Migraine attacks, symptoms, causes, complications and medical treatment


Headache is a common neurological complaint in communities. Migraine, a unique type of headache with a definite onset and signs and symptoms, is an increasingly common neurological disorder that affects one billion people globally, or around 12% of the population, including children. Migraine is the world’s third most common disorder.


  • Migraine is a form of headache that causes intense throbbing pain or a pulsating sensation usually on one side of brain.
  • It’s commonly associated with nausea, vomiting, and severe light and sound sensitivity.
  • The majority of migraine attacks last thirty minutes to three hours, but they can occasionally endure for days.


The classical attack of migraine can progress through four stages:

  • Prodrome,
  • Aura,
  • Attack, and
  • Post-drome.

But not everyone who is suffering from migraine has classical migraine and at the same time, in an individual also, not every attack will be a classical one. Let’s discuss about these four stages:

  • Prodrome: The patient may detect small changes one or two days before a migraine that signal an impending migraine, including:
  • Mood swings
  • Neck stiffness
  • Increased urination or Fluid retention
  • Food cravings
  • Frequent yawning etc.
  • Aura: For some people, migraine attack may be preceded or accompanied by reversible neurological symptoms called ‘Aura’. They’re usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes. Examples of auras include:
  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light or sometimes blind spots or frank blindness.
  • Pins and needles sensations in an arm or leg, dizziness.
  • Slurring of speech or weakness or numbness in the face or one side of the body
  • Attack: If left untreated, a migraine can persist anywhere from 4 to 72 hours. The frequency and severity of migraine varies from person to person. During a migraine, the patient often complains of:
  • Throbbing or pulsating type of head pain usually on one side at a time.
  • Irritation to intense light, sound, and sometimes smell and even touch
  • Nausea and vomiting
  • Post-drome: For up to a day after a migraine attack, the sufferer may feel fatigued, bewildered, and washed out. A sudden head movement may reactivate the discomfort for a brief period of time.


Although the exact causes of migraines are unknown, heredity and environmental factors appear to play a role. It’s possible that changes in the brainstem and its interactions with the trigeminal nerve, the main pain pathways of head and neck region, are to blame. The role of serotonin in migraines is being investigated by scientists. Other neurotransmitters, such as calcitonin gene-related peptide, play a role in migraine discomfort. However, there are few factors acting as a trigger for migraine attack, including:

  • Stress
  • Missing sleep or getting too much sleep.
  • Hormonal changes in women like Fluctuations in oestrogen either before or during menstrual periods, pregnancy and menopause, oral contraceptives.
  • Bright or flashing lights, loud sounds, Strong smells such as perfume, paint
  • Intense physical exertion, including sexual activity.
  • A change of weather or barometric pressure.
  • Cheeses and salty and processed foods
  • Food additives such as sweetener aspartame and the preservative.
  • Alcohol or beverages containing too much caffeine

Apart from triggers which causes the patient of migraine to have another attack, there are few risk factors which predisposes a person to have migraine. These are:  

  • Family history of migraines.
  • Female sex
  • Young age
  • For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.

Complications in migraine

Taking painkillers too often can trigger serious medication-overuse headaches, when medications stop relieving pain and begin to cause headaches. Patients then use more pain medication, which aggravates the cycle. Sometimes migraine attack may last for days, the condition is called ‘Status migrainosus’ a disabling condition affecting badly the quality of life. More than 90 percent of migraine sufferers miss work or can’t function normally during an attack. 2-3 million people suffer from chronic migraine, defined as migraines that occur at least 15 days per month for 3 months. Chronic migraines reduce quality of life, including increased depression, anxiety and pain medication overuse.

When to see a doctor when you have a migraine?

Migraines are overlooked and mistreated so often. Keep track of your migraine attacks and how you dealt with them if you suffer them on a regular basis. Then schedule a consultation with your physician to address your headaches. Even if you’ve had headaches before, consult your doctor if the pattern changes or your headaches feel different.

See your doctor immediately or go to the emergency room if you have any of the following features, which could indicate a more serious mimicking medical problem rather than benign migraine:

  • New headache pain after the age of 50
  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke
  • Headache after a head injury
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement

Dr. Govind Madhaw

MBBS, MD (Medicine), DM (Neurology) AIIMS

Consultant Neuro-physician

Orchid Medical Centre

Dr Govind Madhaw is one of the best consultant Neuro-physician in Ranchi. He is a full-time consultant neuro physician at one of the best hospitals in Ranchi, Orchid Medical Centre. He completed his DM Neurology from AIIMS Rishikesh. He has done his MBBS and MD (Medicine) from RIMS Ranchi. To his credit, he has several scientific publications in international and national indexed journals of high impact factor. Also, he has authored chapters in a number of books on Neurology. Apart from being a well-versed clinician, he is an excellent academician and orator and enjoys teaching.

Area of expertise

  • Stroke
  • Epilepsy
  • Parkinson disease and other movement disorders
  • Myasthenia gravis, Gullian Barre syndrome and other neuromuscular disorders
  • Meningitis
  • Headache
  • Multiple sclerosis and other autoimmune neurological disorders.

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