Do Your Migraines Require Medical Attention?

A migraine isn’t just a bad headache. It’s a neurological disease that impacts 39 million people in the US and 1 billion around the world. 

Migraines are the third most prevalent illness worldwide, and the sixth most disabling. While their most common in women between 18 and 44, migraines can strike any person at any age. That said, your risk is higher if someone in your family suffers from them. 

At Memphis Neurology, board-certified neurologist Dr. Shiva Natarajan and his team have extensive experience evaluating and treating all types of headaches, including migraines. We created this handy guide to help you understand what migraines are, and when you should seek medical attention.

What is a migraine?

A migraine is a collection of neurological symptoms that can last for days. Most migraines present on one side of the head and are sometimes accompanied by nausea and/or vomiting. The pain is usually throbbing and makes daily activities difficult to complete. Migraines come in four stages:

1. Prodrome

This phase can start a few days before the pain phase hits, and every person’s prodrome phase is somewhat different. Some common symptoms are:

• Depression
• Irritability
• Frequent yawning
• Constipation
• Neck stiffness
• Unusual food cravings

2. Aura

If you have migraines with aura (not everybody does), you’ll experience visual disturbances after the prodrome phase, lasting anywhere from 10-30 minutes. Many people see flashing lights, wavy lines, or zigzag patterns. It’s unclear why some experience auras and others don’t.

3. Active (pain) phase

When the pain hits, you know you have a migraine. The pain is excruciating, your senses are distorted, and you can’t think straight. Other common symptoms include:

• Pain behind one eye or ear
• Pain in the temples
• Sensitivity to light, sound, smells, and touch
• Temporary loss of vision
• “Brain fog” (confusion)
• Aphasia (inability to speak coherently)
• Rapidly changing emotions

This phase can last anywhere from four to 72 hours. Most people with chronic migraines have a “rescue” or abortive drug that calms the pain within a couple of hours.

4. Postdrome

Once the pain is through, you might experience a “post-adrenaline crash” that leaves you exhausted for a day or two. This will pass.

What treatments are available for migraines?

Medication treatments come in two classes: preventives and abortives.

Preventive medications

Some medications are made specifically to lower the chance of getting a migraine, and some are repurposed to achieve the same result. These include:

• Blood pressure-lowering medications such as beta-blockers and calcium channel blockers
• Antidepressants such as the tricyclics
• Anti-seizure drugs like valproate and topiramate, although these come with a lot of side effects
• Botox injections in the head and neck regions every 12 weeks or so
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies, the newest FDA-approved drugs specifically designed to prevent migraines

Abortive (rescue) medications

When you’re in the middle of a migraine attack, all you want is relief. There are abortives you can take to “rescue” you from the pain. These include:

• Anti-nausea medicines
• Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Triptans, specifically designed for migraines, which come in tablet, injectable, and nasal spray forms
• Ergotamines, specifically designed for migraines, which come in injectable and nasal spray forms

At what point should you seek out medical attention?

Here’s what you should consider when deciding whether to seek medical attention for your migraines: 

1. Your migraines turn from episodic to chronic 

Most everyone has a migraine at some point. If you experience one a couple of times a year that's no cause for concern. However, if you start having migraines more frequently — say, 15 or more days a month — you might suffer from chronic migraines. 

You should see a neurologist or headache specialist to find out more. 

2. You experience additional symptoms

When you experience a headache with any of the following symptoms, you should seek medical attention:

• Weakness, dizziness, or a sudden loss of balance
• Numbness or tingling
• Difficulty speaking
• Confusion
• Seizures
• Blurry vision, double vision, or blind spots
• Fever, shortness of breath, a stiff neck, or rash
• Severe nausea and vomiting
• Headaches that happen after a head injury or accident
• A migraine that comes on within seconds (a thunderclap), particularly if you’re over the age of 50. You need emergency medical help

If you can’t reach your doctor, call 911 or go to your local emergency room.

Do you have migraines? Are you wondering whether to seek out medical attention? The expert physicians at Memphis Neurology can help. Contact us at either one of our locations, or schedule an appointment online.