A migraine is a type of headache that causes an intense throbbing sensation, usually in one area of the head. It may be accompanied by nausea, vomiting, and sensitivity to light or sound.
In general, migraine headaches are very painful and can interfere with your daily life. They may come on suddenly without warning or be prompted by certain known triggers.
The good news is there are treatments and lifestyle approaches to help you manage the discomfort. (1)
Signs and Symptoms of Migraines
Symptoms of?migraine vary depending on the type of migraine.
What separates migraine attacks from severe tension headaches is that they tend to involve stages.
The four stages of migraine attacks are:
- Prodrome, or the warning stage
- Aura stage
- Postdrome, or the “hangover” stage
People with migraine may not experience all four stages, though. (2)
You may notice the first signs of a migraine attack one or two days before its onset. (3) These early symptoms can include changes in mood, cravings for certain foods, muscle stiffness, trouble concentrating, sensitivity to sound or light, fatigue and difficulty sleeping, yawning, and frequent urination. (3)
Up to a third of people experience the aura phase, which can last for five minutes to an hour and increase in intensity. (3) Auras may involve seeing bright spots or patterns of light, and numbness or tingling but not paralysis.
Pain comes with the headache phase, which can last for several hours and up to three days. The throbbing pain may start on one side and move to include both sides of your head. It may be accompanied by nausea and vomiting as well as blurred vision and sensitivity to certain stimuli.
In the last phase of a migraine attack, when the headache pain has eased, fatigue and body aches may occur. You may have trouble concentrating and also still be hypersensitive to certain stimuli. (3)
Causes and Risk Factors of Migraines
The exact cause of migraine remains unknown. Research suggests that genetic and environmental factors may play a role.
Chemical imbalances in the brain may also be involved.?Depression?and?anxiety?have long been associated with migraine — depression affects 25 percent of migraine patients, and 50 percent have anxiety, according to the American Migraine Foundation (AMF). (6) A study published in October 2017 in?Headache: The Journal of Head and Face Pain?found that migraine frequency was associated with the severity of depression and anxiety. (7)
A change in the weather or barometric pressure, which can cause imbalances in brain chemicals, may prompt a migraine. (9)
Researchers have identified several key risk factors for developing migraine, including the following.
People with migraine typically experience their first symptoms during adolescence. Most people who have migraine have their first attack before they reach age 40. (11) But migraine can start at any time in life, depending on other factors.
During childhood, migraine typically affects boys more than girls, but this trend reverses during adolescence. In adulthood, women are much more likely than men to experience migraine. It seems that hormonal changes, specifically involving?estrogen, play a role. (12)
Some women find that hormonal medications such as contraceptives or hormone replacement therapy worsen migraine attacks, while others find they lessen their frequency. (1)
Menstruation and Menopause
Women who experience migraine attacks often do so immediately before, or shortly after, their menstrual period, when there is a drop in estrogen levels. (1)
The frequency, severity, and duration of migraine attacks may change during pregnancy or menopause. Some women report that they experienced their first migraine attack during pregnancy or that their attacks worsened during pregnancy, while others experience fewer headaches. (13)
The above observations suggest that hormonal fluctuations of?estrogen?and?progesterone?are factors in some women with migraine. Migraine attacks tend to be less common and severe after menopause for some women, when hormone levels are more consistent. (14)
Types of Migraines
There are several different types of migraine headaches, and some migraines fall into more than one category.
This type of episodic migraine is diagnosed mostly in children. Symptoms include abdominal pain, nausea, and vomiting. (15) Kids who experience abdominal migraine often don’t have symptoms in adolescence but then develop migraine headaches as adults.
Migraine With Aura
This term refers to a migraine that is accompanied by neurologic disturbances — visual, speech, or sensory changes that typically occur before or during an attack. Examples of visual aura include flashing or waving lights that are usually on only one side of your vision. (16) This is also called “classic migraine,” while migraine without aura is referred to as “common migraine.” (17) Migraine with aura occurs in up to 30 percent of people who get migraines. (18)
Migraine With Brain-Stem Aura
This type of migraine, formerly known as basilar-type migraine, is a rare type of migraine with aura. It usually includes neurologic symptoms, such as visual disturbances, problems speaking and hearing, and dizziness. (19)
A chronic migraine is defined as migraine pain that is experienced for 15 or more days per month for at least three months. (20 PDF) Any type of migraine can be chronic. An estimated 144 million people suffer from chronic migraine worldwide. As with episodic migraine, chronic migraine is up to three times more common in women than men — 1.3 percent of women in the United States compared with 0.5 percent of men. (20)
This type of migraine comes in two forms: familial hemiplegic migraine (FHM) and sporadic hemiplegic migraine (SHM). Both are characterized by an aura, fever, and hemiplegia (paralysis on one side of the body). Both are relatively rare. (21,22)
Other Types of Headaches
Other rare types of headaches include:
- Cluster headache Intensely painful headaches that happen in patterns or clusters.
- Ice-pick headache?As the name implies, an ice-pick headache is a migraine characterized by stabbing pain. Fortunately, it is relatively uncommon and typically short in duration.
- Intractable headache?Any headache, including a migraine, that doesn't respond to treatment. (23)
- Occipital neuralgia?A disorder that causes pain in the back of the head and upper neck. (24)
- Paroxysmal hemicranias?Throbbing pain on one side of the face or around the eyes. (25)
How Are Migraines Diagnosed?
There’s no single test that can lead to a diagnosis of migraine. Rather, your doctor will take your medical history as well as obtain your family history of migraine and perform a physical and neurological exam. Your healthcare provider may order certain blood tests and imaging tests to rule out other causes of headache. Keep a detailed log of your symptoms to help with diagnosis.
Duration of Migraines
A migraine attack will typically last from 4 to 72 hours. (26) But attacks can go on for several days.
The frequency of attacks varies from person to person. Some people experience them several times a month, while others have them much less frequently.
Treatment and Medication Options for Migraines
There’s no cure for migraine, but there have been recent advances in treatment.
Medical treatment options are twofold: drugs that work to alleviate symptoms once an attack has started and medications that prevent a migraine attack from happening or reduce its frequency and severity.
The first category, known as acute treatment, includes over-the-counter pain relievers and prescription medications called triptans. (17)
In 2019, the FDA approved Ubrelvy (ubrogepant), an oral calcitonin gene-related peptide (CGRP) blocker medicine that’s used to treat symptoms in adults once a migraine attack has already started. (27)
CGRP is a protein in the brain and nervous system involved in the transmission of pain and the reaction of tissues and blood vessels to that pain. It has long been implicated in the process by which migraine occurs. It is hoped that the arrival of anti-CGRP therapies will open a new era in the acute and preventive treatment of primary headache disorders.
Medications that have had a prophylactic effect for migraines haven’t been developed specifically for that particular condition; they’re primarily for treating cardiovascular conditions, seizures, and depression. (Some research has shown a?link between migraine and a greater risk for each of these, so treating migraine may also have protective or beneficial effects with respect to these conditions.)
Three new drugs —?Aimovig (erenumab),?Ajovy (fremanezumab-vfrm), and?Emgality (galcanezumab-gnlm)?— can be taken prophylactically to lower the frequency of migraines. They were approved by the FDA in 2018. All three are CGRP blockers. (28)
Some pharmacological treatments that help with chronic migraines are not effective when it comes to episodic migraines. Treatment will depend on what type of migraine you have.
Nerve Stimulation Devices for Migraine Relief
When medications aren’t providing adequate migraine relief, it may be worth trying a nerve stimulation device. These devices, of which there are several types, reduce pain or help to prevent migraine episodes by delivering electrical or magnetic pulses to selected nerves.
They are unlikely to replace medications in a person’s migraine management plan, but they may help control pain when used alongside meds.
Three external devices target, respectively, the upper branch of the trigeminal nerve, on the forehead; the vagus nerve, via the neck; and the back of the head. An implanted device targets the occipital nerve, at the back of the head.
Side effects from nerve stimulation tend to be mild and include mainly redness, irritation, or muscle twitching at the site of the stimulation.
The main drawback of nerve stimulation devices may be that they’re expensive and not always covered by health insurance plans. (29)
In addition to medications, lifestyle changes (such as getting enough sleep, eating right, and managing stress) can help you avoid certain triggers, potentially preventing some migraine attacks. Practicing relaxation exercises, such as yoga and meditation, may ease migraine pain.
While the evidence isn’t definitive, some people with migraine have found that?home remedies?and?alternative therapies?such as acupuncture and biofeedback have been effective in helping manage their condition. Consult with your healthcare provider to find an approach that works for you. (1)
The?National Institutes of Health (NIH)?recommends calling your doctor or scheduling an appointment if there are changes in your headache pattern, if treatments you’ve been using stop working, if your headaches are more severe when you’re lying down, if you have side effects from your medication, or if you are on birth control pills and have migraine. (17)
You should call 911 if you have problems with speech, vision, movement, paralysis, or loss of balance, particularly if you’ve never had these symptoms before with a migraine attack. If your headache starts suddenly, it may be an emergency.
Can You Prevent Migraine Attacks?
While there’s no way to completely prevent migraine, some people are able to control their exposure to certain triggers that can prompt an episode of symptoms.
Common triggers for migraine attacks include:
Foods and Food Additives
Certain foods, including chocolate, dairy — especially some cheeses — some fruits such as avocado, banana, and citrus, meats containing nitrates (bacon, cured meats, hot dogs, salami), and some nuts and seeds can trigger migraines.
Foods containing the amino acid tyramine have been associated with migraine onset. Examples include aged cheese, smoked fish, chicken livers, figs, certain beans, and red wine. (17)
Research has also suggested that aspartame (an artificial sweetener) and?monosodium glutamate?(MSG, a preservative found in many foods) can trigger migraines. (1) Studies have linked salty and processed foods with migraines. Missing or skipping meals can also trigger attacks.
Additionally, alcohol and highly caffeinated beverages have been identified as potential migraine triggers. (17)
Everyday stress can trigger migraine attacks. The?AMF reports?that stress is a trigger for 70 percent of people with migraine. In turn, the chronic pain of migraine can cause?stress. It’s important to find healthy ways to reduce or avoid stressors, at work and at home, when possible. (30)
Lights, Sounds, or Smells
Bright lights — whether natural, such as sun glare, or the flickering of a fluorescent bulb — are known to trigger migraine attacks in many people with the condition. (31)
Loud noises and strong smells (from perfume, cleaning products, or?secondhand smoke) are also associated with migraine onset.
It’s not entirely clear, though, whether these are triggers themselves or if heightened sensitivity to light, sound, and smell are the early signs of an oncoming attack. (32)
According to the AMF, about one-third of people cite?dehydration?as a migraine trigger. Make sure you’re drinking enough water throughout the day. (31)
Getting?too little or too much sleep?can trigger migraine attacks in some people, as can changes in your sleep-wake pattern, such as jet lag. (1)
Complications of Migraines
Sometimes, the treatments you take for migraine can cause a complication known as a medication-overuse headache. This happens when the meds stop relieving pain and start causing headaches. Taking drugs, such as Excedrin Migraine, aspirin, Advil (ibuprofen), Imitrex (sumatriptan), or Maxalt (rizatriptan), very often or in high doses can trigger this phenomenon. (1)
Also, taking a combination of certain migraine medicines, such as triptans and antidepressants, can cause your serotonin levels to rise and lead to a condition called serotonin syndrome. Symptoms include confusion, agitation, sweating, diarrhea, muscle twitching, and rapid heart rate. This condition can be very serious, even life-threatening, if it’s not treated. (34)
Research and Statistics: Who Gets Migraines?
Migraine disproportionately affects women. About three out of four people with migraine are women, most commonly between ages 20 and 45. (30)
Migraine is associated with other medical conditions, including:
- Mental Health Disorders People who have migraine are also more likely to have depression, bipolar disorder, anxiety disorder, or panic disorder.
- Stroke Studies have shown people who have migraine have about twice the risk of having a stroke at some point. (38)
- Seizures Scientists don’t completely understand the relationship between seizures and migraine, but research suggests they may be linked. (39)
- Heart Disease Some studies show people who have migraine might have a higher risk for heart-related events. (40)
- Endometriosis?Migraine is more prevalent in women with endometriosis compared with women without endometriosis. (41)
Resources We Love
People living with migraine or other types of headaches can benefit from reliable resources offering information and support. Many organizations provide educational materials and can assist you in finding doctors specializing in migraine care. There are also online communities that offer support as well as practical advice and tips.
Favorite Orgs for Essential Migraine Info
The AHS is specifically dedicated to helping healthcare providers stay up-to-date on treatments for headaches and face pain, but patients also will find a wealth of information on new migraine therapies as well as colorful infographics that present a range of tips.
Working alongside the American Headache Society, this nonprofit organization strives to connect migraine patients with the care and support they need. The website features a handy doctor-locator tool and guidance on a range of issues, including managing migraines at work, identifying types of headaches, applying for Social Security disability income, and handling emergency room visits related to migraines.
AMD recognizes that migraine is a full-body condition with a broad spectrum of symptoms. In addition to providing extensive educational materials, the organization hosts Shades for Migraine, a campaign in which participants raise migraine awareness and address the stigma associated with the disease by wearing sunglasses in unexpected places.
While the MRF’s main mission may be raising money for migraine research, the foundation also serves as a source for migraine news, information, and contact details for certified headache specialists, children’s headache doctors, and comprehensive headache centers.
Favorite Migraine Publications
This online magazine for chronic migraine sufferers is put together by volunteers who want to connect readers with helpful real stories from patients, sources of treatment, nutritional advice, and news related to migraine care.
The INvisible Project, the flagship program of the U.S. Pain Foundation, produces online magazines with real stories and photographs of people coping with chronic pain. Several editions are dedicated to migraine sufferers who share how they deal with pain-related challenges in their everyday lives.
Favorite Migraine Apps
This app gets strong ratings from headache sufferers who use it to track medications, disability, and triggers, and share data with their doctors. The app also analyzes your data to determine the type of headache you’re having.
Designed with neurologists and data scientists, this graphic-heavy app makes it easy to record and monitor migraines. The technology helps patients identify likely triggers?associated with their migraines and prevent future headaches. The website also features interesting articles on the effect of alcohol on migraines, how pets may help, migraine auras, and other topics.
Favorite Migraine Diaries
This British organization dedicated to supporting people affected by migraine offers a handy guide and chart for tracking attacks and any drug treatment you may be taking. Finding patterns in migraine attacks can help with treatment.
This center for headache care gives a comprehensive system for recording episodes and medicines. A key helps to pinpoint the types of triggers and evaluate migraine severity.
Favorite Migraine Blogs
Beth Morton shares her experiences with chronic migraine, including how she deals with symptoms of nausea, light sensitivity, sound sensitivity, trouble articulating thoughts, mood swings, and fatigue. The site not only presents blog entries but also links to her Twitter chats with other migraine patients.
As someone who regularly experiences migraine attacks, Lisa Jacobson created this site as a forum for all people with migraine to come together to help heal themselves through knowledge, shared experience, and humor. More than a quarter million migraineurs have connected through her Facebook, Instagram, Twitter, YouTube, and Pinterest
Additional reporting by Julie Marks.
Migraine and COVID-19
For people who have migraine, it’s critically important to manage stress, diet, sleep, and other aspects of daily life to avoid migraine triggers and lower the likelihood of a migraine attack. The COVID-19 pandemic has added a new layer of stress and uncertainty to life in general, making it even more difficult for many to manage all of those daily concerns.
The good news is there’s no reason to think people with migraine are at any greater risk of acquiring COVID-19 than the general public. However, anecdotal reports suggest that those who do get COVID-19 are likely to develop headache as a symptom, and possibly very severe headache.
How to avoid this? The usual precautions apply: Wash your hands frequently, keep your distance from other people, and wear a face covering when you go out in public. Consider seeing your doctor via telemedicine — meaning by phone, video call, or email — so you don’t have to go out in public.
When you talk to your healthcare provider, ask about the safety of your migraine treatment regimen. Are there particular medications you should be cautious about taking? Are there treatments or procedures you won’t be able to get because your doctor’s office isn’t seeing patients in person? If so, what can you use instead to prevent or treat migraine attacks?
As you navigate the practical safety concerns of living through a pandemic, pay attention to your mood. Mental health and migraine health go hand in hand, and while it’s normal to feel some anxiety at this time, it’s also important to seek help if you’re feeling depressed or your anxiety is severe. Reach out to your mental health therapist, if you have one, or ask your migraine specialist or primary care doctor for a mental healthcare referral.
Editorial Sources and Fact-Checking
- Migraine.?Mayo Clinic. January 16, 2020.
- Symptoms and Stages of Migraine.?The Migraine Trust.
- The Timeline of a Migraine Attack.?American Migraine Foundation (AMF). January 18, 2018.
- Noseda R, Burstein R. Migraine Pathophysiology: Anatomy of the Trigeminovascular Pathway and Associated Neurological Symptoms, CSD, Sensitization and Modulation of Pain.?Pain. December?2013.
- Aurora SK, Brin?MF. Chronic Migraine: An Update on Physiology, Imaging, and the Mechanism of Action of Two Available Pharmacologic Therapies.?Headache: The Journal of Head and Face Pain. December 2016.
- Smitherman TA, Baskin?SM. Depression and Anxiety in Migraine Patients.?AMF. August 13, 2015.
- Chu?H-T, Liang C-S, et al. Associations Between Depression/Anxiety and Headache Frequency in Migraineurs: A Cross-Sectional Study.?Headache: The Journal of Head and Face Pain.?October 18, 2017.
- Aggarwal?M, Puri?V, Puri?S. Serotonin and CGRP in Migraine.?Annals of Neurosciences. April 2012.
- Migraines: Are They Triggered by Weather Changes??Mayo Clinic. May 10, 2019.
- About Migraine.?Migraine Research Foundation.
- Migraine in Later Life.?The Migraine Trust.
- Women and Migraine.?AMF. May 1, 2015.
- Preidt R. Pregnancy Often Leads to Changes in Migraine.?AMF. June 5, 2015.
- Headaches and Hormones: What’s the Connection??Mayo Clinic. May 10, 2019.
- Abdominal Migraine.?AMF. September 5, 2016.
- Migraine With Aura.?Mayo Clinic.?May 30, 2019.
- Migraine.?MedlinePlus. January 6, 2020.
- Understanding Migraine With Aura.?AMF. July 6, 2017.
- Migraine With Brainstem Aura.?The Migraine Trust.
- Chronic Migraine [PDF].?American Headache Society. May 2018.
- Familial Hemiplegic Migraine.?NIH Genetics Home Reference. January 2014.
- Sporadic Hemiplegic Migraine.?NIH?Genetics Home Reference. October 2017.
- Cowan?RP.?Intractable Headache.?AMF. June 27, 2016.
- Occipital Neuralgia Information Page.?National Institute of Neurological Disorders and Stroke.?March 27, 2019.
- Paroxysmal Hemicrania Information Page.?National Institute of Neurological Disorders and Stroke. March 27, 2019.
- More Than Just a Headache.?The Migraine Trust.
- FDA Approves New Treatment for Adults With Migraine. U.S. Food and Drug Administration (FDA). December 23, 2019.
- FDA Approves Novel Preventive Treatment for Migraine. FDA. May 17, 2018.
- Rodrigo D, Acin P, Bermejo P. Occipital Nerve Stimulation for Refractory Chronic Migraine: Results of a Long-Term Prospective Study.?Pain Physician. January–February 2017.
- Migraine.?U.S. Department of Health and Human Services Office on Women’s Health. April 1, 2019.
- Top 10 Migraine Triggers and How to Deal With Them.?AMF. July 27, 2017.
- Common Triggers.?The Migraine Trust.
- Medication Overuse Headache.?AMF.?June 11, 2016.
- Triptans, SSRIs/SNRIs, and Serotonin Syndrome. AMF. June 18, 2010.
- Migrainous Stroke. Cedars-Sinai.
- Identifying and Treating Migraine. AMF. April 1, 2015.
- Facts and Figures.?The Migraine Trust.
- Complications: Migraine. NHS. May 10, 2019.
- Huang Y, Xiao H, Qin X, et al. The Genetic Relationship Between Epilepsy and Hemiplegic Migraine. Neuropsychiatric Disease and Treatment. April 2017.
- Kurth T, et al. Migraine and Risk of Cardiovascular Disease in Women: Prospective Cohort Study. BMJ. 2016.
- Karamustafaoglu Balci?B, Kabakci?Z, Guzey?DY, et al. Association Between Endometriosis, Headache, and Migraine. Journal of Endometriosis?and Pelvic Pain Disorders. January 8, 2019.