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Migraine
Medically reviewed article

What is a migraine? Get the answer from one of Denmark's leading specialists

Migraine is a neurological disorder characterized by intense, throbbing headaches that often affect one side of the head. The pain, symptoms, and triggers of migraines can vary greatly from person to person. There are several different types of migraine, and it is estimated that about 16% of the Danish population will experience migraine attacks during their lifetime.¹

By
Hemi Health
Hemi Health

Migraine is more than just a headache.

For many people, migraines mean recurring attacks of intense pain, nausea, sensitivity to light and sound, and the need to withdraw from work, studies, or social activities. Some experience only a few attacks a year, while others live with migraines several times a month or week.

Although migraines cannot be cured, there are a number of effective treatment options available today that can reduce both the frequency of attacks, the symptoms, and the impact of the condition on daily life.

Do you suspect that your symptoms are caused by migraines?

At Hemi, we help both people who have already been diagnosed with migraines and those who are seeking clarity regarding their symptoms.

Read more about: Migraine treatment

Symptoms of migraine

Migraine is characterized by an intense headache, most often located on one side of the head. It is not unusual for the headache to shift from one side of the head to the other or to occur on both sides during a migraine attack.

Neurologist and headache specialist Signe Bruun Munksgaard explains:

"The condition likely arises due to the activation of pain-conducting fibers in the brain's meninges and blood vessels, but we have not yet fully mapped out why people get migraines."

The headache will often feel like a throbbing or pulsating pain and can last between four hours and three days.

The intensity of the headache is moderate to severe and, for many, will affect their daily functioning and activities.

It is also common for symptoms to worsen with physical activity, such as walking up stairs.

"It is very common to have to leave work or school and seek refuge in a dark room", says Signe Munksgaard.

In addition to the headache, many also experience:

  • Nausea
  • Vomiting
  • Sensitivity to light
  • Sensitivity to sound
  • Dizziness
  • Fatigue
  • Difficulty concentrating
  • Sensitivity to smells

Many are surprised by how much migraine affects more than just the head.

Migraine affects the way the brain processes sensory input, which is why many experience symptoms that may initially seem difficult to connect to a headache.

Sensitivity to light and sound occurs, among other reasons, because the brain becomes more sensitive to sensory input during a migraine attack. This means that ordinary daylight, a computer screen, or normal conversations can feel uncomfortable or even painful.

Nausea likely occurs as a result of the same neurological processes that trigger the migraine attack. For some, the nausea is almost as debilitating as the headache itself.

Many also experience pronounced fatigue and difficulty concentrating. The brain functions differently during a migraine attack, and it is common to feel mentally exhausted, have trouble focusing, or find that even simple tasks require more energy than usual.

These symptoms are a natural part of migraine disease and do not mean that there is anything wrong with you or your ability to handle pain.

Not everyone experiences the same symptoms, and symptoms can vary from one attack to the next.

The phases of a migraine

A migraine attack often consists of several phases. Not everyone experiences every phase, but many can recognize large parts of the progression.

The warning phase (prodrome phase)

Hours or days before the attack, some may experience:

  • Fatigue
  • Irritability
  • Neck tension
  • Difficulty concentrating
  • Increased or decreased appetite
  • Food cravings

Many people only realize in hindsight that these symptoms were actually the beginning of a migraine attack.

Aura phase

Some people find that their migraine begins with an aura – a series of visual and/or sensory disturbances that serve as a warning sign of an impending attack.

These can include:

  • Flashing lights
  • Zigzag lines
  • Blind spots in the field of vision
  • Tingling sensations in the arms or legs
  • Speech disturbances

It is estimated that approximately one-third of all migraine sufferers experience migraine with aura.²

Read more: Migraine with aura

Headache phase

The headache phase is the part of the attack that most people associate with migraines.

Typical symptoms include:

  • Throbbing or pulsating headache
  • Nausea
  • Sensitivity to light and sound
  • Worsening with physical activity
  • Need to rest in a dark environment

The postdrome phase

Even though the headache has subsided, the attack is often not completely over.

Many experience:

  • Exhaustion
  • Mental fatigue
  • Difficulty concentrating
  • A feeling of being "drained of energy"

For some, this phase can last for several hours or days.

How is migraine diagnosed?

Diagnosing a migraine typically begins with a general practitioner or neurologist, who reviews the patient's medical history and symptoms and performs an examination.

In rare cases, the doctor may recommend further tests, such as an MRI or CT scan, to rule out other causes for the symptoms.

There are four key characteristics used as part of diagnosing a migraine.

At least two of these characteristics must be met:

  • That the headache is located on one side of the head
  • That it presents as a throbbing pain
  • That the intensity is moderate to severe
  • That the headache worsens with physical activity

In addition to the intense headache, there are also a number of accompanying symptoms that characterize migraine.

You often feel unwell and are bothered by light and sound. Furthermore, you may experience nausea or vomiting.

"It is the overall picture of the headache's location, intensity, duration, and accompanying symptoms that forms an impression of whether migraine is the correct diagnosis for the individual patient", explains neurologist Signe Bruun Munksgaard.

Migraine can occur both with and without aura, be hormonally triggered, and be defined as either episodic or chronic.

Do you need an MRI scan?

Most people with migraine do not need a scan.

If the symptoms match migraine and the neurological examination is normal, further investigations are often unnecessary.

When should you take action?

It is important to see a doctor if you experience:

  • A new and sudden, very severe headache
  • A significant change in your headache pattern
  • Persistent neurological symptoms
  • Headache following a serious head injury

If you are in doubt about your symptoms, you can start with our migraine test.

Who experiences migraines?

Migraines occur at all ages, including in children, but they most severely affect the 35-54 age group.

Migraines affect women about twice as often as men, which is believed to be linked to hormonal factors, among other things.³

At the same time, migraine is one of the most common neurological diseases in the world.

Migraines in children and adolescents

Migraine is not just a disease that affects adults. Children and adolescents can also experience migraine attacks.

However, the symptoms may look different than in adults. Some children experience shorter attacks, more diffuse headaches, or abdominal pain in connection with the migraine.

Migraines in children can affect school attendance, extracurricular activities, and social life. Therefore, it is important to take action if a child or adolescent experiences recurring headaches or other symptoms that may be consistent with migraine.

If you are concerned about your child's symptoms, you should seek a medical assessment.

Causes of migraine

Migraine is a neurological disorder.

There is a genetic predisposition to inheriting migraines. If one parent suffers from migraines, the child's risk of developing the disorder increases.

The risk of passing migraines on to one's children is likely around 15% to 50%.³

Since women are affected by migraines more often than men, there is a greater risk of passing migraines from mother to daughter.

Some women experience an increased frequency of migraine attacks around their menstrual cycle, which suggests a link between hormonal changes and migraines.

The mechanisms behind migraines are not yet fully understood.

However, various changes in the brain have been observed that seem to manifest in connection with a migraine attack.

This includes changes in blood flow (in migraines with aura) as well as the release of various hormones and signaling substances such as CGRP.

Migraine is therefore not something you are to blame for yourself. It is a neurological disease with biological mechanisms in which heredity, hormones, and various signaling substances in the brain all play a role.

Triggers that can cause migraines

"Migraine triggers are highly individual. What triggers an attack in one person may be completely harmless to another. That is why it is important for each patient to become aware of their own triggers through careful observation and, if necessary, by keeping a headache diary. This can help identify specific factors that contribute to your migraines," says neurologist Signe Bruun Munksgaard.

Many people with migraines find that certain factors increase the likelihood of an attack.

These factors are often called triggers.

It is important to understand that triggers are not necessarily the cause of migraines. Migraine is a neurological disease, and an attack typically occurs as a result of several factors affecting the brain simultaneously.

For some, stress plays a major role. For others, it is sleep, hormonal fluctuations, alcohol, or irregular meals. It is therefore important to learn your own patterns rather than focusing on general lists of possible triggers.

For many, a headache calendar can help identify patterns over time.

Headache calendar

Here is an overview of the most common triggers:⁴

Hormonal changes

Many women experience migraine attacks associated with their menstrual cycle due to changes in estrogen levels.

Foods

Certain foods and additives are known migraine triggers, for example, chemicals such as monosodium glutamate (MSG), tyramine, caffeine, aspartame, and nitrates.

Stress

High stress levels can be a significant migraine trigger for many people.

Sensory stimuli

Bright light, sunlight, loud noises, or strong odors can trigger migraines in some people. Light sensitivity (photophobia) is a common symptom of a migraine attack, but light can also be a trigger in itself.

Physical exertion

Intense physical activity can trigger migraines in some cases.

Sleep patterns

An irregular sleep pattern (too little or too much sleep over an extended period) can help trigger migraines.

Weather changes

Some people find that intense or changing weather can cause migraine attacks.

Dehydration

Lack of fluids is a very common migraine trigger.

Alcohol

Certain types of alcohol can trigger migraines.

Smoking

Tobacco products, including cigarettes and e-cigarettes, can be migraine triggers.

Other types of headaches

For some, other types of headaches can help trigger migraine attacks.

It is important to distinguish between myths and scientific facts when it comes to migraine triggers. While many, for example, believe that chocolate can trigger migraines, some studies suggest that this is not necessarily the case – and that the craving for chocolate may in some cases be an early symptom of a migraine rather than a trigger. It varies from person to person.

Migraine treatment

Migraine treatment is – just like triggers – individual from person to person. Treatment often involves a combination of medication and non-medical methods.

Medical treatment can be divided into acute treatment, which is initiated during an attack, and preventive treatment, which aims to reduce symptoms and the number of migraine days.

There is no cure for migraines, but with timely and appropriate treatment, quality of life can be significantly improved.

Migraine attacks are treated with acute medication. This can include pain relief such as ibuprofen, naproxen, paracetamol, and Treo, which can be effective, and potentially in combination with anti-nausea medication.

For some, standard pain relief is not sufficient, and the doctor will often recommend triptans.

Frequent use of pain relief medication can for some lead to medication-overuse headache (MOH).

For those who are severely affected, preventive medication is often recommended.

Treatment is highly individual, and it may be necessary to try several different medications and combinations before finding the right one.

First-line treatment includes blood pressure-lowering medication such as beta-blockers or candesartan. Certain types of antidepressants are also used as preventive treatment.

As a second-line option, your doctor may prescribe epilepsy medication that has proven effective against migraines.

For chronic migraines, both CGRP inhibitors and botulinum toxin A have documented efficacy.

When does preventive treatment make sense?

Preventive treatment may be relevant if your migraines are frequent, significantly impact your daily life, or if you find that acute medication is not effective enough.

The goal of preventive treatment is to reduce:

  • The number of migraine attacks
  • The severity of the attacks
  • The impact of the condition on work, studies, and leisure time

When is Botox relevant?

Botox is primarily used for chronic migraines.

The treatment is administered as a series of small injections around the head and neck and can significantly reduce the number of migraine days for many people.

Internal link: Botox for migraines

When are CGRP inhibitors relevant?

CGRP inhibitors are developed specifically for the treatment of migraines.

For some people, they may be relevant if other preventive treatments have not been sufficiently effective or have caused unacceptable side effects.

What if the first treatment doesn't work?

Migraine treatment is often a process.

It is not unusual to have to try several different treatment options or combinations of treatments before finding the solution that works best.

Types of migraine

Migraine with and without aura

Migraine is divided into two different categories – with and without aura.

Migraine with aura is characterized by the appearance of signals before the headache, which manifest as either visual disturbances or sensory disturbances that gradually spread.

If paralysis occurs as part of the aura, it is referred to as hemiplegic migraine.

Read more: Migraine with aura

Episodic and chronic migraine

Migraine can be either episodic or chronic.

This applies regardless of whether you suffer from migraine with or without aura.

For chronic migraine, you must experience at least 15 days a month with headaches, of which at least 8 must be days with migraine.

Anything that does not fit into this category is characterized as episodic migraine.

Hormonal migraine in women

Hormonal migraine is linked to hormonal changes that can occur during a woman's cycle.

It is common for women to experience migraines in connection with their menstruation or ovulation.

Do you suspect you have migraines?

Through our migraine test, you can get an indication in just a few minutes of whether you might be suffering from migraines and how you should handle your symptoms.

The test can guide you toward the right advice and potential treatment options.

If you are in doubt about when you should see a doctor regarding your headache or migraine, you can read our neurologist's recommendations here.

Take the test: Migraine test

Migraine doesn't have to control your life.

If migraines are affecting your daily life, your work, or your quality of life, it may be worth speaking with a specialist about your options.

Frequently asked questions about migraines

Can migraines be cured?

There is currently no cure for migraines. However, for many people, the right treatment can significantly reduce both the frequency of attacks, the symptoms, and the impact the condition has on daily life.

Is migraine hereditary?

Yes. Migraine has a significant genetic component, and the risk of developing migraines is higher if one or both parents have the condition.

How long does a migraine attack last?

A migraine attack typically lasts between 4 and 72 hours, but this can vary from person to person.

What helps with migraines?

Treatment depends on the individual. Some find relief with acute medication, while others also require preventive treatment.

Read more: Migraine treatment

What is migraine with aura?

Migraine with aura is a type of migraine where you experience neurological symptoms before the headache, such as visual disturbances or sensory changes.

Read more: Migraine with aura

What is the difference between a migraine and a regular headache?

Migraine is a neurological condition often accompanied by nausea, sensitivity to light, and impaired daily functioning. Common headaches are typically less intense and rarely affect daily life to the same extent.

Read more: Tension headaches

How many Danes have migraines?

It is estimated that about 16% of the Danish population will experience migraines during their lifetime.

Sources

  1. Danish Headache Society 2020, Reference Program 2020, https://dhos.dk/wp-content/uploads/2020/06/2932-Referenceprogram_2020_final_web-24.06.20.pdf 
  2. Rigshospitalet, What can trigger a migraine attack with aura? (November 23, 2017), https://www.rigshospitalet.dk/presse-og-nyt/nyheder/nyheder/Sider/2017/november/hvad-kan-fremkalde-et-migraeneanfald-med-aura.aspx 
  3. Sundhed.dk, Migraine (updated), https://www.sundhed.dk/borger/patienthaandbogen/hjerne-og-nerver/sygdomme/migraene/ 
  4. Herlev Hospital, Migraine and treatment (updated), https://www.herlevhospital.dk/undersoegelse-og-behandling/find-undersoegelse-og-behandling/Sider/Migraene-og-behandling-806798.aspx 
  5. To Eat or Not to eat: A Review of the Relationship between Chocolate and Migraines (2020 Mar; 12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146545/
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