What Is a Migraine?
Migraines are different in everyone. In many people, they happen in stages. These stages may include:
Hours or days before a headache, about 60% of people who have migraines 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
Migraine headaches are a symptom of a condition known as migraine. 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 migraines 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 migraines 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.
Other types include:
- Menstrual migraine. This is when the headache is linked to a woman’s period.
- Silent migraine. This kind is also known as an acephalgic migraine. You have aura symptoms without a headache.
- 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.
- Ophthalmic migraine. These are also known as ocular or retinal migraines. They cause 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.
When to Call Your Doctor
See your doctor if a headache doesn’t go away or comes back.
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
- Any other family members who have migraines
- 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:
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 (Panadol, Tylenol), aspirin (Bayer, Bufferin), caffeine, and ibuprofen (Advil, Motrin, Nuprin). 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 include 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), sumatriptan (Imitrex), rizatriptan (Maxalt), and zolmitriptan (Zomig).
- Ergotamine (Cafergot, Migergot, Ergomar). 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 eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) can also prevent migraines.
Neuromodulation and brain stimulation
These treatments use electronic or magnetic pulses to stimulate nerves linked with migraine attacks. Some types of neuromodulation can ease pain. Others may prevent some migraines or end them faster.
- Vagal nerve stimulation (VNS). This uses electricity to stimulate the vagus nerve, a long bundle of fibers that runs from your brain through your body. You hold a small device against your neck, usually for two sessions lasting 90 to 120 seconds. You’ll probably feel a mild buzzy twitching. VNS may ease pain during an intense headache. Daily treatments may help prevent headaches.
- Single-pulse transcranial magnetic stimulation (sTMS). This brain stimulation therapy may help when your migraine is about to come on or right when it starts. sTMS for migraine treatment is usually done at home with a rented device. It sends a very quick and targeted magnetic pulse to the back of your brain, called the occipital cortex, responsible for vision. In a study of 201 people, 38% of those who used a TMS device were pain-free 2 hours later, compared with 10% who didn’t use the device. But TMS didn’t ease other migraine symptoms such as nausea or sensitivity to light.
- Remote electrical neuromodulation (REN). You wear this band on your upper arm, and it sends weak electrical pulses to stop a migraine. The pulses last 30 to 45 minutes. The unit is controlled through a smartphone app.
- Transcutaneous supraorbital nerve stimulation. This treatment targets another large nerve linked with migraine. You wear a plastic band on your forehead over the trigeminal nerve. The band sends a buzzy, painless electrical current. It activates painkilling receptors in your spinal cord and brain stem. To treat a headache, the session lasts 60 minutes and can be repeated once if the headache is not gone in 2 hours. Adults can use TENS every day to prevent migraines. One study showed that many people who wore the device daily saw their headache days drop by at least half.
- Sphenopalatine ganglion (SPG) stimulation. The SPG is a bundle of nerve cells behind your nose. These cells detect pain and connect with the trigeminal nerve, where headaches can form. A surgeon who specializes in the jaws and face implants a device about the size of a small nut through your mouth to your upper gum. A handheld controller against your cheek delivers signals that help shut down pain. The surgery doesn’t leave any visible scars. SPG stimulation has not been cleared for migraine treatments in the U.S. but is under study. The European Union has approved it for cluster headaches, which are different from migraines.
- Occipital nerve stimulation (ONS). This is another surgical neuromodulation that hasn’t been approved by the FDA. It uses electrical leads implanted under the skin on the back of your head. They connect to a wire and battery inside your chest, hip, or belly. The battery sends electrical pulses straight to the nerves to help ease pain. You would try ONS with a battery pack worn outside the body to see if it helps relieve pain before you get one inserted permanently. It has shown promise in treating some migraines and mixed results in preventing them.
Neuromodulation devices can be good choices if you don’t want to take migraine drugs for any reason, such as if you:
- Have other health issues
- Can’t take certain medication
- Have concerns about side effects, like medication overuse headache
- Have trouble remembering to take meds
Some of these devices can make you feel dizzy, sleepy, or uncomfortable. More serious side effects are rare. Neuromodulation may not be an option for children, pregnant women, or people who have a pacemaker.
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
- Massaging your scalp
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 method 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 migraines. 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 migraines.