Migraine

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What is migraine?

Migraine is a health condition that is more than just a bad headache. The symptoms of migraine are different from person to person, but often include headaches that keep coming back. They can also include nausea, vomiting, changes in mood, extreme tiredness, and sensitivity to light, noise, and smells. These symptoms can happen all at once during a migraine attack, or they can happen separately in between migraine attacks. Migraine attacks may last from hours to days and make it hard to do everyday activities.

One of the most common symptoms of a migraine attack is moderate to severe throbbing pain that usually happens on one side of the head. Current research shows that this head pain happens when there is abnormal activity among nerve signals, chemical signals, and blood vessels in the brain.

Some people have migraine attacks at predictable times—such as before their period (menstrual cycle) or on weekends following a stressful week. In between attacks, people living with migraine may also experience symptoms like having a hard time concentrating, depression and anxiety, tiredness, difficulty sleeping, and/or body chills. 

There are different types of migraine. Migraine with aura happens in some people living with migraine. Aura symptoms are usually changes in vision—like seeing dots, zigzags, or sparks—but can also include changes in a person’s ability to speak. They might also include feelings of pins and needles in different body parts. 

There is currently no cure for migraine, but treatments can help manage symptoms.

Several factors can trigger a migraine attack or increase a person’s risk of having one. These factors vary from person to person, and include:

Phases of migraine attack

Migraine attacks happen in phases.

Aura

Only some people living with migraine experience aura. Auras appear about 10 minutes to an hour before the actual headache, and usually last no more than an hour. Classic aura symptoms include vision changes, trouble speaking, tingling in the hands or face, and confusion. Some people will perceive flashing or bright lights, experience muscle weakness, or the sensation of being touched or grabbed.

Headache

A headache during a migraine attack usually starts gradually and gets more intense. Headache pain may happen without warning, and is usually felt on one side of the head. Other common symptoms include nausea, vomiting, sensitivity to light, smell, and sound, confusion, blurred vision, mood changes, and fatigue. This phase can last from hours to days. It's also possible to have a migraine without a headache. In these cases, a person may have visual problems or other symptoms like nausea, vomiting, or constipation.  

Postdrome

People are usually exhausted or confused after a migraine. They might have a hard time concentrating, feel dizzy, or experience mood changes. The postdrome period may last up to two days before people feel healthy again.

Types of Migraine

The most common type of migraine is migraine without aura. There are other types of migraine that affect some people. Those include:

Migraine with aura

     Migraine with aura can be broken up into different subtypes: 

• Migraine with typical aura is when a person has vision changes, other sensory changes (like tingles), and/or difficulty speaking. These symptoms go away after the migraine attack. A typical aura does not have brainstem aura (see below), movement, or vision symptoms. 
• Migraine with brainstem aura includes at least two of these symptoms during an attack: vertigo, double vision, poor muscle coordination (such as shakiness), slurred speech, ringing in the ears, hearing loss, and fainting. 
• Hemiplegic migraine is a rare and severe form of migraine. It causes temporary paralysis—sometimes lasting several days—on one side of the body. The paralysis happens before or during a headache. Symptoms may include vertigo (a feeling of dizziness or losing balance), a pricking or stabbing sensation, and problems seeing, speaking, or swallowing. These symptoms may start before the headache pain, and usually stop shortly after. The disorder is called familial hemiplegic migraine (FHM) when it runs in families. Though rare, researchers have identified at least three distinct genetic forms of FHM. These genetic mutations make the brain more sensitive or increase neuronal activity, most likely by increasing levels of a brain chemical called glutamate. Glutamate transports messages between nerve cells and other cells. Too much glutamate has been linked to increased sensitivity to pain.
• Retinal migraine usually affects one eye and includes attacks of temporary vision loss or changes in eyesight. These attacks, like the more common visual auras, are usually linked with headaches.

Other types of migraine

• Chronic migraine happens when headaches – either the kind experienced in a migraine attack or a tension-type headache – happen on at least 15 days of the month for over three months. They can either happen with or without auras.
• There can be complications of migraine. One rare but serious complication is status migrainosus. In this case, a migraine attack causes debilitating pain and nausea for longer than 72 hours. The pain and nausea may be so intense that people need to be hospitalized.
• In some cases, people might experience syndromes associated with migraine. This can include attacks of abdominal symptoms, vertigo, or (in children) twisted neck. 
• Menstrual migraine affects people who menstruate around the first day of their menstrual cycle for at least two out of three cycles. People living with menstrual migraine can have migraine attacks at other times of the month (menstrually related migraine) or only during the beginning of the cycle. Symptoms may include migraine with or without aura, pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light.
• In addition to migraine as a main health condition, migraine attacks can also be a part of other health conditions. This is called probable migraine.

Who is more likely to have migraine?

Several factors contribute to whether or not a person will have migraine.

Migraine is a genetic disorder, meaning most people with migraine have a family history of the disorder. 

Migraine happens in both children and adults. Clues to watch for in children who are not able to describe their symptoms include sensitivity to light and noise. For example, they may refuse to watch television or use the computer—or they may stop playing to lie down in a dark room. 

In general, migraine affects adult females/women more often than males/men. Hormone changes that happen with the menstrual cycle or pregnancy seem to be one important cause of this disparity. Headaches may begin when a woman's first period begins, or during pregnancy. Most women see improvement in migraine attacks after menopause, although surgical removal of the ovaries (oophorectomy) usually worsens migraine attacks. Using birth control (contraception) can also affect their frequency and severity.

Other migraine disparities exist. Native Americans are more likely to have migraine than other racial/ethnic groups. People who are unemployed and are experiencing poverty are also more likely to have migraine. 

Living with a chronic medical condition can weigh on a person’s wellbeing and quality of life. People living with migraine more commonly experience mental health concerns (like depression and anxiety) and sleep disorders than the general population. Other medical conditions that are more common in people living with migraine include bipolar disorder and epilepsy.

How is migraine diagnosed and treated?

Diagnosing migraine

To diagnose the possible cause of migraine, a doctor will review medical history and do physical and neurological exams. They may also do a screening test or ask questions to understand a person’s symptoms.

Neuroimaging, like an MRI or CT scan, is not usually used to diagnose migraine. A doctor might order one if they suspect the person might have another condition that causes headaches and other symptoms of migraine.

Keeping a headache journal can also help a doctor better diagnose migraine and find the best treatment. They might ask a person to include things like when the migraine attack happened, how intense it was, any activity before it started, and the symptoms a person experienced. 

Treating migraine

The goal of migraine treatment is to relieve symptoms and prevent additional attacks. Quick steps to ease symptoms may include:

• Napping or resting in a quiet, darkened room
• Placing a cool cloth or ice pack on the forehead
• Drinking lots of fluid, especially if a migraine attack includes vomiting

Small amounts of caffeine may help relieve symptoms during a migraine's early stages.

Medicines for migraine include short-term medicines to treat attacks and longer-term medicines to prevent them. Acute or "abortive" medicines are taken as soon as symptoms happen to relieve pain and restore function. Preventive treatment involves taking medicines every day to make future attacks less severe or keep them from happening. It’s important for people to work with their doctor when using headache medicines, as some of them may cause side effects.

Several medicines used to treat migraine target a chemical called serotonin in the brain.  Serotonin has been shown to be lower in people with migraine. Medicines may also target a protein called calcitonin gene-related peptide (CGRP), which plays a role in how people feel pain. 

Short-term treatment for migraine may include any of the following medicines:

• Triptan drugs (such as Sumatriptan and Zolmitriptan) are the standard treatment for migraine. They increase levels of serotonin in the brain.
• Ergot derivative drugs (such as ergotamine and dihydroergotamine) attach to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They work best during the early stages of migraine.
• Calcitonin gene-related peptide antibodies (CGRP) drugs (such as Atogepant) can be used for short or long-term migraine treatment, depending on the type of drug. They prevent activation of specific nerves in the brain related to pain. 
• Over-the-counter medicines (pain relievers such as ibuprofen, aspirin, or acetaminophen) can ease the pain of less severe migraines.
• Nausea relief drugs (such as chlorpromazine and metoclopramide) can ease queasiness brought on by various types of headache, including migraine.

Botulinum toxin type A (commonly known as Botox®) is a long-term treatment for migraine, and may also help reduce migraine attacks if they happen more than 15 days a month.

Some people who get severe or frequent migraine attacks need preventive medicines. In general, if a person gets migraine attacks once a week or more, their doctor should consider treatment to actively prevent attacks. If migraine attacks happen less often but are severe or disabling, preventive treatment may be appropriate. Preventive medicines also are recommended for people who take medicine for headaches more than three times a week. 

Not every preventive migraine treatment works for every person. A person may need to try multiple medicines over the course of several months to find one that works and doesn’t cause problematic side effects. 

Preventive approaches for migraine may include the following treatments: 

• Anticonvulsants raise levels of certain brain chemicals and reduce pain signals, and were originally developed for treating epilepsy.
• Beta-blockers are used to treat high blood pressure and can help prevent migraine attacks.
• Calcium channel blockers help to stabilize blood vessel walls and are also used to treat high blood pressure. When blood vessels in the brain narrow or widen, it can trigger or worsen migraine symptoms. These drugs prevent blood vessels from narrowing or widening.
• Antidepressants work to balance different chemicals in the brain related to migraine, including serotonin, norepinephrine, and dopamine.

Non-drug approaches for treating migraines

Many people take other steps to prevent and reduce their migraine attacks beyond medications. These can include special diets or supplements, meditation or relaxation techniques, cognitive-behavioral therapies for pain, massage, or acupuncture. 

Changes to everyday habits can reduce or prevent migraine attacks in some people. These include exercising, avoiding food and beverages that trigger headaches, eating regular meals, drinking enough water, stopping certain medicines, and going to bed and waking up at the same time everyday. 

Some people living with migraine have found supplements such as riboflavin (vitamin B2), magnesium, coenzyme Q10, and butterbur (a medicinal plant) to be helpful. Others have used biofeedback to manage their symptoms. 

Biofeedback uses electrical and other monitors to assess a person’s heart rate, breathing, and muscle movements as a way to understand how the body is working. Relaxation training is another way to help people cope with or control pain in the body and its response to stress.

The National Center for Complementary and Integrative Health (NCCIH) offers more information about non-drug approaches to treating migraine.

What are the latest updates on migraine?

Learn about related topics

• Headache
• Migraine Trainer
• Pain