Migraine Headache

  • Medical Author:
    Danette C. Taylor, DO, MS, FACN

    Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.

  • Medical Editor: Benjamin Wedro, MD, FACEP, FAAEM
    Benjamin Wedro, MD, FACEP, FAAEM

    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Quick GuideHeadache Pictures Slideshow: A Visual Guide to Migraine Headaches

Headache Pictures Slideshow: A Visual Guide to Migraine Headaches

What are the signs and symptoms of migraines?

The most common symptoms of migraine are:

  • Severe, often "pounding," pain, usually on one side of the head
  • Nausea and/or vomiting
  • Sensitivity to light
  • Sensitivity to sound
  • Eye pain

The International Headache Society defines episodic migraine as being unilateral, pulsing discomfort of moderate-to-severe intensity, which is aggravated by physical activity and associated with nausea and/or vomiting as well as photophobia and/or phonophobia (sensitivity to light and sound). A migraine headache typically lasts for several hours up to several days.

Many patients describe their headache as a one-sided, pounding type of pain, with symptoms of nausea and sensitivity to light, sound, or smells (known as photophobia, phonophobia, and osmophobia). In some cases, the discomfort may be bilateral. The pain of a migraine is often graded as moderate to severe in intensity. Physical activity or exertion (walking up stairs, rushing to catch a bus or train) will worsen the symptoms.

Up to one-third of patients with migraines experience an aura, or a specific neurologic symptom, before their headache begins. Frequently, the aura is a visual disturbance described as a temporary blind spot which obscures part of the visual field. Flashing lights in one or both eyes, sometimes surrounding a blind spot, have also been described. Other symptoms, including numbness or weakness along one side, or speech disturbances, occur rarely.

Some people describe their visual symptoms of loss of vision, which lasts for less than an hour, and may or may not be associated with head pain once the vision returns, as an ocular migraine. These symptoms are also known as retinal migraine, and may be associated with symptoms similar to those described as an aura, such as blind spots, complete loss of vision in one eye, or flashing lights. If a patient experiences these symptoms regularly, evaluation to exclude a primary retinal problem is needed.

Eye pain which is different from sensitivity to light is not a common component of migraine. If eye pain is a persistent symptom, or if eye pain is present and accompanied by blurred vision or loss of vision, then prompt evaluation is recommended.

In comparison, a tension headache is described as being bilateral and the pain is not pulsating, but feels like pressure or tightness. While severity can be mild-to-moderate, the headache is not disabling and there is no worsening of the pain with routine physical activity; additionally, there is no associated nausea, vomiting, photophobia, or phonophobia.

No specific physical findings are found when patients are experiencing a routine migraine headache. If an abnormality is identified on physical examination, there should be suspicion of another cause for the headache.

How are migraines diagnosed?

According to the International Classification of Headache Disorders II (ICHD-II) criteria for migraine without aura, a patient must have had at least five headache attacks fulfilling the following criteria:

  • Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)
  • The headache has at least two of the following characteristics:
    • Unilateral location
    • Pulsating quality
    • Moderate or severe pain intensity
    • Aggravation by or causing avoidance of routine physical activity (for example, walking or climbing stairs)
  • During the headache, at least one of the following characteristics:
    • Nausea and/or vomiting
    • Photophobia and/or phonophobia
  • The headache cannot be attributed to another disorder

Imaging the brain with an MRI and CT scans or performing a brain wave test (electroencephalogram [EEG]) is not necessary if the patient's physical examination is normal.

Medically Reviewed by a Doctor on 3/2/2016
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