Migraine

Migraine is a type of recurrent headache that occurs in episodes, causing symptoms such as throbbing headache, usually unilateral, and worsening with exercise. These episodes typically last between four hours and three days and can be debilitating, significantly affecting a person's quality of life.

Based on the frequency of episodes, migraines can be classified as:

• Infrequent episodic migraine: less than 9 times per month.
• Frequent episodic migraine: between 10 and 14 episodes per month.
• Chronic migraine: 15 or more episodes per month.

There are also different types of migraines based on symptoms, characteristics, or origin:

• Migraine with aura: This is the classic migraine. It was previously called ocular migraine, but the name was changed to avoid confusion with retinal migraine. Patients report the appearance of an aura (seeing flashing lights or wavy lines) before the headache begins.
• Migraine without aura: The most common type of migraine, characterized by a throbbing pain that affects only one side of the head.
• Vestibular migraine: Affects the vestibular system of the inner ear, causing vertigo and dizziness.
• Cervical migraine: Also known as cervicogenic headache, the pain originates from an injury or alteration in the cervical structure (fractures, dislocations, tumors, etc.).
• Menstrual migraine: A hormonal headache that occurs when estrogen levels drop.
• Complicated migraine: Associated with more severe symptoms that persist even after the headache subsides, such as numbness in certain parts of the body or difficulty speaking.
• Abdominal migraine: More common in children, causing abdominal pain accompanied by vomiting and a non-throbbing headache.
• Retinal migraine: Very rare and indicative of a severe condition. Visual changes occur only in one eye.

Migraine episodes usually begin during puberty, but those aged 35 to 45 are the most affected.

Symptoms

Migraine symptoms occur in different phases:

• Premonitory phase: May appear hours or days before the episode.
• Fluid retention.
• Yawning.
• Hypersensitivity to light and noise.
• Aura: Occurs only in some cases.
• Visual disturbances.
• Confusion.
• Difficulty speaking.
• Tingling sensations.
• Migraine:
• Throbbing headache, usually severe, affecting only one side of the head and worsening with physical activity. It may last a few hours or persist for days.
• Nausea and/or vomiting.
• Lack of concentration.
• Photophobia.
• Phonophobia.
• Prodromal phase:
• Fatigue.
• General discomfort.

Additionally, some types of migraines present symptoms such as abdominal pain, vomiting, vertigo, dizziness, or limb numbness.

Causes

Migraine occurs due to the dilation of cerebral arteries, although the exact causes of this inflammation are not entirely understood. Studies suggest that chemical imbalances in the brain or brainstem abnormalities may play a role. However, in most cases, migraines are linked to both genetic and environmental factors. Some of the main migraine triggers include:

• Stimulant drinks (alcohol or caffeine).
• Sleep disturbances.
• Physical exertion.
• Processed foods, excessively salty foods, or those with certain additives.
• Medications such as vasodilators or oral contraceptives.
• In women, hormonal changes during menstruation or pregnancy.
• High stress levels.

Risk Factors

The likelihood of experiencing migraines is higher in:

• Women, especially during hormonal changes such as menstruation, pregnancy, or menopause.
• Adolescents, as this is when the first episode typically occurs.
• Adults aged 30 to 45.
• People with a family history of migraines.
• Patients who frequently or excessively use painkillers.
• Individuals with hypertension.
• People who are overweight or obese.

Complications

The main complication of migraines is disability. During migraine attacks—and sometimes even afterward—patients may be unable to carry out daily activities. In fact, migraines are the second leading neurological cause of disability worldwide. The Spanish Neurology Society estimates that over 70% of chronic migraine patients in Spain experience severe disability.

Other less common complications include:

• Abdominal issues.
• Stroke.
• Brain hemorrhages.

Prevention

Preventing migraines is difficult due to their genetic component. However, leading a healthy lifestyle can reduce the risk of experiencing them. This includes exercising regularly, getting enough sleep, avoiding processed foods, and not consuming stimulant drinks.

When the first symptoms appear, the following measures can help:

• Resting in a calm environment.
• Turning off lights.
• Sleeping.
• Sometimes, cold compresses can relieve the pain.

Which Doctor Treats Migraines?

Neurologists diagnose and treat migraines. In early stages, especially during adolescence, pediatric neurologists may be involved.