It’s not just a headache: What you need to know about migraine

Brian M. Plato, D.O., FAHS, Norton Neuroscience Institute neurologist board certified in headache medicine, answers some commonly asked questions about migraine attacks.

Despite 39 million Americans experiencing migraine attacks each year, many people still don’t take the condition seriously. People who’ve never had a migraine may not understand and offer unsolicited advice: “You can power through. It’s just a headache.”

Brian M. Plato, D.O., FAHS, a Norton Neuroscience Institute neurologist board certified in headache medicine, seeks to set the record straight. In terms of years lived with a disability, migraine is the second-leading cause. Here are his answers to some commonly asked questions about migraine.

What is a migraine?

Five or more headache attacks lasting between four and 72 hours with two of these four headache features:

  • Primarily affecting one side of the head
  • A throbbing sensation
  • Moderate or severe pain
  • Worsened by or causes the avoidance of physical activity

In addition, we also look for the following nonheadache features:

  • Heightened sensitivity to light and sound
  • Nausea
  • Vomiting

Some other characteristics that are fairly common are phases leading up to migraine attacks called prodrome and aura.

READ MORE: Migraine can get in the way of work


Not all migraine patients experience prodrome (about 30% do) but those who do typically experience symptoms such as irritability, depression, fatigue, muscle stiffness and food cravings.


About 20% to 25% of patients experience auras, which mainly take the form of visual disturbances such as flashing lights, bright colored lines or even a temporary loss of sight. Sensory auras are also experienced fairly often and result in numbness and tingling that slowly moves throughout the body.

What causes migraine headaches?

It is unclear as to what the “cause” of migraine is — it is generally believed that an individual with migraine has a brain that is more sensitive to stimulation/change. This can be a genetic predisposition, due to head injury, infection (such as meningitis), etc.

The triggers for migraine are numerous and often not a specific trigger, but rather a culmination of several triggers together. Common triggers include menstruation, certain foods/alcohols, sleep deprivation and changes in stress.

Are migraine attacks dangerous?

Permanent damage to brain cells and an increased risk of stroke can occur, however both of these outcomes are extremely rare. The biggest thing to be concerned about is rare, or episodic, migraine attacks being left untreated and becoming more frequent and difficult to treat in what can then become chronic migraine.

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Once migraine is chronic, a process called allodynia gradually makes nerves in the brain more excitable. Eventually these hypersensitized nerves begin to perceive nonpainful stimuli, such as a light touch of the skin, to be painful. This often results in medication overuse, which can cause more headaches, further contributing to the chronification of migraine. It’s important to seek treatment as early as possible to prevent the condition from progressing out of control.

When should I go to an emergency room for a migraine?

You should seek help urgently if you experience a sudden-onset migraine that reaches maximum intensity within one minute. This type of attack is known as a thunderclap headache. You also should seek urgent care if you begin to experience neurological symptoms such as weakness, numbness or inability to speak.

More generally, I typically suggest that people should contact their doctor at any point that they feel they are not getting satisfactory treatment of a condition that can cause significant disability. As we know, migraine certainly can meet this criteria.

Why don’t people take migraine seriously?

I think a large part of the problem stems from the lack of concrete information on what causes a migraine and the lack of uniformity in the way that patients respond. There isn’t an easy one-size-fits-all model for the public to wrap their heads around. Different people have different migraine symptoms and respond differently to them. This sometimes can lend to the misconception that people with migraine are “exaggerating symptoms.”

Patients with migraine tend to hear others around them reinforce these stigmas, and then they internalize them. If nobody around you is taking your condition seriously, that can start to get to you — and then all of a sudden you’re questioning whether it’s “all in your head.”

The reality is that these are serious conditions that if not addressed, can be extremely debilitating. Your migraine is real. Your pain is real. Your risk is real. But the good news is that your chance at a recovery is too. Please don’t wait until it’s too late.

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