migraine
Meaning of migraine: A whole-brain event that happens to hurt: the pain is one stage of an attack starting hours before it and outlasting it.
Definition of migraine
A migraine is a headache disorder in which attacks of moderate to severe head pain, often on one side and pulsating, come with sensitivity to light and sound, sickness, and worsening on movement. An attack lasts hours to days. Between attacks the person is usually well, and a minority also experience an aura, a wave of neurological symptoms arriving before or with the pain.
What happens during an attack?
An attack is a sequence rather than a single event, and the pain occupies only part of it. Hours or even a day beforehand, many people notice a warning phase of yawning, food cravings, neck stiffness, mood change or unusual tiredness. Then comes the aura, in those who get one, and after that the headache itself, during which the nerves supplying the blood vessels of the head become activated and release inflammatory signaling molecules around them. Movement, light, sound and smell all amplify the pain. A recovery phase follows, often described as feeling washed out, and it can occupy another day. The serotonin system is bound up in that sequence, which is why the drugs developed specifically to stop an attack act on serotonin receptors.
What does an aura look like?
Most auras are visual. A small flickering spot grows over minutes into a zigzag arc of bright lines, leaving a blind area behind it as it drifts across the field of vision. Others take the form of pins and needles marching slowly from the hand up the arm into the face, or of sudden difficulty finding words. Pace is the distinguishing feature. An aura builds gradually and adds a sensation before taking one away, while the symptoms of a stroke usually arrive at full strength at once and take function away from the start.
How does it differ from other headaches?
| Feature | Migraine | Tension-type | Cluster |
|---|---|---|---|
| Pain | Throbbing, often one side | Tight band, both sides | Boring pain behind one eye |
| Length | Hours to days | Half an hour to days | Short, repeating daily for weeks |
| Movement | Makes it worse | Little effect | Restlessness and pacing |
| Other features | Sickness, light and sound sensitivity | Few | Watering eye, drooping lid |
Sickness matters as much as the pain. Nausea and vomiting are so characteristic that the stomach empties slowly during an attack, which is one reason tablets swallowed late work poorly. Drugs taken daily to reduce how often attacks come are borrowed from unrelated families, among them amitriptyline and medicines first developed for epilepsy or blood pressure. A headache reaching maximum intensity within seconds does not fit the migraine pattern.
Also known as
Used in a sentence
Migraine with aura was recorded in the history, with attacks preceded by visual zigzags.
Good to know
A migraine aura spreads over minutes and adds symptoms such as zigzag lights before removing function, whereas stroke symptoms usually reach full intensity at once, and a headache peaking within seconds of onset does not fit the migraine pattern at all.
Word origin
Where “migraine” comes from
Migraine descends from the Greek hemikrania, half of the skull, from hemi meaning half and kranion meaning skull, reflecting the one-sided pain.