Migraine Headache Treatment

The Four Phases of a Migraine: A Clinical Overview

Migraine with Aura

In many sufferers, migraines can also be accompanied by ‘migraine aura’. Aura is the term used to describe the gradual development of neurological symptoms, which precedes a migraine attack. It lasts from 20-30 minutes, followed by the main attack.

Symptoms may include:

– Altered vision with flickering lights, dark or white spots, lines, waves, or in some cases temporary loss of vision
– Sensory symptoms such as a burning or prickling sensation, or loss of sensation
– Speech disturbances
– Nausea and or vomiting
– Sensitive to light, sound and smell
– Abnormal sensation, weakness or numbness down one side of the face or body
– Confusion

Migraine without Aura

Migraine without aura occurs in approximately 70-90% of people with migraines. This refers to a migraine attack without visual disturbances such as flickering lights, colourful lines, dark or white spots, or temporary vision loss. These attacks will usually occur without warning and pain is usually felt on one side of the head.

Symptoms may include:

– Nausea and or vomiting
– Confusion
– Mood changes
– Fatigue
– Sensitivity to light, sound or smell
– Diarrhoea

Migraine without Headache (Silent Migraine)

Migraine attacks without headache, as the title suggests, are for those who suffer with the associated migraine symptoms, however without any typical head pain or headache. This indicates that the actual pain in the head is completely absent. Although the headache pain is absent, a migraine without headache can still be debilitating due to the other side effects it comes with.

Symptoms may include:

– Altered vision with flickering lights, dark or white spots, lines, waves, or in some cases temporary loss of vision
– Speech disturbances
– Nausea and or vomiting
– Sensitive to light, sound and smell
– Abnormal sensation, weakness or numbness down one side of the face or body
– Confusion
– Mood changes
– Fatigue
– Diarrhoea

Chronic Migraine

Chronic migraine is classified by having frequent migraine attacks more than 15 days per month, for more than 3 months in a row. Of these attacks, at least 8 out of the 15 attacks need to be true migraines. The remaining 7 out of the 15 attacks for people with chronic migraine can be other types of headaches, such as tension-type headaches. These migraines can be with or without aura, and are usually disabling due to the frequency of attacks per month.

Episodic Migraine

Episodic Migraine is classified by having migraines and headache attacks less than 15 days per month. These migraines can be with or without aura, and are usually disabling due to the frequency of attacks per month. Including both episodic and chronic migraines, it affects approximately 14% of the world’s population and up to 18% of women.

Migraine with Brainstem Aura (Basilar-Type Migraine)

Migraine with Brainstem aura occurs more commonly in children and adolescents. It most often occurs in teenage girls and can be associated with the commencement of their menstruation. This migraine includes ‘Migraine with Aura’ symptoms, and usually originates from the brainstem, without the symptoms of motor weakness (muscle weakness). Due to the origin of this disorder, it can affect the balance of that person with vestibular symptoms.

Symptoms may include:

– Dizziness
– Imbalance issues
– Vertigo
– Poor muscle coordination
– Tinnitus (ringing in the ears)
– Fainting
– Temporary partial or total vision loss or double vision
– Throbbing pain on either side of the head

Hemiplegic Migraine

Hemiplegic migraine is a form of migraine that causes temporary paralysis to one side of the body. This usually occurs prior to or during a migraine attack, which can last from one hour to several days. During an attack the person will experience temporary weakness which can involve the face, arm or leg, and is usually accompanied by pins & needles or numbness. The attack can be terrifying as symptoms mimic and are similar to a person suffering from a stroke. The severe headache can be similar to a typical migraine with aura, or at times be absent.

Symptoms may include:

– Vertigo
– Pricking or stabbing sensation
– Swallowing difficulties
– Speaking difficulties
– Confusion
– Weakness on one side of the body
– Temporary partial or total vision loss

Ocular Migraine

Ocular migraines, sometimes referred to as retinal migraines, are a rare type of migraine that can cause temporary vision loss or visual disturbances in one eye. These episodes are usually brief, lasting from a few minutes to an hour, and often accompany or precede a migraine headache. While the exact cause is not fully understood, it is believed that changes in blood flow or nerve signals within the eye or brain may play a role.

Symptoms may include:

• Temporary vision loss in one eye
• Flickering or flashing lights
• Blurry vision
• Blind spots
• Headache following visual disturbances

Abdominal Migraines

Abdominal migraines primarily affect children, though they can occasionally occur in adults. These migraines are characterised by recurrent episodes of moderate to severe abdominal pain, without headache pain typically associated with other migraine types. Each episode may last from one hour to several days. While the exact cause isn’t completely understood, abdominal migraines may share the same neurological roots as traditional migraines, involving a sensitised brainstem. 

Symptoms may include:

• Moderate to severe abdominal pain, usually centred around the belly button
• Nausea and vomiting
• Loss of appetite
• Pale skin or flushing
• Sensitivity to light or sound
• Fatigue or lethargy during episodes

Menstrual Migraine

Menstrual migraines, sometimes referred to as hormonal migraines, are migraines that occur in relation to the menstrual cycle. While hormonal fluctuations were once thought to be the sole cause, recent research suggests that menstrual migraines do not stem from hormonal abnormalities alone. Instead, they are believed to result from a sensitised brainstem, which reacts to the natural changes in hormone levels.

Symptoms may include:

• Throbbing or pulsating headache pain
• Sensitivity to light, sound, and smell
• Nausea or vomiting
• Visual disturbances such as flashing lights or blind spots
• Increased severity compared to other migraine types

Lifestyle Strategies for Migraine Management

While targeted treatment and having your migraine diagnosed professionally are essential for effectively addressing migraines, adopting supportive lifestyle strategies can also significantly enhance your overall migraine management. Many patients find relief by identifying and actively avoiding migraine triggers, such as certain foods (e.g., caffeine, chocolate, processed meats), stress, irregular sleep patterns, and strong sensory stimuli.

Incorporating daily relaxation techniques like mindfulness meditation, gentle yoga, or controlled breathing exercises can help reduce stress (known to trigger migraines) and minimise the frequency of attacks. Maintaining a regular sleep schedule, staying well-hydrated, and engaging in consistent, moderate exercise can also contribute to preventing migraine episodes. 

For a fully comprehensive education on migraine management strategies, get in touch with our team today to organise your initial assessment.

What is a migraine?

A migraine is a neurological disorder characterised by recurrent episodes of moderate to severe headache, often described as throbbing and typically affecting one side of the head. It is commonly associated with nausea, and sensitivity to light (photophobia) and sound (phonophobia).

Migraine is more than “just a headache” and can significantly impact daily function. Symptoms, frequency, and severity can vary widely between individuals, which is why careful assessment is important.

What causes a migraine?

Migraine is linked to increased sensitivity within the nervous system, particularly involving the trigeminovascular pathway. Rather than a single cause, it typically reflects a combination of genetic predisposition and external triggers. Common triggers include disrupted sleep, stress, hormonal changes, alcohol, and sensory inputs like bright lights. These factors don’t directly cause migraine, but can lower the threshold for an attack.

Assessment may also consider whether dysfunction in the upper cervical spine is contributing to this sensitivity. The Watson Headache Approach is one method used by clinicians to evaluate and address this potential contributor.

How long can a migraine last?

A migraine attack typically lasts between 4 and 72 hours if untreated, although some people experience shorter or longer episodes. For those with more frequent symptoms, migraine can become chronic, with migraine headaches occurring on 15 or more days per month. Duration can vary depending on individual sensitivity, trigger exposure, and how early the episode is managed.

How to get rid of a migraine?

During a migraine, some people find relief by resting in a dark, quiet environment, staying hydrated, and minimising sensory input. Some may also use prescribed medications to manage symptoms during an attack.

While short-term relief can help during an episode, longer-term management focuses on reducing how often migraines occur and how severe they become. This may involve identifying triggers, improving consistency in sleep and lifestyle factors, and addressing underlying contributors to nervous system sensitivity.

At Brisbane Headache and Migraine Clinic™, clinicians take a medication-free, surgery-free approach using the Watson Headache Approach to assess potential cervical contributions to migraine.