Migraines

How common are migraine headaches? 

The World Health Organization (WHO) has estimated that one out of every seven adults is affected by migraine, and worldwide prevalence is believed to be more than 10%. Migraines are three times more common in women than men.

What causes migraine headaches?

Migraine headaches are believed to be caused by a combination of various genetic and environmental factors. They are likely precipitated by various triggers, and sufferers are likely to have a genetically determined reduced threshold for these triggers. This means that the brain is essentially more sensitive to things like hormonal changes and exposure to certain chemicals or products. 

The proposed mechanisms that cause migraine headaches are not well understood. Changes in brain metabolism, activation of nerve networks, and the release of inflammatory chemicals are believed to cause the pain and accompanying symptoms experienced during a migraine.

What makes a migraine headache different from other headaches?

Migraines are different from other headache types because they tend to be very painful and have other associated symptoms, which are often debilitating. The term migraine headache is often misused for severe headaches of other types, but migraines are recurrent and have distinguishing features. 

Nausea, vomiting, light-or-sound sensitivity, and activity intolerance are common migraine features. They tend to be one-sided more often than tension headaches, and a sensory aura precedes or accompanies the pain for some who suffer from them. Migraines are also associated with a high degree of impairment and are the third leading cause of global disability in people under age 50.

Are migraine headaches hereditary (do they run in families)?

It is believed that migraines are likely inherited in most cases, although no clear inheritance pattern has been identified. More than half of all people who suffer from migraines report having a family member who also has been affected by these headaches. 

The common forms of migraines probably involve multiple genes plus environmental factors. Specific genes identified that are linked with these types of headaches are the KCNK18 and CSNK1D genes.

A form of migraine called “familial hemiplegic migraine (FHM)” does exist and is associated with mutations in a few specific genes. A sporadic form of hemiplegic migraine also exists. Hemiplegic migraines are rare, and symptoms involve a migraine headache and weakness on one side of the body. Individuals typically also have other neurological signs and symptoms including migraine aura, vision loss, and speech changes. 

What is meant by the term “atypical” migraines?

An atypical or “complex” migraine usually has a prolonged aura in which an individual will experience neurological symptoms. Typically, a migraine aura will last less than one hour and symptoms completely resolve during this time. 

An aura can include vision changes such as seeing colors or shapes, sensory changes, and less often, language difficulties or motor issues, like weakness to one side of the body. When someone suffers from an atypical or complex migraine, they may experience neurological symptoms like weakness or vision loss that lasts over an hour and can be confused for stroke symptoms or even a seizure. 

It is important to note that people who do experience atypical or complex migraines should be seen in person for a complete neurological examination and testing, if indicated.

What are red flag symptoms, things that when associated with a headache require urgent evaluation?

There are several symptoms that would warrant an emergeny evaluation if they occur with a headache, including fever, chills, vomiting, body aches, weight loss, and night sweats. Individuals who develop an acute headache and have a history of cancer, immune system dysfunction (including HIV), or who are pregnant or in the immediate postpartum period should be evaluated promptly. New onset headaches in individuals older than age 50 should be further investigated.

If there are neurological signs and symptoms such as weakness on one side of the body, numbness, speech or vision changes, confusion, or difficulty walking, urgent evaluation is advised. In addition, headaches that come on very suddenly and reach maximum severity in a few minutes are called thunderclap headaches and require an emergency evaluation. 

Other concerning characteristics are changes in normal headache pattern; progression in severity, frequency, or clinical features; pain that does not go away; pain that changes significantly with positional changes; and pain that increases substantially with physical exertion (exercise or sex) or valsalva maneuvers (sneezing, coughing, and/or straining).

When should someone with chronic headaches get further diagnostic testing or see a headache specialist?

If an individual experiences any of the aforementioned “red flag” symptoms or has headache features that suggest a secondary headache, imaging with a head CT or MRI may be advised. 

A consultation with a neurologist or headache specialist is recommended when headaches become very frequent or disabling, when a person experiences multiple medication failures, or when the diagnosis is not clear cut.