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Migraine is a common problem affecting up to 12% of people. More common in women than men, it is found in families and is more common in the 3rd decade of life. Migraines without aura are more common than those with and comprises 75% of the cases.

Science has changed our perspective on how migraines start. It was thought to be from vasodilation but that occurs all over. It was actually a changed in the electrical conduction of the brain. Cortical Spreading Depression is a wave of nerve depolarization that moves accrues the neurons at a rate of 2-5mm/min. Once the trigeminal nerve is stimulated the inflammation ensues and pain begins. It is like a cascade of energy depolarization as it moves though the brain triggering other symptoms.

Migraines can be recurrent and can last hours to days. Some may have warning signs before starting: yawning, euphoria, depression, irritability, food cravings, constipation and neck stiffness. Auras may or may not precede the headache. This is followed by the headache which progresses over hours. Throbbing pain more often on one side but may move to the other or start together. The pain can be throbbing or constant with pulsations followed by nausea and vomiting. Untreated the headache can last 4 hours to days.

There are many variances to this scenario just as there are triggers.

Treatments are available and a majority of them are generic medications. They include intermittent treatment to daily medication or prevention with Botox injections. Depending on your medical health and risk there are options.

Lifestyle measures — Therapeutic lifestyle measures may be beneficial for controlling migraine, including good sleep hygiene, routine meal schedules, regular exercise, and managing migraine triggers. Sleep apnea has been known to cause daily headaches.

Nonpharmacologic interventions — Nonpharmacologic therapies with at least moderate-quality evidence suggesting benefit for migraine headache prevention include aerobic exercise, biofeedback, other forms of relaxation training, cognitive-behavioral therapies, acupuncture, and transcutaneous electrical nerve stimulation. More information is available on Uptodate.com.