What is a migraine, exactly?

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Contrary to what internalized stigma may tell you, a migraine isn’t just a headache.

Among people under 50, chronic migraines are the leading cause of disability, according to a 2018 study. But many people who live with the condition may find it difficult to recognize its severity and get the medical care they need for their migraines, said Kylie Petrarca, nurse and associate program director for the Association of Migraine Disorders.

“People don’t give her the recognition she deserves,” she added.

Many doctors don’t know enough about the nuances of migraine disorders, said Dr. Frederick Godley, an ear, nose and throat specialist and president of the Association of Migraine Disorders.

But there are professionals who research and treat migraines. A new study published Wednesday in Neurologythe journal of the American Academy of Neurology, showed that cluster headaches and migraines are linked to circadian systems, which means time of day and sleep patterns can have a big impact on these terms.

Understanding what migraines are, why you can get them, and what you can do is a powerful tool for defending yourself and getting the proper treatment, Petrarca said.

What used to be called a migraine is now called a migraine attack to better capture how far the condition extends beyond head pain, Petrarca said.

Migraines start deep in the brain, said Dr. Stewart Tepper, a neurologist based in Lebanon, New Hampshire. The condition is best understood as a complex neurological disease that affects many parts of the nervous system, Godley said.

To be diagnosed with a migraine, a patient must have at least five attacks in their lifetime that each last from four to 72 hours when left untreated. The condition must also meet at least two of four criteria: moderate to severe intensity, stabbing pain, worsening with activity and occurrence on one side of the head, Tepper said. Attacks must also have at least one of two characteristics: nausea and sensitivity to light or sound, he added.

It’s hard to say exactly, but there’s plenty of evidence to show that there are genetic and environmental factors that lead people to get migraines, Petrarca said.

Migraines tend to run in families, but can still present differently in different family members, Godley said.

Although genetics is a major cause, some migraines can also be caused by head injuries, he added. And hormonal changes, especially in estrogen, can really impact migraine attacks.

It’s important to note, however, that there’s a difference between what makes a person prone to migraines and what triggers them, Tepper said.

Migraine triggers are different for everyone, so Petrarca recommends keeping a diary of when you have attacks so you can track factors that might be correlated.

People usually start having migraines after puberty, but they can show up in young children in forms like colic, motion sickness and dizziness, Godley said.

For many women, migraine attacks tend to accompany the phases of the menstrual cycle as estrogen levels change, Petrarca said. But they can also be triggered by weather changes, stress, trouble sleeping, skipping meals, dehydration and alcohol, she added.

Unfortunately, chocolate and wine can be a big trigger, Petrarca said. But each person who suffers from migraines will have their own triggers.

When people think of migraines, they often think of headaches. But many people experience many more symptoms than that.

About a third of people will experience an aura leading to their migraine, which is “a temporary disturbance in perception that lasts five minutes to an hour,” Petrarca said.

It can look like blurry vision, spotting, numbness in extremities or speech changes, she added.

The list of possible symptoms that accompany a migraine is long but includes: dizziness, vertigo, brain fog, tinnitus, mood swings, yawning, neck pain and food cravings, Petrarca said.

“I think taking that away from the pain in the head, you know, there are many, many other symptoms that also accompany a migraine attack,” she said.

And some of the symptoms, including exhaustion, can occur before a migraine, after or between attacks, Tepper added.

There are many medications you can discuss with your doctor to treat migraine attacks or prevent them from happening, but it’s important to find a doctor who understands migraine conditions, Godley said.

Because healthcare professionals knowledgeable about treating migraines are rare, you may need to advocate for yourself and your pain to get diagnosed and effectively treated, Petrarca said.

When you get these drugs, prepare them and try to take them as soon as you start having symptoms rather than waiting until later, she added.

“It’s very hard to stop it once it starts,” she said.

But medications are not the only way to treat migraine disorders. One of the first things a person can do is change their lifestyle, Petrarca said.

Cognitive-behavioral therapy is often useful to help manage the stress that can trigger migraine attacks, and taking vitamins and supplements, such as magnesium and riboflavin, can be effective in reducing the frequency of migraines, a she declared.

But getting back to the basics of health can be extremely helpful — track your migraines, create a sleep routine, exercise regularly, eat well-balanced meals, manage stress and stay hydrated, Petrarca said.