Migraine is a neurological disease characterized by repeated episodes of symptoms, called attacks, that usually include headache, often accompanied by nausea; vomiting; sensitivity to light, touch, smell, or sound; dizziness; visual disturbances; and tingling or numbness in the face, hands, or feet.
Migraine attacks may come on suddenly without warning, or they may be preceded by certain known triggers, such as skipping a meal, being exposed to smoke or air pollution, or experiencing a change in hormone levels as part of the menstrual cycle. Most migraine attacks last from 4 to 72 hours, although effective treatment can shorten them to a matter of hours. On the other hand, some migraine attacks can last even longer than 72 hours.
What Should You Know About Nausea and Vomiting?
Having migraine can be disabling and can lead to missing days of school or work, being less productive at school or work, being unable to perform household responsibilities, and missing out on family, social, and leisure activities.
An estimated 1 billion people worldwide, and 39 million Americans, have migraine.
While a variety of triggers can set off migraine attacks, they don’t directly cause the attacks or the underlying disease.
There are still gaps in doctors’ understanding of what causes migraine. However, some doctors describe the migraine brain as hyperactive, or supersensitive, by which they mean that the brain of someone with migraine reacts more strongly to environmental stimuli such as stress or sleep disturbance than the brain of someone who doesn’t have migraine, resulting in the symptoms known as a migraine attack.
Types of Migraine
Migraine is also categorized as chronic or episodic, based on the number of days per month a person has symptoms. Chronic migraine is defined as migraine pain that is experienced for 15 or more days per month for at least three months. Episodic migraine is defined as fewer than 15 days of migrainous symptoms per month.
Identifying what type of migraine you have may help you and your doctor choose the right treatment for you. It can be essential if you want to participate in clinical trials.
Migraine Without Aura
Formerly known as common migraine, migraine without aura is characterized by a headache that’s usually on one side of the head, has a pulsating quality, is worsened by physical activity, and is accompanied by nausea or light and sound sensitivity.
Migraine without aura may have a prodrome, or warning, phase, in which a person experiences symptoms such as depression, food cravings, difficulty focusing, uncontrollable yawning, and others.
It can also have a postdrome phase, when the headache pain has receded, but a person feels tired and achy and has trouble concentrating.
Alternatively, a person may feel elated and even euphoric after the headache phase of a migraine has passed.
Migraine With Aura
Sensory disturbances may include a feeling of pins and needles or numbness in a part of the body, face, or tongue.
In some cases, aura symptoms occur with no headache accompanying or following them.
Migraine With Brain Stem Aura
Chronic migraine is defined as headache occurring 15 or more days per month for at least three months, with the headache having migrainelike features on at least eight of those days.
Given the frequency of symptoms in chronic migraine, it can be impossible to determine when one migraine attack ends and another begins. It can also be difficult to determine whether an individual in fact has chronic migraine or has another condition, such as medication-overuse headache, that would be expected to cause daily or near-daily head pain.
Syndromes That May Be Associated With Migraine
Certain disorders occur more frequently among people with migraine or people, usually children, at a higher risk of developing migraine:
Cyclical Vomiting Syndrome In cyclical vomiting syndrome, an individual experiences attacks of severe nausea and vomiting lasting an hour or more for up to 10 days at a time. Between attacks, which occur on a regular cycle, the person has no symptoms of nausea or vomiting.
Benign Paroxysmal Vertigo In this syndrome, otherwise healthy children experience recurrent brief attacks of vertigo that come on without warning and resolve spontaneously without loss of consciousness. During the attacks, a child may have nystagmus (uncontrolled horizontal or vertical eye movement), impaired balance or coordination (called ataxia), vomiting, pale skin, and fearfulness.
Benign Paroxysmal Torticollis Occurring in infants and small children, this syndrome causes the head to tilt to one side, with or without slight rotation, and stay tilted for minutes to days before spontaneously resuming its normal position. During the attack, the infant or child may be pale and irritable, seem uncomfortable or generally unwell, vomit, or in older children, have impaired balance or coordination.
Other Types of Headaches
Other rare types of headaches include these varieties:
- Cluster Headache These intensely painful headaches last 15 to 180 minutes without treatment and happen in cycles, or clusters.
- Paroxysmal Hemicranias Severe, sometimes throbbing pain on one side of the face or around the eyes lasts 2 to 30 minutes and occurs more than 5 times a day.
- 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 migraine, that doesn't respond to treatment.
- Occipital Neuralgia This disorder causes pain in the back of the head and upper neck.
What Is the Difference Between Headache and Migraine?
Migraine is a type of primary headache disorder, as is tension-type headache. The cause of neither is fully understood, but both appear to involve heightened sensitivity to stimuli, whether pain, in the case of tension headache, or environmental changes, in the case of migraine.
While head pain is a symptom of both migraine and tension headache, migraine attacks are often accompanied by nausea and are made worse with routine physical activity, while tension-type headache is not.
In addition, headaches caused by migraine typically occur on one side of the head, while tension headaches typically affect both sides.
And migraine tends to have a pulsating or throbbing quality, while the pain of a tension-type headache is described as pressing or tightening.
Having one type of primary headache disorder doesn’t rule out having another. In fact, many people have both migraine and tension-type headache.
Causes and Risk Factors of Migraine
The exact cause of migraine remains unknown. Research suggests that genetic and environmental factors may play a role.
Researchers have identified several key risk factors for developing migraine, including the following.
Some women find that hormonal medications such as contraceptives or hormone replacement therapy worsen migraine, while others find that they lessen the frequency of their headaches.
Menstruation and Menopause
Women who experience migraine often do so immediately before or shortly after their menstrual period, when there is a drop in estrogen.
Learn More About Migraine Causes and Risk Factors
Duration of Migraine
The frequency of attacks varies from person to person. Some people experience migraine several times a month, while others have them much less frequently.
Treatment and Medication Options for Migraine
There’s no cure for migraine, but there have been recent advances in treatment.
Medications to Treat and Prevent Migraine Attacks
Medical treatment options for migraine are twofold: drugs that work to alleviate symptoms once an attack has started and medications that prevent attacks from happening or reduce their frequency and severity.
Abortive Medications Acute, or abortive, treatments include over-the-counter pain relievers and prescription medications called triptans.
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, including migraine disease.
A newer abortive migraine treatment is Reyvow (lasmiditan), which is taken as an oral tablet and is the only approved drug in the 5-HT1F receptor agonist class.
Preventive Medications Most of the medications that have a preventive, or prophylactic, effect on migraine weren’t developed specifically for migraine; they’re primarily used 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.)
Injections of Botox (onabotulinumtoxina) every 12 weeks may also help prevent migraine in some people with chronic migraine.
Some pharmacological treatments that help with chronic migraine are not effective when it comes to episodic migraine. 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 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.
Side effects from nerve stimulation tend to be mild and mainly include 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.
Learn More About Nerve Stimulation Devices for Migraine Treatment
Alternative and Complementary Therapies
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 are effective. Consult with your healthcare provider to find an approach that works for you.
According to MedlinePlus, you should see your doctor 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, or if you have bothersome side effects from your medication.
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. If your headache starts suddenly, it may be an emergency.
Learn More About Treatment for Migraine: Medication, Alternative and Complementary Therapies, and More
Prevention of Migraine
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. Often you need several triggers to lead to a migraine attack, not just one.
Common triggers for migraine attacks include the following:
Changes in the Weather
Many people report that changes in the weather, particularly changes in barometric pressure, trigger migraine attacks. Other weather-related migraine triggers include heat, humidity, wind, and reduced light exposure.
Poor air quality, from wildfires or other sources of air pollution, can also be a trigger for some people.
Lights, Sounds, or Smells
Loud noises and strong smells (from perfume, cleaning products, or secondhand smoke) are also associated with migraine onset.
According to the American Migraine Foundation, about one-third of people cite dehydration as a migraine trigger. Make sure you’re drinking enough water throughout the day.
Getting too little or too much sleep can trigger migraine in some people, as can changes in your sleep-wake pattern, such as jet lag.
Foods and Food Additives
Certain foods and beverages, particularly alcoholic beverages, can be triggers. The flavor enhancer monosodium glutamate can also be a trigger, as can caffeine.
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.
The nitrates in cured meats such as bacon, hot dogs, salami, and other lunch meats are a trigger for some.
Research has also suggested that the artificial sweeteners aspartame and sucralose can be triggers.
And for some people, fruits such as avocados, bananas, and citrus as well as some nuts and seeds can trigger migraine.
Missing or skipping meals can trigger attacks, too.
One approach to discovering migraine food triggers is to try an elimination diet, in which certain foods are eliminated from the diet for a few weeks, then reintroduced one at a time to see whether a migraine attack occurs.
However, a given food does not always trigger a migraine attack; sometimes another trigger, such as a change in the weather, also has to be present for an attack to take place. Or a certain amount of food has to be consumed before it has an effect, according to an article published in June 2020 in the journal Nutrients.
Elimination diets can deprive you of whole-food groups for an extended period, potentially leading to nutrient shortfalls, and they can be difficult and stressful to follow. What’s more, undernutrition itself can be a migraine trigger, as noted in an article in Cephalagia.
For that reason, most experts recommend consulting your physician before trying an elimination diet for migraine and, if you do decide to try it, working with a registered dietitian to maintain good nutrition.
Stress or Relief From Stress
Complications of Migraine
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 to stop a migraine attack, such as Excedrin Migraine (acetaminophen), aspirin, Advil (ibuprofen), Imitrex (sumatriptan), or Maxalt (rizatriptan), too often or in high doses can trigger this phenomenon.
BIPOC Communities and Migraine
The prevalence of migraine among Black, Indigenous, and People of Color (BIPOC) in the United States has not been well studied.
Of course, the prevalence of a disease doesn’t tell the whole story. A paper in the Journal of the National Medical Association looked into the experience of headache among Black Americans and found that compared with white people with headache, “African American headache patients are more likely to (i) be diagnosed with comorbid depressive disorders; (ii) report headaches that are more frequent and severe in nature; (iii) have their headaches underdiagnosed and/or undertreated; and (iv) discontinue treatment prematurely, regardless of socioeconomic status.”
- Only 47 percent of Black individuals with headaches have an official headache diagnosis, compared with 70 percent of white individuals.
- Latinos with headaches are 50 percent less likely to receive a migraine diagnosis than white individuals.
- Only 14 percent of Black patients with headache receive prescriptions for acute migraine medications, compared with 37 percent of white patients with headache.
Dr. Kiarashi also noted that BIPOC communities were underrepresented in migraine and headache research, based on the sample of studies on headache and migraine that her team reviewed.
Learn More About Healthcare Disparities in the Migraine Community on MigraineAgain
Migraine is associated with other medical conditions:
- Mental Health Disorders People who experience migraine are also more likely to have depression, bipolar disorder, anxiety disorder, or panic disorder.
- Stroke Studies have shown that people who have migraine have a slightly higher risk of having a stroke at some point.
- Seizures Scientists don’t completely understand the relationship between seizures and migraine, but research suggests they may be linked.
- Heart Disease Some studies show that people who have migraine might have a higher risk for heart-related events.
- Endometriosis Migraine is more prevalent in women with endometriosis compared with women without endometriosis.
- Irritable Bowel Syndrome People who have migraine have a higher incidence of irritable bowel syndrome than the general public.
Resources We Love
People living with migraine or a headache disorder 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.
Learn More About Migraine Resources
Favorite Orgs for Essential Migraine Info
American Headache Society (AHS)
The AHS is specifically dedicated to helping healthcare providers stay up to date on treatments for headaches and face pain, but patients will also find a wealth of information on new migraine therapies as well as colorful infographics that present a range of tips.
American Migraine Foundation (AMF)
Working alongside the American Headache Society, this nonprofit organization strives to connect people with migraine with the care and support they need. The website features a handy doctor-locator tool and guidance on a range of issues, including managing migraine at work, identifying types of headaches, applying for Social Security disability income, and handling emergency room visits related to migraine.
Association of Migraine Disorders (AMD)
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.
Migraine Research Foundation (MRF)
While the MRF’s main mission may be raising money for migraine research, the foundation's website serves as a source for migraine news, information, and contact details for certified headache specialists, children’s headache doctors, and comprehensive headache centers.
Migraine at Work
The Migraine at Work campaign aims to help employees with migraine stay employed and productive on the job, and to help employers support and accommodate those employees. The website offers articles, taped webcasts, newsletters, and links to more information. Migraine at Work is a project of the World Health Education Foundation.
Favorite Migraine Publications
My Chronic Brain
This online magazine for people with chronic migraine 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 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 people with migraine, who share how they deal with pain-related challenges in their everyday lives.
Migraine Again calls itself a lifestyle website for people with migraine and the people who love them. It features expert information and advice, tips and personal stories from people who have migraine, and articles on just about every aspect of living with migraine.
Migraine Patient Toolkit: A Guide to Your Care
The downloadable resource was created by the Society for Women’s Health Research to assist those with migraine in getting the care they need, dealing with health insurance issues, and incorporating wellness practices into their lives.
Favorite Migraine Apps
This app gets strong ratings from people with headache and migraine 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 migraine. The technology helps patients identify likely triggers associated with their migraine and prevent future headaches. The website also features interesting articles on the effect of alcohol on migraine, how pets may help, migraine auras, and other topics.
Favorite Migraine Diaries
The Migraine Trust
This British organization dedicated to supporting people affected by migraine offers a pdf of this handy guide and chart for tracking attacks and any drug treatment you may be taking. Finding patterns in migraine can help with treatment.
Hartford Healthcare Headache Center Migraine Diary
The pdf from this center for headache care gives a comprehensive system for recording episodes and medicines. A key helps pinpoint types of triggers and evaluate migraine severity.
Favorite Migraine Blogs
The Counterfactual Brain
Beth Morton shares her experiences with chronic headaches, 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 people with migraine.
The Daily Migraine
As someone who regularly experiences migraine, Lisa Jacobson created this site as a forum for everyone with migraine to come together to help heal themselves through knowledge, shared experience, and humor. More than a quarter million people with migraine have connected through her Facebook, Instagram, and Twitter feeds.
Editorial Sources and Fact-Checking
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- Migraine. IHS Classification ICHD-3.
- Chronic Migraine. American Headache Society.
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- Migraine. MedlinePlus. May 25, 2021.
- Migraine With Brainstem Aura. The Migraine Trust.
- Familial Hemiplegic Migraine. MedlinePlus. August 18, 2020.
- Sporadic Hemiplegic Migraine. MedlinePlus. August 18, 2020.
- Retinal Migraine. IHS Classification ICHD-3.
- Chronic Migraine. IHS Classification ICHD-3.
- Abdominal Migraine. American Migraine Foundation. September 5, 2016.
- Paroxysmal Hemicrania Information Page. National Institute of Neurological Disorders and Stroke. March 27, 2019.
- Intractable Headache. American Migraine Foundation. June 27, 2016.
- Occipital Neuralgia Information Page. National Institute of Neurological Disorders and Stroke. March 27, 2019.
- The Timeline of a Migraine Attack. American Migraine Foundation. January 18, 2018.
- Symptoms and Stages of Migraine. The Migraine Trust.
- What Are Signs and Symptoms of Migraine? Dr. Andrew Charles Answers the Most Common Questions. Migraine Again. July 24, 2020.
- I Had No Idea That Was a Migraine Symptom! Migraine.com. April 22, 2016.
- Aurora SK, Brin MF. Chronic Migraine: An Update on Physiology, Imaging, and the Mechanism of Action of Two Available Pharmacologic Therapies. Headache. December 2016.
- Depression and Anxiety in Migraine Patients. American Migraine Foundation. August 13, 2015.
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- Headaches and Hormones: What’s the Connection? Mayo Clinic. December 10, 2020.
- Caronna E, Gallardo VJ, Fonseca E, et al. How Does Migraine Change After 10 Years? A Clinical Cohort Follow-Up Analysis. Headache. May 2020.
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- FDA Approves New Treatment for Adults With Migraine. U.S. Food and Drug Administration. December 23, 2019.
- Drug Trials Snapshots: Nurtec ODT. Food and Drug Administration. December 23, 2019.
- FDA Approves Novel Preventive Treatment for Migraine. Food and Drug Administration. 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.
- Top 10 Migraine Triggers and How to Deal With Them. American Migraine Foundation. July 27, 2017.
- Common Triggers. The Migraine Trust.
- Medication Overuse Headache. American Migraine Foundation. June 11, 2016.
- Migraine. Office on Women’s Health. April 1, 2019.
- Triptans, SSRIs/SNRIs, and Serotonin Syndrome. American Migraine Foundation. June 18, 2010.
- Migrainous Stroke. Cedars-Sinai.
- Identifying and Treating Migraine. American Migraine Foundation. April 1, 2015.
- Facts and Figures. The Migraine Trust.
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- From the Journal: The Prevalence of Migraine and Severe Headache. American Headache Society.
- Racial Disparities in Migraine and Headache Care. American Migraine Foundation. February 25, 2021.
- 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. 2017.
- Kurth T, Winter AC, Eliassen AH, et al. Migraine and Risk of Cardiovascular Disease in Women: Prospective Cohort Study. BMJ. 2016.
- Balci BK, Kabakci Z, Guzey DY, et al. Association Between Endometriosis, Headache, and Migraine. Journal of Endometriosis and Pelvic Pain Disorders. January 2019.