From the Guidelines
The first occurrence of a migraine is typically triggered by a combination of genetic predisposition and environmental factors, with stress, hormonal changes, and certain foods being common triggers. People with a family history of migraines are more susceptible to developing them. Common triggers for a first-time migraine include hormonal changes (particularly in women), certain foods like aged cheese or processed meats, alcohol (especially red wine), caffeine withdrawal, lack of sleep, dehydration, weather changes, bright lights, strong smells, and skipping meals 1. The underlying mechanism involves abnormal brain activity affecting nerve signals, blood vessels, and chemicals like serotonin. During a migraine, blood vessels in the brain initially constrict and then dilate, causing inflammation and pain.
For immediate relief, over-the-counter pain medications like ibuprofen or acetaminophen can help if taken early, and counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy, can improve efficacy 1. Resting in a dark, quiet room, applying cold compresses to the forehead, and staying hydrated are also beneficial. It is also important to highlight the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, managing stress with relaxation techniques or mindfulness practices, and, where applicable, pursuing weight loss for those who are overweight or obese 1. If migraines become recurrent, keeping a headache diary to identify personal triggers can help prevent future episodes. Persistent or severe migraines warrant medical attention to rule out other conditions and explore preventive treatments.
Some key factors to consider when treating migraines include:
- Medication overuse headache, which is a potential complication of migraine treatment, defined as headache occurring on 15 or more days per month for at least 3 months in people with a preexisting headache disorder that develops because of overuse of acute medication 1
- The importance of exploring modifiable migraine triggers or contributing factors during a detailed history 1
- The potential benefits of preventive medications if the episodic migraine occurs frequently or treatment does not provide an adequate response 1
From the Research
Causes of Migraine
- The exact cause of migraine is not fully understood, but it is believed to involve a combination of genetic and environmental factors 2.
- Migraine is a type of primary headache disorder, which means that it is not caused by an underlying medical condition 2.
- Secondary headache disorders, on the other hand, are caused by an underlying medical condition, such as a vascular, neoplastic, infectious, or intracranial pressure/volume disorder 2.
Triggers of Migraine
- Certain triggers can set off a migraine attack, including:
- Hormonal changes
- Stress
- Sensory stimuli (e.g. bright lights, loud noises)
- Certain foods or drinks
- Changes in sleep patterns or environment
- However, the exact triggers of migraine are not well understood and may vary from person to person 3, 4.
First-Time Migraine
- The first-time migraine can be triggered by a variety of factors, including:
- Genetic predisposition
- Hormonal changes
- Stress
- Sensory stimuli
- It is not clear what causes a person to experience their first migraine, but it is believed to involve a combination of genetic and environmental factors 2, 5, 6.
Treatment of Migraine
- Treatment of migraine typically involves a combination of acute and preventive therapies, including:
- Acute treatments, such as triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and combination products
- Preventive treatments, such as antihypertensives, antiepileptics, antidepressants, and calcitonin gene-related peptide monoclonal antibodies
- The choice of treatment will depend on the individual's specific needs and medical history 2, 3, 4, 5, 6.