Symptoms, Diagnosis, Treatment

migraine-headache-symptomsWhat Are the Symptoms of Migraine Headaches?

Migraine headaches may progress through four stages, including pro-drome, aura, headache and post-drome, although not everyone experiences all of the stages. Symptoms that may be experienced in the pro-drome phase, a day or two prior to onset of the migraine, include:

  • Constipation
  • Depression
  • Food cravings
  • Hyperactivity
  • Irritability
  • Neck stiffness
  • Uncontrollable yawning
Symptoms that may occur during the aura, headache and post-drome phases include:

  • Seeing shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in limbs
  • Speech or language problems (aphasia)
  • Pain on one side or both sides of the head
  • Pulsating, throbbing pain
  • Sensitivity to light, sounds and smells
  • Nausea and vomiting
  • Blurred vision
  • Lightheadedness
  • Fainting
  • Feeling drained or "washed out"
  • Feeling mild euphoria

How is Migraine Diagnosed?

Migraine headaches are diagnosed by a neurologist based on a review of your medical history, symptoms, and physical and neurological exams. If your migraine headaches are severe or have sudden onset, a doctor may perform additional tests like blood tests, CT scans, MRIs, or a spinal tap to rule out other physiological causes for severe headache.

How Are Migraine Headaches Treated?

There are a variety of medications used in the treatment of migraine headaches, one category is abortive, these are pain-relieving medications designed to stop migraine symptoms that have already started. The other category is preventative and is designed to be taken regularly to reduce the frequency and severity of migraine headaches.

Abortive migraine medications include1, 2:

  • Over the Counter Pain Relievers – NSAIDs- non-steroidal anti-inflammatory medications like aspirin, Advil®, Motrin IB®, or combinations of acetaminophen and caffeine (Excedrin Migraine®) may relieve mild to moderate migraine pain in some individuals. These medications can lead to ulcers, gastrointestinal bleeding and medication-overuse headaches if taken too often for long periods of time.
  • Triptans – Triptans promote constriction of blood vessels and block pain pathways in the brain. Triptan containing drugs are available in nasal sprays, injections, tablets and a patch. Examples include: Almotriptan (Axert®), Eletriptan (Relpax®), Frovatriptan (Frova®), Naratriptan (Amerge®), Rizatriptan (Maxalt®), Sumatriptan ( Alsuma®, Dosepro®, Imitrex®, Sumavel®, Treximet®, Zecuity®), and Zolmitriptan (Zomig®). Triptan drugs can cause chest tightness, flushing, tachycardia (rapid heartbeat), nausea, dizziness, drowsiness, and muscle weakness.
  • Dihydroergotamine (D.H.E. 45, Migranal®) – Migranal® is available as a nasal spray and in injection form. Dihydroergotamine may cause blood vessels in the body to constrict (become narrower) which can lead to serious side effects if blood flow to many parts of the body is restricted.
  • Anti-nausea Medications – Chlorpromazine, metoclopramide (Reglan®) or prochlorperazine (Compro®) help reduce the nausea and vomiting that can accompany migraine headaches.
Preventive migraine treatments include1, 2:

  • Cardiovascular Medications – Beta blockers propranolol (Inderal La®, Innopran XL®, others), metoprolol tartrate (Lopressor®) and timolol (Betimol®) which are typically used to lower blood pressure and treat coronary artery disease, have also been proven to reduce the frequency and severity of migraine headaches. Calcium channel blockers, Verapamil (Calan®, Verelan®, others) are drugs that are typically used to treat high blood pressure and keep blood vessels intact are also used to prevent migraines. ACE inhibitor, lisinopril (Zestril®), may also be useful in reducing the length and severity of migraines. Angiotensin II receptor blocker (ARB) drugs like candesartan (Atacand®) may also be used to prevent migraine headaches.
  • Antidepressant Medications – Tricyclic antidepressants, like amitriptyline (Elavil®) and nortriptyline (Pamelor®, Aventyl HCI®), may lower the frequency of migraine headaches by impacting the level of serotonin and other brain chemicals. Tricyclic antidepressants can cause dryness of mouth, constipation, weight gain and other side effects. Serotonin and norepinephrine reuptake inhibitor drugs (SNRIs) like venlafaxine (Effexor®) and duloxetine (Cymbalta®) are also used to reduce migraine headache frequency.
  • Antiseizure Medications – Anti-seizure drugs, like topiramate (Topamax®), may reduce frequency of migraine headaches. Topamax® may cause diarrhea, nausea, weight loss, memory difficulties and concentration problems.
  • OnabotulinumtoxinA (Botox®) – Botox® has been shown to be helpful in treating chronic migraine headaches in adults. Injections of onabotulinumtoxinA (Botox®) are made into the muscles of the forehead and neck. When effective, treatment usually needs to be repeated every 12 weeks to maintain the benefits.

Where Can I Get More Information?

The Coriell Personalized Medicine Collaborative research study has a board-certified genetic counselor that is available to talk with you about the information you may learn as a result of being in the study. Click here for more information. If you would like to talk with a CPMC genetic counselor, email us at This email address is being protected from spambots. You need JavaScript enabled to view it. . For more information about migraines:

American Migraine Foundation
American Headache Society

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