Migraine

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What is migraine?

It’s common to hear migraine episodes referred to as “migraines” or “migraine headaches.” In this article, we use "migraine" to describe an ongoing health condition with a complex set of symptoms. We use "migraine episodes" to describe short-term headaches as part of this ongoing health condition, which often includes other symptoms.

Migraine is a health condition that is more than having a bad headache. The symptoms of migraine are different from person to person but often include headaches that keep coming back. Other symptoms might be nausea, vomiting, changes in mood, and feeling extremely tired. People with migraine may also be sensitive to light, noise, and smells. These symptoms can happen all at once during a migraine episode, or they can happen separately in between migraine episodes. Migraine episodes may last from hours to days and make daily life hard.

One of the most common symptoms of a migraine episode is moderate to severe throbbing pain that usually happens on one side of the head. Current research shows that migraine-associated head pain happens when nerve signals, brain chemicals, and blood vessels aren’t working properly in the brain.

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

There are different types of migraine. One type is migraine with aura. Aura symptoms usually affect vision—like seeing dots, zigzags, or sparks—but can change a person’s ability to speak. Aura symptoms might also include feelings of pins and needles throughout the body.

There is currently no cure for migraine, but treatments can help manage symptoms.
Several factors can trigger a migraine episode or increase a person’s risk of having one. These factors differ from person to person and include:

Phases of a migraine episode

Migraine episodes happen in these phases:

Prodrome

The prodrome phase is the beginning of a migraine episode. This phase can happen a few hours to a few days before an episode starts. Symptoms can include food cravings, unexplained mood changes such as feeling unexpectedly sad or very happy, uncontrollable yawning, swelling, or needing to urinate (pee) more than usual.

Aura

Only some people living with migraine episodes have an aura. Auras appear about 10 minutes to an hour before the actual episode, and usually last no more than an hour. Symptoms of an aura include vision changes, trouble speaking, tingling in the hands or face, and confusion. Some people will see flashing or bright lights, feel their muscles get weak, or feel like they are being touched or grabbed.

Headache

Headache pain from a migraine episode usually starts slowly and gets worse. Headache pain may happen without any warning and is usually felt on one side of the head. Other common symptoms that come with pain include nausea, vomiting, sensitivity to light, smell, and sound, confusion, blurred vision, mood changes, and tiredness.

The headache phase can last from hours to days. Some people have a migraine episode without a headache. In these cases, a person may have problems with vision or other symptoms like nausea, vomiting, or constipation.

Postdrome

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

Types of migraine

The most common type of migraine is migraine without aura. Other types of migraine include:

Migraine with aura

There are several types of migraine with aura:

Migraine with typical aura is when a person has changes in their vision, other symptoms affecting their senses (like tingles), or problems with speaking. These symptoms go away after the migraine episode.
Migraine with brainstem aura includes at least two of these symptoms during a migraine episode: a spinning feeling (vertigo), seeing double, trouble with balance or movement, slurred speech, ringing in the ears, hearing problems, or fainting.
Hemiplegic migraine is a rare and severe form of migraine. It causes temporary paralysis on one side of the body, which may last for several days. The paralysis can happen before or during an episode. Symptoms may include vertigo, a pricking or stabbing sensation, and trouble seeing, speaking, or swallowing. These symptoms may start before the headache pain, and usually stop soon after it.
Retinal migraine usually affects one eye and includes temporary problems with vision or loss of eyesight. People with this type of migraine, like the more common visual auras, usually have headaches.

Other types of migraine

Chronic migraine happens when headaches from migraine happen on at least 15 days of the month for more than three months. Headaches can either happen with or without auras.
Status migrainosus is a rare but serious complication of migraine that lasts longer than 3 days and can cause severe pain and nausea. The pain and nausea may be so intense that a person needs to be hospitalized.
Syndromes associated with migraine can include stomach problems, a spinning feeling (vertigo), or head-tilting (sometimes called “twisted neck,” which can happen rarely in children with migraine).
Menstrual migraine happens on the first day of a person’s menstrual cycle for at least two out of three cycles. People living with menstrual migraine can have migraine episodes 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.
Probable migraine includes migraine episodes that relate to other health conditions.

Who is more likely to have migraine?

Several factors affect whether or not a person will have migraine.

Migraine happens in both children and adults. Very young children who aren’t able to describe their symptoms, like sensitivity to light and noise, might refuse to watch television or use an electronic device—or they may stop playing to lie down in a dark room.

Hormone changes that happen with the menstrual cycle or pregnancy seem to be one important trigger for migraine. This is likely why females experience migraine more than males.

Migraine episodes may begin during a person’s first menstrual period or during pregnancy. Most females see improvement in migraine episodes after menopause. But removing the ovaries (“surgical menopause”) can make migraine episodes worse. Using birth control (contraception) can also change how often migraine episodes happen and how severe they are.

People living with migraine more commonly experience mental health conditions (such as depression and anxiety). They are also more likely to have sleep disorders compared to the general population. Some health conditions, including epilepsy and bipolar disorder, are more common in people with migraine.

How is migraine diagnosed and treated?

Diagnosing migraine

To determine what might be causing migraine, a doctor will review a person’s health history and do physical and neurological exams. They may also ask specific questions about headaches—such as when they start, how long they last, what they feel like, what triggers them, and if there are any other symptoms like nausea or vision changes.

Imaging tests, such as an MRI or CT scan, aren’t usually used to diagnose migraine. A doctor might order one of these scans if they suspect a person might have another condition that causes headaches or other symptoms of migraine.

Learn more about neurological tests and procedures.

Keeping a headache journal

Understanding what’s causing a person’s headache can help guide treatment. A headache journal can help a doctor better diagnose the type of headache and find the best treatment. After each headache, write down:

The time of day when it happened
How intense it was and how long it lasted
Any sensitivity to light, smells, or sound
Any activity right before the headache started
Any medicines taken, including both prescription and over-the-counter
The quality and length of the previous night’s sleep
Any stress or strong emotions before developing symptoms
The weather or changes in daily routine
Food and drinks consumed in the previous 24 hours
Any other health conditions

People who menstruate can record the days of their periods. Notes about other family members who have a history of headache conditions or other health conditions are also helpful. This information can help identify any patterns to help a doctor and patient create a headache-management plan.

NINDS developed Migraine Trainer® to help teens age 13 and older understand possible causes of their migraine headaches. Use the Migraine Trainer® log(pdf, 88 KB) to track triggers, treatments, and daily goals that help reduce pain.

Treating migraine

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

Napping or resting in a quiet, dark room
Putting a cool cloth or ice pack on the forehead
Drinking lots of fluid, especially if a migraine episode includes vomiting

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

Medicines for migraine include short-term medicines to treat individual episodes and longer-term medicines to prevent them from happening. Acute (short-term) medicines are taken as soon as symptoms begin. They aim to help relieve pain and help a person return to normal activities.

Some people take long-term migraine medicines every day to help stop migraine episodes from happening or make them less severe when they do happen. Doctors who treat people with migraine can explain potential side effects of headache medicines.

Medicines for migraine symptoms

Some people with migraine have lower levels of the brain chemical serotonin. Several medicines used to treat migraine target serotonin. Medicines may also target a protein called calcitonin gene-related peptide (CGRP), which helps the body send pain signals.

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

Triptan medicines (such as sumatriptan and zolmitriptan) are a common treatment for migraine. They act like serotonin in the brain to relieve symptoms.
Ergot derivative medicines (such as ergotamine and dihydroergotamine) narrow widened blood vessels and reduce nerve signals linked to pain. They work best when taken during the early stages of a migraine episode.
Calcitonin gene-related peptide (CGRP) medicines (8 different types are available) block CGRP, a protein involved in migraine pain that increases during migraine episodes. They can be used to either prevent migraine from happening or to treat short-term pain.
Over-the-counter medicines (pain relievers such as ibuprofen, aspirin, or acetaminophen) can ease the headache pain of less-severe migraine episodes.
Nausea relief medicines (such as chlorpromazine and metoclopramide) can treat nausea caused by migraine.

Preventive medicines

People who have migraine episodes once a week or more are usually prescribed treatment to prevent them from happening. The same is true for people who have severe migraine episodes that happen less often.

Not every preventive migraine treatment works for every person. Finding the right medicine may take time, and some people need to try several options before finding one that works well for them.

Preventive approaches for migraine may include the following treatments:

Anticonvulsants (medicines used to treat seizures)
Beta-blockers and calcium channel blockers (medicines often used to treat high blood pressure)
Some antidepressants
Botulinum toxin type A (commonly known as Botox®) can be a long-term treatment for chronic migraine (15 or more headache days per month)

Non-medicine treatments

There are other ways to prevent and treat migraine besides taking medicines. Some people find the following helpful:

Special diets
Meditation or relaxation techniques
Yoga
Acupuncture
Psychological therapy that helps people learn ways to cope with pain

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

Dietary supplements are marketed to relieve migraine symptoms, but many have not been thoroughly tested by researchers. If you’re considering dietary supplements for migraine, it’s important to talk with your doctor first. Combinations of some medicines and supplements can cause unwanted, even dangerous, side effects.

Some people with migraine have used biofeedback to manage their symptoms. Biofeedback is a technique that teaches a person to notice and control body signals like muscle tension, which may be helpful for some types of headache.

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

What are the latest updates on migraine?

The National Institutes of Health (NIH), which includes NINDS, is the leading federal funder of research on the brain and nervous system—including research on migraine. NIH supports new and innovative research to better understand, diagnose, and treat many pain conditions, including migraine.

NIH-supported research projects cover a wide range of topics on migraine. Research covers understanding brain circuits involved in migraine, predicting episodes, improving current treatments, and testing new potential medicines that can treat migraine.

Understanding migraine

NIH-funded researchers are studying how brain circuits affect migraine episodes to understand how these communication pathways work. This includes understanding the role of specific brain chemicals (neurotransmitters), hormones, and the immune system.

Researchers supported by NIH are also discovering how to more accurately predict migraine episodes. They are also investigating how health conditions like obesity, depression, and sleep disturbance may affect migraine and its severity. A new NIH-supported study shows how aura triggers a migraine episode.

NIH funds several projects using research in animals to learn how headache and migraine work, which may lead to new treatments. Scientists are also using advanced brain scans to understand what happens in the brain during migraine and other headaches.

The goal of these studies is to improve treatment, quality of life, and wellbeing for people living with migraine.

Innovative therapies for migraine

Scientists funded by NIH are identifying and testing new medicines and other treatment options for migraine. This includes potential medicines that block a brain pathway involved in stress. Other NIH-funded researchers are studying chemical communication between different types of cells in the body. These include cells that fight infections and cells that sense pain, which could lead to new ways to treat and prevent migraine episodes.

NIH-funded research is studying how to relieve a migraine episode without medicines. These studies are focusing on things like using different types of lighting and changes in diet.

Other research supported by NIH explores relaxation and stress-management techniques for children, therapies that help people manage pain, and non-surgical brain stimulation that uses gentle electrical or magnetic signals. They are also studying biomarkers (biological signs of disease or disease progression) to predict and explain outcomes related to migraine.

The NIH-supported Childhood and Adolescent Migraine Prevention Study (CHAMP) compared two medicines doctors prescribe for migraine (amitriptyline and topiramate) to understand if they prevent migraine episodes in children and adolescents. The research showed that migraine treatments that work for adults may not necessarily work in young people.

Coordinating pain research

Several NIH activities on pain research—including migraine—are focused on coordinating efforts across NIH and with other federal agencies:

The NIH Pain Consortium is a collaboration between 25 NIH institutes and centers that helps identify, coordinate, and promote funding opportunities. It also supports pain research initiatives and activities at NIH.
The Interagency Pain Research Coordinating Committee (IPRCC) is a Federal advisory committee created by the Department of Health and Human Services (HHS) to better understand and treat pain.
The Helping to End Addiction Long-term® or NIH HEAL Initiative® is a major NIH-wide effort to quickly find scientific solutions for two intertwined public health challenges: the opioid crisis and undertreated pain. As part of NIH HEAL, NINDS aims to understand how pain happens in order to create effective, non-addictive treatments for pain. The initiative also supports migraine research.

For more information on research about migraine, check NIH RePORTER, a searchable database of current and past research projects funded by NIH and other federal agencies. RePORTER also has links to publications and resources from these projects.

For research articles and summaries on migraine, search PubMed, which contains citations from medical journals and other sites.

How can I or my loved one help improve care for people with migraine?

Consider participating in a clinical trial so clinicians and scientists can learn more about migraine and related disorders. Clinical research with human study participants helps researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

All types of participants are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities. This helps make sure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research, visit the NINDS Clinical Trials site and NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with migraine at ClinicalTrials.gov, a searchable database of current and past clinical studies and research results.

Where can I find more information about migraine?

Information may be available from the following sources: