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Migraine: definition, causes, online consultation

Migraine is characterised by moderate to severe pain on one or both sides of the head. Occurring as attacks, throbbing or pulsating pain, it is often made worse by light, smells, sounds and physical activity. Headaches can also be accompanied by nausea or vomiting in people who suffer from migraine. When it is chronic (or recurrent, 15 days a month), migraine is a common reason for consulting a GP. For a diagnosis and to put in place an appropriate treatment, Feeli's doctors and specialists are available 24/7 for an online consultation.

What causes migraine?

Migraines affect people whose nervous system sensitivity is higher than average. Under intense stimulation, nerve cells in the brain then produce electrical activity. When this electrical activity spreads through the brain, several signs appear. These temporary disturbances affect several functions:
   • Vision;
   • Balance;
   • Sensation;
   • Speech;
   • Muscle coordination.
These symptoms are called the headache aura (or migraine aura). Headache is a general term for any pain in part of the head, including the inside of the head, the top of the neck, the face or the skull. Migraine is therefore a type of headache. It is also the most common cause of moderate to severe headaches. Migraine attacks are triggered when the fifth cranial nerve is stimulated. This nerve (the trigeminal nerve) sends electrical signals from the skull, eyes, forehead, upper eyelids and jaw. Substances are then released, causing painful inflammation inside the blood vessels of the brain. The meninges are also affected by this inflammation. The throbbing sensations in the head, sensitivity to sound and light, and the nausea and vomiting, are explained by this inflammation. Puberty is also a period when migraines become more frequent in both men and women. Women may in particular experience migraines just before or during their period. Generally speaking, the intensity of migraines varies under the effect of oestrogen. For example, they get worse after childbirth, when oestrogen levels drop rapidly, or during perimenopause. Other factors can trigger a migraine:
 • Barometric pressure or changes in weather;
 • Lack of sleep (insomnia);
 • Red wine;
 • Certain foods;
 • Hunger;
 • Certain lights or smells;
 • Stress.

What are the symptoms of migraine?

Migraine is usually felt on one side of the head, as throbbing and pulsating pain during attacks. The pain is often disabling and severe, even though a migraine attack can remain moderate in intensity. Certain factors can also make the headache worse:
   • Physical activity;
   • Loud noises;
   • Bright light;
   • Certain smells.
Generally, migraine eases with sleep. It is often accompanied by nausea; more rarely by vomiting. During a migraine attack, the person may also experience difficulty concentrating. These attacks vary considerably in severity and frequency. In fact, many people suffer from several types of headache, including mild attacks with no sensitivity to light or sound. These sometimes resemble tension headaches, or mild-intensity migraines. A migraine usually lasts from 4 hours to a few days. They can, however, disrupt family life or work, particularly when they are chronic. Finally, doctors use the term "prodrome" to describe sensations that occur before a migraine starts. This prodrome can include localised pain in the neck, mood swings, loss of appetite or intense food cravings. In France, migraine is preceded by an aura in around 25% of people. This involves temporary and reversible abnormalities, such as disturbances of vision, sensation, movement, balance or speech. Patients experiencing an aura before their migraine generally describe the following to their GP:
   • A blind spot in their field of vision;
   • Flickering or flashing lights.
Rarer symptoms of the aura include:
   • Numbness;
   • Weakness in the limbs;
   • Loss of balance;
   • Difficulty speaking.
The aura can last from a few minutes to an hour before the migraine begins and can persist throughout it. Finally, some people may experience this aura and ultimately only have a mild migraine, or even no headache at all.

What is a tension headache?

A tension headache is a common type of headache, generally presenting as diffuse, moderate pain. Patients describe a sensation of tightness, squeezing or pressure around the head. A tension headache can also last from a few hours to a few days. Unlike migraines, tension headaches are rarely accompanied by extreme sensitivity to light or sound, or by other symptoms such as nausea and vomiting. As with migraines, the exact causes of tension headaches are unclear. Doctors point to risk factors such as stress, muscle tension, anxiety, sleep problems, dehydration or fatigue. In addition, lifestyle habits and genetic factors also play a role in the onset of headaches. Common symptoms of tension headaches include:
 • Constant, diffuse pain across the whole head. Patients describe a squeezing sensation around the head;
 • Mild to moderate pain.
Unlike migraines, tension headaches do not usually cause nausea or vomiting. There is also generally no phonophobia (sensitivity to sound) or photophobia (sensitivity to light). In addition, physical activity does not usually make this type of headache worse. Treatment for tension headaches can include:
 • Taking a pain-relief medication or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen;
 • Reducing stress;
 • Improving sleep quality;
 • Learning to relax the muscles; managing muscle tension.

How can you relieve a migraine?

Migraine treatments can include:
 • Relaxation techniques aimed at changing brainwave activity, controlling stress and relieving muscle tension;
 • Behavioural interventions: biofeedback, stress management, yoga, etc.;
 • Medication to stop a migraine progressing or to stop it as soon as it appears;
 • Other medications to relieve pain;
 • And medications used to prevent a migraine.
Doctors can also help patients identify the triggers for their migraines, so they can be avoided as far as possible. For mild to moderate migraines, the doctor may prescribe:
 • Painkillers (analgesics);
 • Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen;
 • Or paracetamol.
For severe migraines, certain medications can be used to stop them; others are taken as prevention:
 • Triptans: taken orally or as a nasal spray;
 • Gepants: these work by blocking a protein in the blood responsible for migraines;
 • Ditans: this is a new class of medication that can stop migraines. However, they can have side effects affecting the heart;
 • Certain anti-nausea medications (metoclopramide, prochlorperazine);
 • Gepants: these work by blocking a protein in the blood responsible for migraines;
 • Dihydroergotamine given subcutaneously, intravenously or as a nasal spray to stop persistent, severe headaches.

What are the symptoms of migraine aura?

Migraine aura is characterised by sensory, visual and sometimes even motor symptoms. These symptoms usually precede the painful phase of the migraine. Migraine aura is temporary, but can nonetheless last from a few minutes to an hour. Common symptoms of migraine aura include:
 • Visual phenomena: blind spots, flashes of light, visual hallucinations, sometimes distorted vision;
 • Numbness;
 • Tingling;
 • Muscle weakness;
 • Or even motor difficulties, such as difficulty speaking.
Lastly, not all migraines are preceded by an aura.

What is an ophthalmic migraine?

Ophthalmic migraine is also known as “migraine with aura”. It is characterised by visual symptoms that precede or accompany a headache. The aura can present as blind spots, flashes of light, wavy lines, temporary vision disturbances or even visual hallucinations. When the headache occurs after an aura, it is generally intense and may be accompanied by other symptoms typical of migraine (sensitivity to sound and light, nausea, vomiting, etc.). The visual symptoms of ophthalmic migraine are temporary and generally disappear in under an hour. The pain from the headache, however, can last longer. Lastly, it's worth remembering that not all migraines are preceded by an aura. For example, many patients may suffer from migraines without any prior visual symptoms.

What are the criteria for a migraine diagnosis?

The International Headache Society has provided clarification on the international classification of headaches. The main diagnostic criteria for migraine (to be considered someone who suffers from migraines) are:
 • The person has had at least 5 migraine attacks (headache episodes);
 • The migraine, treated or untreated, lasts 4 to 72 hours;
The migraine also has at least 2 of the following characteristics:
 • It is unilateral, affecting one side of the head;
 • It is pulsating (a throbbing sensation);
 • Migraines are moderate to severe in intensity, disrupting daily activities.
One of the following symptoms must also be present:
 • Nausea and/or vomiting;
 • Sensitivity to light (photophobia) and/or sound (phonophobia).
It is important to consult a general practitioner to look for any underlying causes of chronic migraines, such as a neurological condition. Several types of migraine exist, whether with aura (visual symptoms) or without aura; it is therefore important to get a diagnosis in order to put in place the most appropriate treatment.