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FAQs:

What is a Migraine Specialist?

A migraine specialist specifically treats migraine headaches. A migraine specialist may hold a certification from the United Council for Neurologic Subspecialties (UCNS). Others, however, just have a specialist interest in treating migraines.

What is Migraine?

Migraine is a type of headache characterized by recurrent attacks of moderate to severe throbbing and pulsating pain on one side of the head. The pain is caused by the activation of nerve fibers within the wall of brain blood vessels traveling inside the meninges (three layers of membranes protecting the brain and spinal cord).

How Often Do Migraines Happen?

The frequency of migraine varies from person to person. You might have one migraine per year or one per week. On average, most people experience two to four per month. They’re most common in the morning. Most migraines are unpredictable, but sometimes, you can have an idea of when a migraine will happen, like before menstruation or after feeling stressed.

What Does a Migraine Feel Like?

Migraine headache pain may feel like the following:

- Throbbing.

- Pulsing.

- Pounding.

- Dull.

A migraine can feel different for each person. A migraine headache ranges from mild to severe. Head pain can start on one side and shift to the opposite side. You may also have pain around your eyes or temple, and sometimes, around your face, sinuses, jaw, or neck.

How Do I Know if I'm Having a Migraine?

A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

What's the Difference Between a Headache and a Migraine?

A tension-type headache, the most common type of headache, causes pain on both sides of the head. It's a tight pressure rather than a throbbing, and you might also have soreness in your temples, neck, and shoulder muscles. Headache pain isn't usually considered 'severe'.

Migraine, on the other hand, has many symptoms — including headache. This can feel like a throbbing pain that might be worse on one side of your head. You can also feel pain around your eyes, temples, face, jaw, or neck. The pain may increase with physical activity, which is why it helps to lie down.

But the key difference between a headache and migraine? Migraines can be distressing and debilitating and can affect your whole body. People can feel vaguely unwell for a day or two before a migraine headache comes on (although not all migraines involve headaches). Once it has started, a migraine headache can last for between 4 hours and several days.

Migraine is a chronic disorder of the brain with recurrent severe attacks... other common features [besides headache] are nausea or even vomiting. Many people have sensitivity to light, odors, or sounds and are unable to carry on daily activities.

Are Migraines Genetic?

Migraine is strongly influenced by genetics, with heritability estimated to account for up to 60% of migraine cases. While a single gene is rarely responsible, multiple genetic factors likely combine to increase susceptibility. These genetic factors make individuals more sensitive to environmental triggers, like stress, lifestyle changes, or hormonal shifts, which can prompt migraine attacks. However, not everyone with these genes will develop migraines, as environmental influences play a significant role. This interplay of genes and environment classifies migraine as a complex genetic disorder.

Can Stress Cause Migraines?

Stress and migraines are linked to a vicious cycle. Stress in your life can trigger a migraine and keep it going. Chronic migraine pain can boost your stress. As many as 80% of people who get migraines list stress as a common trigger. These people also have reported high-stress levels. The stress-headache connection may be worse in women than in men.

Is an Ocular Migraine a Sign of a Stroke?

Ocular migraines and stroke are two conditions that share similar symptoms and can often be confused. Although an ocular migraine alone does not indicate a stroke, studies show that those who suffer from ocular migraines may be at a higher risk of experiencing a stroke.

A stroke occurs when an artery in the brain is compromised, depriving different parts of the brain of oxygen-rich blood and nutrients. This can happen when the artery becomes obstructed (called an ischemic stroke) or when an artery bursts (called a hemorrhagic stroke).

Ocular migraines in particular are migraines accompanied by auras or visual disturbances. Studies show that many people experience an aura before the onset of other ocular migraine symptoms. Auras generally affect both eyes and cause visual disturbances such as flashing or zigzagging lights, blind spots, or shimmering lights or stars.

How Long Do Migraines Last?

Migraines usually last between 2 hours and 3 days, with some symptoms (such as feeling very tired) starting up to 2 days before the head pain starts and finishing after the headache stops. Some people have migraines several times a week, while others do not have them very often. It's common to have migraines before or during your period, called menstrual migraines. Most people find their migraines slowly get better as they get older.

Types of Migraines

Migraines occur in both children and adults but affect adult women three times more often than men. Migraines are genetic. Most migraine sufferers have a family history of the disorder. They also frequently occur in people who have other medical conditions. Here are the types of migraines.

1. Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache.

2. Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise.

3. Abdominal migraine mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting one to 72 hours, with little or no headache. Additional symptoms include nausea, vomiting, and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life.

4. Basilar-type migraine mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head.

5. Hemiplegic migraine is a rare, severe migraine type that causes temporary paralysis on one side of the body, lasting from hours to days, along with symptoms like vertigo, pricking sensations, and vision or speech issues. When hereditary, it’s called familial hemiplegic migraine (FHM), linked to genetic mutations that heighten brain sensitivity, possibly through increased glutamate levels.

6. Menstrual migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura, pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light. 

7. Migraine without headache is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.

8. Ophthalmoplegic migraine is an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil, and double vision that may last for weeks, long after the pain is gone.

9. Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches.

10. Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that people need to be hospitalized.

Four Phases of Migraine

Migraine is divided into four phases, all of which may be present during the attack:

1. Premonitory symptoms occur up to 24 hours before developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination.

2. Aura—Some people will see flashing or bright lights or what looks like heat waves immediately before or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.

3. Headache—A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache.

4. Postdrome—Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy again.

Causes of Migraine

Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks. Several different factors can increase your risk of having a migraine. These factors, which trigger the headache process, vary from person to person and include:

- Sudden changes in weather or environment

- Too much or not enough sleep

- Strong odors or fumes

- Emotion

- Stress

- Overexertion

- Loud or sudden noises

- Motion sickness

- Low blood sugar

- Skipped meals

- Tobacco

- Depression

- Anxiety

- Head trauma

- Hangover

- Some medications

- Hormonal changes

- Bright or flashing lights

When to See a Migraine Specialist

Knowing when you need to see a migraine specialist is another critical aspect of living with migraines. Get emergency medical help if you experience:

- A headache worse than any you’ve experienced in the past

- Problems speaking, along with vision and motor function changes

- Loss of balance or other neurological symptoms

- Sudden onset of headache

In addition, call a specialist if any of the following happens:

- There’s a change in the pattern of your headaches.

- Your treatments aren’t working anymore.

- You’re experiencing side effects from medications.

- You’ve started taking birth control while on medications.

- You’re taking pain medications three or more days a week.

- Headaches are worse when you’re lying down.

What to Expect from a Migraine Specialist Appointment

If you're preparing for a migraine specialist appointment, taking a few simple steps beforehand can make a significant difference in understanding and managing your symptoms.

Expect the specialist to ask lots of questions about your history, medications, treatments, triggers, diet, etc. So if you write down a brief description of each symptom and how it impacts you each day, you'll have a written record that you can look back on. It will also help your doctor know more about your migraines, which will help them figure out what's going on. Keeping a daily headache journal is an easy way to track your migraine attacks.

There are many resources online that can provide tips on tracking headaches. Many smartphone apps also include headache tracking features which could help you keep track of your symptoms. It may be helpful to keep a written log of other factors that seem to trigger your migraines, such as missed meals, sleep disturbances, or stressors at work.  Be prepared to give lots of information about these things. 

You will probably do some physical exams. This might include checking your reflexes, looking in your eyes with lenses or an instrument called an ophthalmoscope, and checking the surface of your skin with what feels like little rubber-tipped toothpicks under different pressures or temperatures. The examinations aim to look for any medical /pathological cause of your migraines so that they may order other special tests such as a brain scan or blood tests.

The specialist will want to know what medications you've tried in the past, and whether they've worked for you.  They also want to know what non-medication treatments have been effective for you in the past. If relaxation techniques have helped you cope with migraines before, let the doctor know! If dietary changes have been effective, tell them which foods seem to trigger your migraines and which seem to help prevent them.

The more information you can provide about your history, the better equipped your doctor will be to help. You may want to ask questions that are important to you, so again, coming prepared with these questions makes sure that you get answers to your questions.

How to Get Rid of a Migraine

Treating a migraine at the first sign is the quickest way to get relief. Here are strategies on what to do when you feel a migraine coming on.

1. Use a Cold Pack

Applying ice or cold packs to painful areas is an easy way to reduce migraine pain. Cold therapy reduces inflammation and also slows nerve transmission of pain messaging so that your brain registers coldness instead of pain. Try using a cold pack product or a bag of frozen veggies. If you don't have either of those, you can soak a towel in cold water, wring it out, fold it, put it in a plastic bag, and put it in the freezer for about 15 minutes.

2. Turn the Lights Down

Many people who get migraines have an aversion to brightness. They may feel like lights are brighter than they are, and light can make migraine pain feel worse. It's believed that certain cells may carry light signals to brain cells responsible for transmitting pain. Dimming the lights or turning them off can provide relief when you're in the throes of a migraine attack.

3. Ginger

Taking a ginger supplement may help reduce migraine symptoms. A 2021 meta-analysis of the effects of ginger consumption on migraines found that compared to a placebo, eating raw ginger or taking a ginger supplement reduced the risk of migraine-related nausea and vomiting. To reduce migraine symptoms, try taking a ginger supplement, adding ginger to a meal or eating it raw, or sucking on ginger lozenges.

4. Identify Triggers

The most simple way to prevent a migraine is to avoid what triggers them. However, that means identifying the trigger, which can be challenging. Try keeping a headache diary and noting the frequency, intensity, and duration of attacks. Log what you discover is triggering the condition, and avoid triggers as much as possible.

5. Medication

Medications are at the front line of relieving migraine attacks. Delivered as tablets or pills, nasal sprays, suppositories, or injections.

6. Make a Plan

Develop a plan for how you're going to tackle your migraine so that you're prepared when one strikes. Your plan may involve ensuring you have your medication or other symptom-reducing items available at all times and that you have a place to retreat to when you feel the onset of migraine symptoms. This plan will save you time so that you can focus on recovering instead of trying to figure out how to recover.

7. Hydrate

Dehydration can be a migraine trigger or can make a migraine last longer. So it makes sense that drinking fluids can help prevent a migraine and can help alleviate them when they do occur.

One study found that migraine sufferers who drank about six cups of water daily for two weeks in addition to their usual daily intake experienced 21 fewer hours of pain and less intense headaches than participants who took a placebo medication.

8. Caffeine

The presence or absence of caffeine, as in coffee or certain teas, can affect the dilation of the vessels. Both too much of this substance or withdrawal from it can bring on migraines.

If withdrawal is causing your migraine, having caffeine may help. But this will only continue the addiction cycle. Try weaning yourself off of caffeine over time. If too much coffee is causing your migraines, try cutting back and swapping your regular caffeinated beverage for decaffeinated coffee or tea when possible.

9. Massage

There is some evidence that acupressure—a traditional Chinese medical approach involving applying pressure on a specific part of the body—may help you manage the pain. Evidence suggests that applying pressure on several points can help reduce nausea. They include Li4, or "Hegu," found between the thumb and forefinger, and PC6, on the inside arm, about three finger lengths up from the wrist.

10. Take a Nap

Research suggests that going to sleep can stop a migraine. No set amount of sleep time is known to be necessary, and every case varies. One study found that napping during a migraine didn't disrupt nightly sleep patterns.

Tips to Avoid Migraine Triggers

Migraine triggers aren't the reason you have migraine. Nobody knows what causes migraine or why some people have migraine attacks and others don't. But your triggers are events, changes, acts, or other external or internal stimuli that make a migraine attack more likely. Some triggers will be easy for you to manage and avoid, while others may be beyond your control. Here are some tips on how to avoid migraine triggers.

1. Pay attention to what you eat and drink. If you get a migraine attack, write down the foods and drinks you had before it started. If you see a pattern over time, stay away from that item.

2. Eat at regular intervals. Following your normal routine is key to avoiding migraine attacks. Don't skip meals or change your snacking or meal times too much from one day to the next.

3. Curb the caffeine. Daily caffeine can raise the risk of migraine in some people. If you’re one of them, slowly cut down on caffeine. (That’s because suddenly missing your morning coffee can trigger a migraine attack.) If a cup of coffee each morning isn't one of your migraine triggers, it's OK to stick to that, too.

4. Be careful with exercise. Everyone needs regular physical activity. It's a key part of being healthy. But it can be a migraine trigger for some people. If you're one of them, you can still work out. Ask your doctor what would help or see if they can refer you to a personal trainer who can help you find a good routine.

5. Get regular shut-eye. If your sleep habits are disrupted, or if you're very tired, it can make a migraine episode more likely.

6. Downsize your stress. There are many ways to do it. You could exercise, meditate, pray, spend time with people you love, take a walk in nature, and generally do things you enjoy. If you can change some of the things that make you tense, set up a plan for that. Counseling and stress management classes are great to try, too. You can also look into biofeedback, where you learn how to influence certain things (such as your heart rate and breathing) to calm down stress.

7. Stay hydrated. Dehydration is a trigger for many people. Carry a water bottle with you and make sure you're getting enough fluids every day.

8. Stay away from sensory stimulants. If bright lights, strong scents, or loud sounds bother you, take steps to avoid them as much as you can. Wearing sunglasses, earplugs, or noise-canceling headphones may also help.

9. Avoid the heat. Weather changes can be a trigger you can't always control. But you can take steps to limit your exposure. If the summer heat bothers you, for example, try to avoid spending time outdoors during the hottest part of the day.

10. Avoid taking medicine too much. It might seem counterintuitive, but taking medicine to help with your migraine attacks too often can lead to what's known as medication overuse headaches. If you find yourself in this vicious cycle, talk to your doctor or migraine specialist about a treatment plan that may help you avoid turning to over-the-counter or other medicines too often.

How to Find the Top Migraine Specialist Near Me

It is important to find a migraine specialist who has experience in the diagnosis and treatment of headache disorders. We know that finding the right one isn’t always easy. Here are some tips on how to find a migraine specialist.

1. Get referrals from friends or primary care providers

Friends and community members can be great resources in the search process along with primary care providers. Listening to people you trust can help you find a migraine specialist who will help guide you in your journey. You can also make these helpful connections online in virtual support groups and communities.

2. Do your research on the practice and physician

You can call ahead to get more detailed information about the practice or the specific doctor. 

Even if you do research in advance, the provider may lack experience in diagnosing and treating specific headache disorders. It can be frustrating to start over with each doctor. But don’t feel discouraged as finding a healthcare professional with the necessary experience is the priority. While you may not “click” with the first doctor you visit, finding the right successful patient-provider relationship can make all of the difference on your migraine journey.

3. Make the most of your visit

To have a successful visit, prepare by keeping a migraine journal so that you can describe your migraine in detail. You should also be able to provide your full medical history to your doctor so they have a well-rounded view of your health. Thoroughly planning for your appointment will help you make the most out of your visit. Advocate for yourself by preparing for your appointments and making your needs and goals clear. It’s important to rely on your migraine support team as you look to add a migraine specialist to the mix. That way, you can find the best migraine treatment strategy for you.

Sources:

Pain Ends Here

Melbourne Headache Solutions

NIH

Cleveland Clinic

Migraine Trust

Flint Rehab

NHS

Very Well Health

American Migraine Foundation

Mayo Clinic

Health Direct