Migraine is a neurologic disorder that often causes a strong headache. The headache comes in episodes and sometimes also comes with nausea, vomiting, and sensitivity to light.
Migraine is different in everyone. In many people, it happens in stages. These stages may include:
Hours or days before a headache, about 60% of people who have migraine notice symptoms like:
- Being sensitive to light, sound, or smell
- Food cravings or lack of appetite
- Mood changes
- Severe thirst
- Constipation or diarrhea
These symptoms stem from your nervous system and often involve your vision. They usually start gradually, over a 5- to 20-minute period, and last less than an hour. You may:
- See black dots, wavy lines, flashes of light, or things that aren’t there (hallucinations)
- Have tunnel vision
- Not be able to see at all
- Have tingling or numbness on one side of your body
- Not be able to speak clearly
- Have a heavy feeling in your arms and legs
- Have ringing in your ears
- Notice changes in smell, taste, or touch
A migraine headache often begins as a dull ache and grows into throbbing pain. It usually gets worse during physical activity. The pain can move from one side of your head to the other, can be in the front of your head, or can feel like it's affecting your entire head.
About 80% of people have nausea along with a headache, and about half vomit. You may also be pale and clammy or feel faint.
Most migraine headaches last about 4 hours, but severe ones can go for more than 3 days. It’s common to get two to four headaches per month. Some people may get migraine headaches every few days, while others get them once or twice a year.
This stage can last up to a day after a headache. Symptoms include:
- Feeling tired, wiped out, or cranky
- Feeling unusually refreshed or happy
- Muscle pain or weakness
- Food cravings or lack of appetite
Doctors don’t know the exact cause of migraine headaches, although they seem to be related to changes in your brain and to your genes. Your parents can even pass down migraine triggers like fatigue, bright lights, or weather changes.
For many years, scientists thought migraine happened because of changes in blood flow in the brain. Most now think this can contribute to the pain but is not what starts it.
Current thinking is that a migraine likely starts when overactive nerve cells send out signals that trigger your trigeminal nerve, which gives sensation to your head and face. This cues your body to release chemicals like serotonin and calcitonin gene-related peptide (CGRP). CGRP makes blood vessels in the lining of your brain swell. Then, neurotransmitters cause inflammation and pain.
Migraine Risk Factors
The American Migraine Foundation estimates that more than 38 million Americans get migraines. Some things may make you more likely to get them:
- Sex. Women have migraines three times more often than men.
- Age. Most people start having migraine headaches between ages 10 and 40. But many women find that their migraines get better or go away after age 50.
- Family history. Four out of five people with migraine have other family members who get them. If one parent has a history of these types of headaches, their child has a 50% chance of getting them. If both parents have them, the risk jumps to 75%.
- Other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy can raise your odds.
Some common migraine triggers include:
- Hormone changes. Many women notice that they have headaches around their period, while they’re pregnant, or when they’re ovulating. Symptoms may also be tied to menopause, birth control that uses hormones, or hormone replacement therapy.
- Stress. When you’re stressed, your brain releases chemicals that can cause blood vessel changes that might lead to a migraine.
- Foods. Some foods and drinks, such as aged cheese, alcohol, and food additives like nitrates (in pepperoni, hot dogs, and lunch meats) and monosodium glutamate (MSG), may be responsible in some people.
- Skipping meals
- Caffeine. Getting too much or not getting as much as you’re used to can cause headaches. Caffeine itself can be a treatment for acute migraine attacks.
- Changes in weather. Storm fronts, changes in barometric pressure, strong winds, or changes in altitude can all trigger a migraine.
- Senses. Loud noises, bright lights, and strong smells can set off a migraine.
- Medications. Vasodilators, which widen your blood vessels, can trigger them.
- Physical activity. This includes exercise and sex.
- Changes to your sleep. You might get headaches when you sleep too much or not enough.
There are several kinds of migraines. The most common are migraine with aura (also known as a classic migraine) and migraine without aura (or common migraine).
Other types include:
- Menstrual migraine. This is when the headache is linked to your period. These usually happen 2 days before your period starts and last through 3 days after. You may also have other kinds of migraine headaches at other times of the month, but the migraine around menstruation is usually without aura.
- Silent migraine. This kind is also known as an acephalgic migraine. You have aura symptoms without a headache. In fact, aura is usually the main warning sign of this type of migraine. But you may also have nausea and other migraine symptoms. It usually lasts only about 20-30 minutes.
- Vestibular migraine. You have balance problems, vertigo, nausea, and vomiting, with or without a headache. This kind usually happens in people who have a history of motion sickness.
- Abdominal migraine. Experts don’t know a lot about this type. It causes stomach pain, nausea, and vomiting. It often happens in children and may change into classic migraine headaches over time.
- Hemiplegic migraine. You have a short period of paralysis (hemiplegia) or weakness on one side of your body. You might also feel numbness, dizziness, or vision changes. These symptoms can also be signs of a stroke, so get medical help right away.
- Ocular migraine. This is also known as an ophthalmic or retinal migraine. It causes short-lived, partial, or total loss of vision in one eye, along with a dull ache behind the eye, which may spread to the rest of your head. Get medical help right away if you have any vision changes.
- Migraine with brainstem aura. Dizziness, confusion, or loss of balance can happen before the headache. The pain may affect the back of your head. These symptoms usually start suddenly and can come along with trouble speaking, ringing in your ears, and vomiting. This type of migraine is strongly linked to hormone changes and mainly affects young adult women. Again, get these symptoms checked out by a doctor right away.
- Status migrainosus. This severe type of migraine can last more than 72 hours. The pain and nausea are so intense that you may need to go to the hospital. Sometimes, medicines or medication withdrawal can cause them.
- Ophthalmoplegic migraine. This causes pain around your eye, including paralysis of the muscles around it. This is a medical emergency because the symptoms can also be caused by pressure on the nerves behind the eye or by an aneurysm. Other symptoms include a droopy eyelid, double vision, or other vision changes.
Doctors divide migraine into three levels of frequency.
Episodic migraine means you get migraine now and then. High-frequency episodic migraine means you have eight to 14 migraine headache days per month. This condition also makes you more likely than others to develop chronic migraine.
Chronic migraine means you have migraine headaches on more than 15 days of the month and eight of those days have migraine features such as:
- Moderate to intense head pain
- Pain is on side of head (one or both)
- Pain throbs or pulsates
- Pain gets worse when you move
- You have nausea or vomiting
- You’re sensitive to light and sound
About 12% of Americans get migraine from time to time, but only about a third of those have chronic migraine.
Chronic and even high-frequency episodic migraine can be disabling conditions. And the higher the pain intensity of each headache, the more disabling it can be. That’s why it’s especially important to work closely with your doctor on a treatment plan.
Are Migraines Curable?
There's no cure for migraines yet. But medications can help prevent or stop them, or keep your symptoms from getting worse.
You can also avoid things that trigger your migraines. Lifestyle changes like easing stress and having good sleep habits can help, too.
Are Migraines Fatal?
Most migraines don't cause lasting harm.
Rarely, you can have a complication called migrainous infarction. That's when you have a stroke while you're having a migraine. But there's no evidence migraine can trigger a stroke.
It's extremely rare, but a hemiplegic migraine can sometimes lead to a coma or other serious complications.
A very intense headache that starts suddenly can be a sign of another, more serious condition, like a stroke or aneurysm. Get medical help right away if this happens.
When to Call Your Doctor
See your doctor any time a headache doesn’t go away or comes back.
See a doctor right away or go to the emergency room if you have a headache with a stiff neck, fever, vomiting, numbness or weakness in the limbs, or trouble speaking.
Your doctor will ask about your health history and your symptoms. It may help if you have a diary of your symptoms and any triggers you’ve noticed. Write down:
- What symptoms you have, including where it hurts
- How often you have them
- How long they last
- Other family members who have migraine
- All the medicines and supplements you take, even over-the-counter ones
- Other medicines you remember taking in the past
Your doctor may order tests to rule out other things that could cause your symptoms, including:
- Blood tests
- Imaging tests like MRI or CT scans
- Electroencephalogram (EEG)
Migraine Treatment and Home Remedies
There's no cure for migraine headaches. But many drugs can treat or even prevent them. Common migraine treatments include:
- Pain relief. Over-the-counter (OTC) drugs often work well. The main ingredients are acetaminophen, aspirin, caffeine, and ibuprofen. Never give aspirin to anyone under the age of 19 because of the risk of Reye’s syndrome. Be careful when you take OTC pain meds because they might also add to a headache. If you use them too much, you can get rebound headaches or become dependent on them. If you take any OTC pain relievers more than 2 days a week, talk to your doctor about prescription drugs that may work better. They may suggest prescription medicines that may work well to end your migraine pain, including triptans, as well as the newer ditans and gepants. Your doctor can tell you if these are right for you.
- Nausea medicine. Your doctor can prescribe medication if you get nausea with your migraine.
- Triptans. These drugs balance the chemicals in your brain. You might get a pill to swallow, tablets you dissolve on your tongue, a nasal spray, or a shot. Examples include almotriptan (Axert), eletriptan (Relpax), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).
- Ergotamine (Cafergot, Ergomar, Migergot). This also works on the chemicals in your brain.
- Lasmiditan (Reyvow). This drug eases pain, nausea, and sensitivity to light or sound.
- CGRP receptor antagonists. Your doctor might give you rimegepant (Nurtec) or ubrogepant (Ubrelvy) if other treatments don’t help.
- Preventive medicines. If other treatments don’t work, your headaches are severe, or you have four or more migraine days a month, your doctor may suggest these. You take them regularly to make your headaches less severe or frequent. They include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), some antidepressants, and shots of botulinum toxin type A (Botox). CGRP antagonists such as atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) can also prevent migraines.
- Single-pulse transcranial magnetic stimulation (sTMS). You place this device on the back of your head at the start of a migraine with aura. It sends a pulse of magnetic energy to part of your brain, which may stop or reduce pain.
- Neuromodulation devices. Other devices can affect the vagus nerve and the trigeminal nerve to give relief from or prevent migraines.
You may ease migraine symptoms by:
- Resting with your eyes closed in a dark, quiet room
- Putting a cool compress or ice pack on your forehead
- Drinking plenty of liquids
Complementary and alternative treatments
Some people get relief with therapies they use in addition to or instead of traditional medical treatment. These are called complementary or alternative treatments. For migraine, they include:
- Biofeedback. This helps you take note of stressful situations that could trigger symptoms. If the headache begins slowly, biofeedback can stop the attack before it becomes full-blown.
- Cognitive behavioral therapy (CBT). A specialist can teach you how actions and thoughts affect how you sense pain.
- Supplements. Research has found that some vitamins, minerals, and herbs can prevent or treat migraines. These include riboflavin, coenzyme Q10, and melatonin. Butterbur may head off migraines, but it can also affect your liver enzymes.
- Body work. Physical treatments like chiropractic, massage, acupressure, acupuncture, and craniosacral therapy might ease headache symptoms.
Talk to your doctor before trying any complementary or alternative treatments.
Try these steps to prevent symptoms:
- Identify and avoid triggers. Keep track of your symptom patterns in a diary so you can figure out what’s causing them.
- Manage stress. Relaxation techniques like meditation, yoga, and mindful breathing can help.
- Eat on a regular schedule.
- Drink lots of fluids.
- Get plenty of rest.
- Get regular moderate exercise.
- Ask your doctor about preventive medicines if you get migraines around your period or if lifestyle changes don’t help.
Some new devices can also prevent migraine. Cefaly is a headband-like gadget that sends electrical pulses through the skin of your forehead. It affects your trigeminal nerve, which is linked with migraine headaches. You use Cefaly once a day for 20 minutes. When it's on, you'll feel a tingling or massaging sensation. Another stimulator, gammaCore, sends out a mild electrical signal to the fibers of the vagus nerve in your neck to relieve pain and help prevent migraine.