of Migraines and make Migraine management more difficult.


In addition to the medications listed above, medications are sometimes prescribed for relief of symptoms such as nausea, vomiting, and diarrhea. Sometimes, these are taken in addition to and at the same time as abortive medications.



Reviewed by David B. Watson, MD.


© Teri Robert, 2016. All rights reserved.
last updated August 6, 2016.



All content © Teri Robert, 2004 - Present, unless otherwise noted.  All rights reserved.

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