If you’re the one with migraine, particularly if you’re newly diagnosed, it’s likely many of the terms your doctor uses to describe the symptoms of migraine and what causes them are unfamiliar to you — that is, unless you enjoy reading medical dictionaries in your free time! If you don’t understand something that your doctor or pharmacist tells you about your migraine disease or treatments for it, it’s important to ask questions or ask for clarification. Likewise, if you read or hear something about migraine that you want to know more about, write it down, and ask your care provider the next time you see them. Use this glossary as an additional resource to help you better understand many of the different aspects of migraine. About 2 out of 3 children “outgrow” abdominal migraine by their teens, though 50 to 70 percent will go on to experience the more classic type of migraine that includes head pain as a symptom. Abortive Medication Also referred to as acute medication, this type of drug is taken as soon as a person feels a migraine attack beginning. Abortive migraine treatments include analgesics such as ibuprofen and acetaminophen, a class of drugs known as triptans, and a newer class of drugs called CGRP receptor antagonists, or “gepants” (pronounced JEE’-pants). Allodynia This describes the experience of feeling pain through ordinary stimuli that would not normally cause pain. Examples can include experiencing pain while brushing your hair or putting your head on a pillow. Allodynia can occur in people with migraine and is more common in people who experience migraine 10 or more days a month. Aura This term is used to describe a type of sensory disturbance that happens to about 1 out of 4 people with migraine. Aura usually involves visual changes, in which a person sees bright dots or zigzags in their field of vision, but it can also include tingling on one side of the body and trouble speaking. Aura symptoms are usually “positive” phenomena, meaning they involve seeing new things or feeling new sensations, as opposed to “negative” phenomena, such as loss of vision or sensation, and which is what occurs more commonly during a stroke. Aura symptoms typically occur as a migraine attack is starting, before the headache phase has gotten underway. Botox This drug is made from a toxin produced by the bacterium Clostridium botulinum. Injections of Botox (onabotulinumtoxinA) into the forehead and neck are approved for the treatment of chronic migraine, which is defined as 15 or more headache days per month. Botox has been shown to significantly reduce migraine frequency and severity, as well as headache-related disability. Cervicogenic Headache This type of headache is classified as a secondary headache, which means the pain is caused by something besides the headache itself. In this case, the pain arises from a source in the neck. Possible causes of a cervicogenic headache include a neck injury, arthritis, pinched nerves, or bulging or herniated spinal disk. The pain of a cervicogenic headache is typically one-sided, starts in the neck, and is often made worse by moving the neck. CGRP (Calcitonin Gene-Related Peptide) This small protein is released during migraine attacks and is believed to have a role in causing migraine attacks. Higher levels of CGRP in the blood is associated with chronic migraine. Two newer types of medications — CGRP receptor antagonists and CGRP antibodies — work by blocking CGRP or binding to it to prevent it from working. Chronic Migraine When a person with migraine has headache with migrainous features on at least 15 days per month, for more than three months, the person is said to have chronic migraine. About 85 percent of people with this disorder are women. The name “cluster headache” refers to the way these headaches occur in “clusters,” or cycles, of frequent headaches for weeks or months, followed by periods of no headaches for months or even years. Cluster headache is estimated to affect between 200,000 and one million people in the United States. Concussion A concussion is a type of traumatic brain injury (TBI) that’s caused by a blow, bump, or sudden jolt to the head or a hit to the body that causes the head and brain to move rapidly back and forth. The blow or movement can make the brain bounce around or twist in the skull, which can create chemical changes in the brain and sometimes stretch or damage the brain cells. Headache is one of the most common symptoms that can persist after a TBI. Cortical Spreading Depression This phenomenon takes place in the brain and is described as a slow spreading wave of altered brain activity that involves extreme changes in neuronal, glial, and vascular function. Neurons are the cells that transmit messages within the brain and to and from the brain and spinal cord to the rest of the body. Glial cells are another major component of central nervous system cells, with a variety of functions. Cortical spreading depression is thought to contribute to the changes in the brain that lead to migraine aura and could contribute to causing a migraine headache. Cyclic Vomiting Syndrome (CVS) This is a rare disorder that can affect both children and adults. People with CVS have recurrent episodes of severe nausea and vomiting that can last for a few hours to several days, followed by a period where they feel fine or have much milder symptoms before the cycle resumes. Addition symptoms can include dizziness, lack of energy, pale skin, abdominal pain, and headaches. Children with CVS can outgrow the episodes, but in many cases, they eventually develop migraine. Episodic Migraine Individuals who have migraine and up to 14 headache days per month are said to have episodic migraine. Those with more frequent headache days have chronic migraine. Hemiplegic Migraine This is a rare subtype of migraine with aura. It causes weakness on one side of the body that may switch sides between or during attacks. Other symptoms that are often part of aura, such as visual changes, tingling, numbness, and lethargy, can also occur. The attacks usually include a headache. Symptoms of hemiplegic migraine can last for a few hours to days, and in extreme cases can last up to four weeks. Severe hemiplegic migraine attacks may be associated with encephalopathy (altered brain function) or coma, and in rare cases can cause permanent brain injury or even death. Medication-Overuse Headache (MOH) Also called rebound headache, medication-overuse headache is caused by the too-frequent use of acute migraine or pain-relieving medications. This type of headache can occur almost every day and is often present upon waking up. The risk of medication-overuse headache increases when analgesics such as NSAIDs or acetaminophen are used 15 or more days a month, or triptans, ergotamines, or opioids are used more than 10 days per month. Caffeine intake of more than 200 milligrams per day increases the risk of MOH. Menstrual Migraine About 3 out 5 women with migraine experience menstrual, or menstrually related, migraine, which is when a migraine attack occurs before, during, or immediately after the period, or during ovulation. Doctors sometimes refer to this type of migraine as “catamenial” migraine. It’s suspected that this type of migraine is mostly caused by changes in the level of estrogen, the female sex hormone that regulates the menstrual cycle. Fluctuations in estrogen and the hormone progesterone are associated with migraine attacks. Migralepsy This is a syndrome that can occur in migraine with aura. In migralepsy, a migraine headache is almost immediately (within an hour) followed by an epileptic seizure, or the headache can follow a seizure. The relationship between migraine and epilepsy is unclear. There are some shared environmental risk factors, such as head injury, that increase the risk of both diseases. Nerve Block A nerve block can be an effective way to relieve the pain of some types of headaches, including migraine and cluster headaches. Doctors may inject local anesthetic and steroids into the base of the skull, over the eyes, or in the temple to block pain signals from the nerves. Another option is a sphenopalatine ganglion (SPG) block, in which anesthetic is delivered through an intranasal catheter to a collection of nerve cells just behind the bony structures of the nose. The SPG is closely associated with the trigeminal nerve, which is the main nerve involved in headache disorders. Nerve blocks don’t work for everyone, but when they are effective, the relief can last anywhere from a few days to a few months. Neurologist This type of doctor treats neurological diseases, sometimes specializing in one type of disease, such as migraine. Neurologists may also help their patients manage other medical issues, such as pain and depression. Neuromodulation This form of therapy, also referred to as neurostimulation, is used to treat different types of chronic pain, including migraine. Neuromodulation is the alteration of nerve activity through a targeted delivery of stimulus to specific sites in the brain; the stimulus can be electrical stimulation or a chemical agent. The goal of neuromodulation is “reset” the nervous system so that it will function normally and lead to pain relief. Phases There are potentially four phases of a migraine attack, including prodrome, aura, headache, and postdrome. Not everyone with migraine experiences all four phases, and an individual may not always experience the same phases in each migraine attacks. Photophobia (Light Sensitivity) This is a common symptom in headache disorders, including migraine. Photophobia is a term used when a person has discomfort or pain caused by light. Levels of light that another person would not consider bothersome can trigger a headache or make it worse in a person with photophobia. Postdrome Phase This is the fourth and final phase of a migraine. Sometimes called a “migraine hangover,” this phase can come with symptoms such as fatigue, muscle aches, dehydration, dizziness, and brain fog; however, some individuals may feel hyperactive or euphoric in the postdrome phase. Preventive Medications Preventive medications are used to reduce the frequency and severity of migraine attacks. These drugs are often recommended if a person is experiencing 4 to 5 migraine attacks — or even more — a month. Options include medications used in other conditions, such as beta-blockers or antidepressants, or migraine-specific medications, such as long-acting triptans or calcitonin gene-related peptide therapy (CGRP). Primary Headache Disorder These headaches are chronic brain disorders that aren’t caused by underlying systemic disease, trauma, or tumor. Migraine and tension-type headaches are examples of primary headaches. Prodrome Phase This is the first, or warning, phase of a migraine attack, although not everyone who has migraine experiences the prodrome phase. It can last hours or days before the aura or headache phase of the attack. Symptoms can include excessive yawning, neck soreness, fatigue, difficulty concentrating, and sensitivity to light, sound, smells. Rescue Medication This can also be known as “bridge,” or short-term preventive, therapy. Rescue medications are used if abortive treatments fail to relieve symptoms, or if they can’t be tolerated. These drugs are usually only given for a short period of time to “break” a migraine cycle and can include steroids or anti-nausea medications. Scotoma The visual symptoms that occur as part of migraine aura often begin as a small hole of light that can expand to a larger pattern and may include zigzags, bright spots, and flashes. Scotoma refers to an area in the visual field where the vision is disrupted or vision is partially lost. Secondary Headache Disorder This type of headache is caused by another condition or injury that triggers pain-sensitive areas in the neck and head. Although they are far less common than primary headaches, secondary headaches can be a potential sign of a serious health condition, such as a brain tumor, aneurysm, meningitis (an infection that causes inflammation of the brain), or a neck or brain injury. Secondary headache disorders typically come on without warning and cause severe pain. Status Migrainosus Also called intractable migraine, this is a migraine attack where the headache phase lasts more than 72 hours and doesn’t responding to treatment. Status migrainosus can cause severe distress and dehydration and in acute cases, may require hospitalization. Tension Headache Formally called “tension-type headache,” a tension headache feels like a band is squeezing the head, and the pain can also affect the scalp and neck. Unlike migraine, tension head is not typically accompanied by the nausea and vomiting and light and sound sensitivity that is typical of migraine. Tension headaches may be brought on when the neck and scalp muscles tense or contract as a response to stress, depression, anxiety, or head injury. People with migraine can also get tension-type headaches. Tinnitus Tinnitus is most often described as a ringing in the ears, but it can also be experienced as roaring, clicking, hissing, or buzzing. It can be soft or loud, high-pitched or low-pitched, and it can be present in one or both ears. Tinnitus is associated with different types of headache disorders, including migraine. Trigeminal Nerve The trigeminal nerve is a three-branched nerve that’s responsible for sensations in the face and other parts of the head and for functions like chewing and biting. The nucleus (central part) of the trigeminal nerve is located high in the back of the neck, in the c1,c2, and c3 vertebrae, which are the highest vertebrae in the spine. It is believed that the trigeminal nerve pathways are activated during a migraine attack. Trigger Triggers are what bring on migraine attacks. They aren’t the same for everyone, and they may not be the same from one attack to another for a given individual. But there are some migraine triggers that are commonly reported, including changes in the weather, particularly barometric pressure or humidity; high altitude; air travel; unpleasant odors; bright lights; dehydration; skipping meals; hormonal changes in women; stress; loud sounds; and too little or too much sleep. Triptans These drugs are a class of medication approved to treat acute migraine once it begins. Triptans work best when taken early in an attack. These medications are selective serotonin receptor agonists, meaning they work, in part, by stimulating the neurotransmitter serotonin to reduce inflammation and constrict blood vessels. Vestibular Migraine People with this type of migraine have vertigo, which means a person feels as though they are spinning, or the world around them is spinning. This sensation can bring on nausea and vomiting. Hearing issues such as tinnitus can occur with this type of migraine. A vestibular migraine can occur with or without a headache. Vertigo People with vertigo have the sensation that they are spinning or moving when they’re not, or that their surroundings are spinning. Vertigo is different from dizziness, which is characterized by feeling light-headed, disoriented in space, and off-balance.
