Migraines and Headaches Explained: Causes, Phases, Treatment, and Self-Care

Migraines and Headaches Explained: Causes, Phases, Treatment, and Self-Care

Learn about headaches and migraines, their causes, types, symptoms, diagnosis, and effective treatments. Discover prevention tips to manage pain and improve quality of life.

Headache, or cephalgia, is a common issue for people of all ages. While it can be uncomfortable and sometimes disabling, a headache is a symptom, not a disease. It can result from various causes, such as:

• Neurological disorders

• Stress responses

• Blood vessel changes (e.g., migraines).

• Muscle tension in the head and neck.

• Or a combination of factors.

Types of Headaches

1. Primary Headaches

These occur without an underlying disease. Common types include:

• Migraine

• Tension-type headache

• Cluster headache

2. Secondary Headaches

These occur due to an underlying medical condition, such as:

• Brain tumor or aneurysm

• Stroke or subarachnoid hemorrhage

• Severe hypertension

• Meningitis or head injury

• Glaucoma or other eye disorders

• Hypoglycemia or metabolic issues

• Cranial nerve disorders (neuralgias)

• Substance use or withdrawal.

Migraine Headache

Migraine is a recurring and often intense headache. It usually happens due to changes in blood flow in the brain. It affects 18% of women and 6% of men, often starting during puberty. Migraines tend to run in families.

Migraines happen more often in women. This is mainly due to estrogen and other female hormones. These hormones affect brain blood vessels and pain pathways. Genetic factors and differences in pain sensitivity also play a role. Women's brains are more sensitive to migraine triggers because of these biological factors.

Phases of a Migraine Attack

1. Prodrome Phase (hours to days before headache – seen in approximately 60% of patients)

   • Mood changes: depression, irritability.

   • Physical changes: feeling cold, food cravings, increased urination, diarrhea, or constipation

2. Aura Phase (in some patients, < 1 hour)

   • Visual disturbances: light flashes, blind spots (hemianopia)

   • Sensory changes: numbness or tingling in lips, face, or hands

   • Mild weakness, dizziness, or confusion

3. Headache Phase (lasts 4–72 hours in ~60% of cases)

   • Severe, throbbing pain (often one-sided)

   • Worsens with physical activity

   • Associated with nausea, vomiting, and light sensitivity

4. Recovery Phase (Postdrome)

   • Pain gradually decreases.

   • Neck and scalp muscle stiffness, exhaustion, and mood changes.

   • Extended sleep may follow.

Diagnosis

A healthcare provider may perform:

• Physical and neurological examinations

• Detailed headache history

• Imaging tests (CT scan, MRI, cerebral angiography)

• Blood tests (CBC, electrolytes, glucose, thyroid hormones)

• If doctors suspect muscle tension, they will use electromyography (EMG).

Treatment Approaches:

1. Acute (abortive) treatment – for stopping an attack

• Triptans: sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan

• Ergotamine preparations (with or without caffeine)

• 100% oxygen therapy (15 minutes)

• Pain relief: analgesics, sedatives, anti-anxiety medications, antiemetic drugs.

Note: Do NOT take triptans and ergotamines together. This can cause dangerous blood vessel reactions.

2. Preventive (prophylactic) treatment – to reduce frequency/severity.

• Beta-blockers: propranolol

• Antidepressants: amitriptyline

• Antiseizure medicines: divalproex and topiramate.

• Calcium channel blockers: flunarizine

• Other options: lithium, naproxen, methysergide (in select cases)

Preventive treatment is especially useful for people with frequent or predictable migraines.

Key Takeaways

• Headaches can be primary (no underlying disease) or secondary (due to another condition).

• Migraines often follow a predictable pattern with distinct phases.

• Early treatment improves recovery.

• Preventive medication can significantly lower the frequency of migraines for chronic sufferers.

Patient Recommendations for Managing Headaches and Migraines

1. Know Your Triggers

• Keep a headache diary: note food, sleep, stress, and activities before each attack

• Common triggers include:

  • Skipping meals

  • Caffeine overuse or withdrawal

  • Alcohol

  • Bright lights

  • Strong smells

  • Stress

  • Poor sleep

2. Maintain a Healthy Lifestyle

• Sleep 7–9 hours nightly, on a consistent schedule

• Eat balanced meals and drink enough water

• Engage in exercise on a consistent basis, such as walking, swimming, or practicing yoga.

• Limit screen time to prevent eye strain

3. Reduce Stress

• Practice relaxation: deep breathing, meditation, stretching

• Take short breaks at work or while studying

• Spend time outdoors or listen to calming music

4. Act Early

• Take prescribed medicine at the first warning signs

• Rest in a quiet, dark room

• Use a cold pack or warm compress on your head or neck

5. Follow Your Treatment Plan

• Use acute medicines exactly as prescribed to avoid overuse headaches

• Take preventive medicines as recommended.

6. Seek Emergency Help If You Have:

• Sudden, severe headache (“worst headache of your life”)

• Headache with fever, stiff neck, confusion, or seizures

• Headache after a head injury

• New headaches after age 50

• Headache with weakness, vision changes, or speech problems

In short: Address headaches early, adopt healthy habits, and understand your triggers to better manage headaches and migraines. If headaches come back or get worse, see your doctor for a full check-up.