Migraine is a neurological condition that typically causes painful headache attacks that occur with additional symptoms, such as sensitivity to light, sound, smell, or touch.
More than just the cause of “really bad headaches,” migraine is a neurological condition that can cause multiple symptoms. While intense, debilitating headaches frequently characterize it, additional symptoms may include:
- difficulty speaking
- numbness or tingling
- sensitivity to light and sound
The condition often runs in families and can affect all ages. People assigned female at birth are more likely than people assigned male at birth to be diagnosed with migraine.
The diagnosis of migraine is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headaches (or attacks) are episodic versus chronic, and then those without aura and those with aura.
People describe migraine pain as:
It can also feel like a severe, dull, steady ache. The pain may start out as mild. But without treatment, it can become moderate to severe.
Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides or shift.
Most migraine attacks last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraine with aura, pain may overlap with an aura or may never occur at all.
Migraine symptoms may begin 1 to 2 days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
- food cravings
- fatigue or low energy
- frequent yawning
- neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, you may have problems with your vision, sensation, movement, and speech. Examples of these problems include:
- difficulty speaking clearly
- feeling a prickling or tingling sensation in your face, arms, or legs
- seeing shapes, light flashes, or bright spots
- temporarily losing your vision
The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of migraine can vary from person to person.
Some symptoms may include:
- increased sensitivity to light and sound
- dizziness or feeling faint
- pain on one side of your head, either on the left side, right side, front, or back, or in your temples
- pulsing and throbbing head pain
After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy to feeling very fatigued and apathetic. A mild, dull headache may persist.
The length and intensity of these phases can occur to different degrees in different people. Sometimes, a phase gets skipped, and a migraine attack may occur without causing a headache.
Researchers haven’t identified a definitive cause for migraine. But they still believe the condition is due to “abnormal” brain activity that affects nerve signaling, and chemicals and blood vessels in the brain.
There are also many migraine triggers that are continually reported, including:
- bright lights
- severe heat, or other extremes in weather
- changes in barometric pressure
- hormone changes in people assigned female at birth, like estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
- excess stress
- loud sounds
- intense physical activity
- skipping meals
- changes in sleep patterns
- use of certain medications, like oral contraceptives or nitroglycerin
- unusual smells
- certain foods
- alcohol use
If you experience a migraine attack, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you took before your migraine attack began can help identify your triggers.
Migraine can’t be cured, but your doctor can help you manage migraine attacks by giving you the tools to treat symptoms when they occur, which may lead to fewer attacks in general. Treatment can also help make migraine less severe.
Your treatment plan depends on:
- your age
- how often you have migraines attacks
- the type of migraine you have
- how severe they are — based on how long they last, how much pain you have, and how often they keep you from going to school or work
- whether they include nausea or vomiting, as well as other symptoms
- other health conditions you may have and other medications you may take
Your treatment plan may include a combination of:
- lifestyle adjustments, including stress management and avoiding migraine triggers
- OTC pain or migraine medications, like Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol)
- prescription migraine medications that you take every day to help prevent migraine headaches and reduce how often you have headaches
- prescription migraine medications that you take as soon as an attack starts to keep it from becoming severe and to ease symptoms
- prescription medications to help with nausea or vomiting
- hormone therapy if migraines seem to occur in relation to your menstrual cycle
- alternative care, which may include meditation, acupressure, or acupuncture
Medications can be used to either prevent a migraine attack from happening or treat it once it occurs. You may be able to get relief with OTC medication. But if OTC medications aren’t effective, your doctor may decide to prescribe other medications.
The severity of your migraine and any other health conditions you have will determine which treatment is right for you.
Acute medications — taken as soon as you suspect a migraine attack is coming — include:
- NSAIDs: These medications, like ibuprofen or aspirin, are typically used in mild-to-moderate attacks that don’t include nausea or vomiting.
- Triptans: These medications, like sumatriptan, eletriptan, and rizatriptan, are typically the first line of defense for individuals who have nerve pain as a symptom of their migraine attacks.
- Antiemetics: These medications, like metoclopramide, chlorpromazine, and prochlorperazine, are typically used with NSAIDs to help decrease nausea.
- Ergot alkaloids: These medications, like Migranal and Ergomar, aren’t prescribed that often and are usually reserved for individuals who don’t respond to triptans or analgesics.
Preventative medications — prescribed to people whose migraine attacks can be debilitating or happen more than four times a month — are taken once a day, or every 3 months via injection. These medications include:
- Antihypertensives: These drugs are prescribed for high blood pressure and can also help with migraine attacks. Beta-blockers and angiotensin receptor blockers (candesartan) are some examples of antihypertensive drugs used for migraine prevention.
- Anticonvulsants: Certain anti-seizure medications may also be able to prevent migraine attacks.
- Antidepressants: Some antidepressants, like amitriptyline and venlafaxine, may also be able to prevent migraine attacks.
- Botox: Botox injections are administered to the head and neck muscles every 3 months.
- Calcitonin gene-related peptide treatments: These treatments are administered either via injection or through an IV and work to prevent a migraine attack from developing.
While migraine attack triggers can be very personal, certain foods or food ingredients may be more likely to trigger an attack than others. These may include:
- alcohol or caffeinated drinks
- food additives, like nitrates (a preservative in cured meats), aspartame (an artificial sugar), or monosodium glutamate (MSG)
- tyramine, which occurs naturally in some foods
Tyramine also increases when foods are fermented or aged. These include foods like some aged cheeses, sauerkraut, and soy sauce. But ongoing research is looking more closely at the role of tyramine in migraines, as it may not be as big of a trigger as previously thought.
Other migraine attack triggers can be varied and seem random:
- hormone triggers in people assigned female at birth
- poor sleep quality
- strenuous exercise (if you don’t do it often)
- bright lights
- changes in climate
- hormone replacement therapy drugs
Keeping a journal of when your migraine attacks occur can help you identify your personal triggers.
There are many types of migraine. Two of the most common types are migraine without aura and migraine with aura. Some people have both types.
Many people living with migraine have more than one type of migraine.
Migraine without aura
Most people with migraine don’t experience an aura with their headaches.
Individuals who have migraine without an aura have had at least five attacks that have
- attack usually lasts 4 to 72 hours without treatment or if treatment doesn’t work
- attack has at least two of these traits:
- it occurs only on one side of the head (unilateral)
- pain is pulsating or throbbing
- pain level is moderate or severe
- pain gets worse when you move, like when walking or climbing stairs
- attack has at least one of these traits:
- it makes you sensitive to light (photophobia)
- it makes you sensitive to sound (phonophobia)
- you experience nausea with or without vomiting or diarrhea
- attack isn’t caused by another health problem or diagnosis
Migraine with aura
An aura typically
If you have a migraine with aura, you most likely have at least two attacks that have these characteristics:
- an aura that goes away, is completely reversible, and includes at least one of these symptoms:
- visual problems (the most common aura symptom)
- sensory problems of the body, face, or tongue, like numbness, tingling, or dizziness
- speech or language problems
- problems moving or weakness, which may last up to 72 hours
- brainstem symptoms, which includes:
- difficulty talking or dysarthria (unclear speech)
- vertigo (a spinning feeling)
- tinnitus or ringing in the ears
- diplopia (double vision)
- ataxia or an inability to control body movements
- eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur, they’re called retinal migraines)
- an aura that has at least two of these traits:
- at least one symptom spread gradually over 5 or more minutes
- each symptom of the aura lasts between 5 minutes and 1 hour (if you have three symptoms, they may last up to 3 hours)
- at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
- aura occurs with the attack or 1 hour before the attack begins
- attack isn’t caused by another health problem and transient ischemic attack has been excluded as a cause
An aura usually occurs before the headache pain begins, but it can continue once the attack starts. Alternatively, an aura may start at the same time as the attack does.
Chronic migraine used to be called a “combination” or “mixed” because it can have features of migraine and a tension headache. It’s also sometimes called a severe migraine headache and can be caused by medication overuse.
People who have chronic migraine have a severe tension headache or migraine attack more than 15 days a month for 3 or more months. More than eight of those attacks are migraine with or without aura.
Some additional risk factors that may make an individual susceptible to chronic migraine include:
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), like high blood pressure
- previous head or neck injuries
Acute migraine is a general term for a migraine attack that
People who have episodic migraine have attacks up to 14 days a month. Thus, people with episodic migraine have fewer attacks a month than people with chronic ones.
Vestibular migraine is also known as migraine-associated vertigo. About 1 percent of the general population lives with vestibular migraine. The symptoms affect balance, cause dizziness, or both. People of any age, including children, may experience vestibular migraine attacks.
If diagnosed, your doctor may suggest you see a vestibular rehabilitation therapist. They can teach you exercises to help you stay balanced when your symptoms are at their worst. Because these migraine attacks can be so debilitating, you and your doctor may talk about taking preventive medications.
According to the National Headache Foundation, menstrual-related migraine affects up to 60 percent of women who experience any type of migraine. It can occur with or without an aura. Attacks can also happen before, during, or after menstruation and during ovulation.
Research has shown that menstrual migraine tends to be more intense, last longer, and have more significant nausea than migraine not associated with the menstrual cycle.
Migraine aura without headache, also called a silent migraine or visual migraine without headache, occurs when a person has an aura, but doesn’t get a headache. This type of migraine is more common in people who start having migraines after age 40.
Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur, with symptoms spreading over several minutes and moving from one symptom to another. After visual symptoms, people may have numbness, speech problems, and/or tingling in the face or hands.
Hormonal migraine, or menstrual migraine, is linked with the female hormones, commonly estrogen. Many people who ovulate report migraine headaches during:
- their period
Many people experience nausea as a symptom of migraine. Many also vomit. These symptoms may start at the same time the attack does. Usually, though, they start about 1 hour after the headache pain begins.
Nausea and vomiting can be as troubling as the attack itself. If you only have nausea, you may be able to take your usual migraine medications. Vomiting, though, can prevent you from being able to take pills or keep them in your body long enough to be absorbed. If you have to delay taking migraine medication, migraine is likely to become more severe.
Treating nausea and preventing vomiting
If you have nausea and vomiting, your doctor may suggest medication to ease nausea called anti-nausea or antiemetic drugs. In this case, the antiemetic can help prevent vomiting and improve nausea.
Acupressure may also be helpful in treating migraine nausea. A
If you’ve been diagnosed with migraine, there are a few options that may help you prevent a migraine attack. Some may work better for you than others:
- Learn the foods, smells, and situations that trigger your migraine attacks and avoid those things when possible.
- Stay hydrated. Dehydration can lead to both dizziness and headaches.
- Avoid skipping meals when possible.
- Focus on quality sleep. A good night’s sleep is important for overall health.
- Quit smoking.
- Make it a priority to reduce stress in your life.
- Invest time and energy in developing relaxation skills.
- Exercise regularly. Exercise has been linked to lowered stress levels.
Doctors diagnose migraine by listening to your symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes.
Surgery for migraine isn’t recommended, but some medical tools have been studied and endorsed for helping lessen migraine attacks by either decreasing or increasing nervous system activity. Currently, the FDA has approved four neuromodulation treatments:
- single-pulse transcranial magnetic stimulator, a handheld device that produces a magnetic impulse that affects electrical signaling in the brain
- transcutaneous vagus nerve stimulator, a small, noninvasive tool that targets the vagus nerve in the neck via electrical stimulation
- transcutaneous supraorbital neurostimulator, a device that simulates the supraorbital nerves with electrical stimulation
- multi-channel brain neuromodulation system, a headset that can target multiple nerves in the head
Talk with your doctor about the best neuromodulation treatment for you and your specific type of migraine.
Children can have many of the same types of migraine as adults.
Until they’re older teens, children may be more likely to have symptoms on both sides of the head. It’s rare for children to have headache pain in the back of the head. Their migraine attacks tend to last 2 to 72 hours.
A few migraine variants are more common in children. One of the more common variants is abdominal migraine.
Children with abdominal migraine may have a stomachache instead of a headache. The pain can be moderate or severe. Usually, pain is in the middle of the stomach, around the belly button. But the pain may not be in this specific area. The belly may just feel “sore.”
Your child may also have experience headache. Other symptoms can include:
- lack of appetite
- nausea with or without vomiting
- sensitivity to light or sound
Children who have abdominal migraine are likely to develop more typical migraine symptoms as adults.
For many pregnant people, their migraine attacks improve during pregnancy. But they may become worse following delivery due to sudden hormonal shifts. Attacks during pregnancy need special attention to make sure that the cause of the attack is understood.
Research is ongoing, but a recent
Certain migraine medications may not be considered safe during pregnancy. This can include aspirin. If you have migraine during pregnancy, work with your doctor to find ways to treat your migraine that won’t harm your developing baby.
The frequent and recurring use of migraine medication can sometimes cause what’s known as
When determining how to deal with migraine, talk with your doctor about the frequency of your medication intake. Also, make sure to discuss alternatives to medications.
Migraine and tension headaches, the most common type of headaches, share some similar symptoms. But migraine is also associated with many symptoms not shared by tension headaches. Migraine and tension headaches also respond differently to the same treatments.
Both tension headaches and migraine can have:
- mild-to-moderate pain
- a steady ache
- pain on both sides of the head
Only migraine can have these symptoms:
- moderate-to-severe pain
- pounding or throbbing
- an inability to do your usual activities
- pain on one side of the head
- nausea with or without vomiting
- an aura
- sensitivity to light, sound, or both
You can try a few things at home that may also help remedy the pain from migraine:
- Lie down in a quiet, darkroom.
- Massage your scalp or temples.
- Place a cold cloth over your forehead or behind your neck.
Sometimes the symptoms of migraine can mimic those of a stroke. It’s important to seek immediate medical attention if you or a loved one has a headache that:
- causes slurred speech or drooping on one side of the face
- causes new leg or arm weakness
- comes on very suddenly and severely with no lead-in symptoms or warning
- occurs with a fever, neck stiffness, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
- has an aura where the symptoms last longer than an hour
- would be called the “worst headache ever”
- is accompanied by loss of consciousness
If headaches are getting in the way of your daily life, and you’re not sure if they are a migraine symptom, it’s important to talk with your doctor. Headaches can be a sign of other issues, and while migraine can feel debilitating at times, there are many treatments available.
The sooner you start to talk about your symptoms, the sooner your doctor can get you on a treatment plan that may include medication and lifestyle changes.