More than just a headache.
Everyone gets a headache now and then. But when the pain is intense, recurring, and accompanied by nausea, throbbing, sensitivity to light or possibly flashing lights (aura), it is called a migraine.
Migraines can be chronic (happening more than 6 times a month for more than 6 months) and greatly affect your daily activities. It’s important to know your triggers to figure out the best way to control them.
Clinical researchers are seeking to better understand migraines and how to treat them. Read on to learn more.
If you have Migraines, we would like to hear from you.
- Take our brief online survey to be considered for an upcoming clinical trial.*
- We also invite you to join our Migraine Team online patient community to connect with others facing this condition.
*If you are eligible and choose to participate, you will receive all study-related care and study medication at no cost during your participation. Compensation for study-related travel costs may also be provided.
Thank you for sharing with us.
Causes & Symptoms
Who gets migraines?
- Migraines often begin in childhood, teen or early adulthood. They are most common between age 18 and 44.
- Migraine is the 3rd most prevalent illness in the world and the 6th most disabling.
- Worldwide, nearly 1 billion people have migraines. In the U.S., 39 million people are affected.
- Three times as many women as men suffer from migraines in adulthood and about 85% of chronic migraine sufferers are women.
- About 90% of migraine sufferers have a family history of migraine.
- About 10% of school-age children suffer from migraines.
What causes migraines?
- Migraines are thought to result from abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.
- An imbalance of certain brain chemicals (serotonin) is believed to play a role in migraines.
- In women, fluctuating estrogen levels can cause more severe and more frequent migraines.
- Migraines tend to run in families: A child with one parent with migraines has a 50% chance of inheriting them. That rises to 75% if both parents have them.
What are the main symptoms of migraines?
- Intense headache, usually on one side of the head
- Throbbing that worsens when you move your head or with activity
- Nausea and vomiting
- Sensitivity to light
- About 1/3 of people with migraines have early warning signs called aura, which can include seeing spots, flashing lights, blurred vision, smelling strange odors, feeling hot and cold, or tingling in the arms or legs
What complications are associated with migraines?
- People who get migraines with aura are at slightly higher risk for stroke. These people should be careful about using estrogen-containing birth control pills or estrogen therapy after menopause.
- Some 40% to 60% of people who have migraines with aura have patent foramen ovale (PFO), which is essentially a hole in the tissue separating the two upper chambers of the heart. However, it’s unclear if one condition causes the other, or if they just happen to occur together.
- Migraines are associated with a very small increased risk of mental health problems, such as depression, anxiety, bipolar disorder or panic disorder.
- Status migrainosus is a debilitating migraine attack lasting for more than 72 hours. It can be caused by medication overuse. The pain and nausea may be so intense that sufferers need to be hospitalized.
- Medication overuse headache (rebound headache) can result from overuse of acute pain-relief medicine, e.g. more than 2 or 3 times a week or more than 10 days out of the month. When the pain medicine wears off, a headache appears, or sometimes a headache and migraine can appear on top of each other. This creates a vicious cycle of more and more headaches, and more and more pain-relief medicine being taken. The cycle is broken by stopping the medicine and riding out the headache.
1. Migraine Research Foundation
3. NHS Choices
4. Migraine Trust
5. Mayo Clinic
Stages & Triggers
Migraines often develop in stages:
- Prodromal (pre-headache) stage – changes in mood, energy levels, behavior and appetite, which can happen several hours or days beforehand
- Aura – usually visual symptoms, such as flashing lights or blind spots, which can last for 5 minutes to an hour (only some people get these)
- Headache stage – usually a pulsating or throbbing pain on one side of the head, along with feeling sick, vomiting or extreme sensitivity to bright light and loud sounds, which can last for 4 hours to 3 days
- Resolution stage – after the headache and other symptoms gradually fade away, you may feel tired for a few days afterwards
Migraine triggers are things that set off a migraine attack. They can range from hormonal to emotional, physical, dietary, environmental or medical factors. Your doctor may suggest that you keep a diary to identify, and avoid, your triggers. Examples include:
- Emotional: stress, anxiety, tension, shock, depression, excitement
- Physical: tiredness, lack of sleep, shift work, poor posture, tension, jetlag, low blood sugar, strenuous exercise
- Dietary: skipping meals, dehydration, alcohol, caffeine, chocolate, citrus fruit, or foods containing tyramine (found in cured meats, yeast, smoked fish, and certain cheeses such as cheddar, camembert, and stilton)
- Environmental: bright lights, flickering television or computer screens, smoking (or smoky rooms), loud noises, changes in climate, such as changes in humidity or very cold temperatures, strong smells, or a stuffy atmosphere
- Fluctuating hormone levels: Such as a menstrual cycle, pregnancy or menopause
- Medicines: some sleep tablets, contraceptives, or hormone replacement therapy (HRT)
2. Mayo Clinic
Diagnosis & Treatment
When is a headache considered a migraine?
A headache is considered a migraine attack if it:
- lasts between 4 and 72 hours
- affects one side of the head
- is throbbing or pounding
- has moderate to severe pain that gets worse with physical activity
Typically, a person must have at least 5 such attacks that meet all or most of these criteria to be diagnosed as having migraines.
What tests are used to diagnose migraines?
Neurologists (specialists in diseases of the nervous system) use a variety of tests and procedures to diagnose migraines and rule out other problems, such as:
- Blood tests – to check for possible blood vessel problems or infections in the spinal cord or brain, or toxins.
- Computerized tomography (CT) scan – to create detailed cross-sectional images of the brain for use in diagnosing possible medical problems that may be causing headaches.
- Magnetic resonance imaging (MRI) – used to produce detailed images of the brain and blood vessels for use in diagnosing brain and nervous system (neurological) conditions.
How are migraines treated?
Treatment for migraines varies based on how often and how severe they are, what causes them, how they impact you, and other medical conditions or complications. Treatment may include:
- “Rescue” medicines to stop the symptoms after a migraine starts.
- “Preventive” medicines to help reduce how often you get migraines (frequency).
- Lifestyle changes to reduce triggers and help you cope better when migraines happen.
- Alternative treatments which may relieve the migraines as well as help you cope with them better.
“Rescue” medicines used for migraines include:
- Pain relievers – aspirin, acetaminophen or ibuprofen (or combinations of these, sometimes also with caffeine) may help relieve mild to moderate migraines. A suppository of indomethacin may be used if the migraine is accompanied by nausea.
- Triptans – sumatriptan, rizatriptan, almotriptan, naratriptan, zolmitriptan, frovatriptan and eletriptan are used to constrict blood vessels and block pain pathways in the brain. They are available in pill, nasal spray and injection form.
- Ergots – ergotamine and caffeine combination drugs may be used for people whose pain lasts for more than 48 hours. They are taken soon after migraine symptoms start.
- Anti-nausea medicines - chlorpromazine, metoclopramide or prochlorperazine may be given in combination with other treatments.
- Opioids – medicines containing narcotics, such as codeine, are sometimes used to treat migraine pain for people who can’t take triptans or ergots, or when other treatments don’t relieve the symptoms. They should be used sparingly because they are habit-forming.
- Glucocorticoids – prednisone, dexamethasone or other similar medicines may be used in combination with other medications for pain relief.
“Preventive” medicines used for migraines:
- Botulinum toxin – thought to work by blocking pain transmissions, this medicine is given by injections into the scalp and neck. Each treatment usually lasts 10-12 weeks. Multiple treatments are given over time to prevent chronic migraines.
- Anti-CGRP antibodies – used to counteract the effect of calcitonin gene-related peptide (CGRP), a chemical produced in the body that causes blood vessels to dilate. This medicine is given by injection twice monthly. Similar medicines have been used for rheumatological disorders or neurological diseases such as multiple sclerosis.
- Blood pressure-lowering medicines – beta blockers such as propranolol and metoprolol tartrate or calcium channel blockers such as verapamil may be used in preventing migraines with aura.
- Antidepressants – a tricyclic antidepressant (amitriptyline) can be used to prevent migraines, or other antidepressants may be prescribed instead due to side effects.
- Anti-seizure medicines – valproate or topiramate may help reduce the frequency of migraines, but can have side effects such as dizziness, weight changes, and nausea.
Lifestyle changes to manage migraines:
By identifying triggers and managing them, some people are able to reduce their migraines. (See “Stages & Triggers” for some example triggers.) Some general suggestions for managing migraines include:
- Eat regular, healthy meals
- Get regular exercise and keep a healthy weight
- Get enough sleep and follow a regular daily sleep pattern
- Manage stress, e.g. through meditation, yoga or other stress reduction techniques
- Quit smoking if you smoke
- Limit alcohol, especially if this is one of your migraine triggers
However, no matter how diligent you are, lifestyle changes alone may not prevent all migraines. Do not get discouraged if this happens to you. It’s important to keep in communication with your doctor about what is working and what isn’t
so he or she can help you figure out how best to manage them.
Alternative treatments for migraines:
Other, nontraditional therapies used for chronic migraines include:
- Acupuncture - a practitioner inserts many thin, disposable needles into several areas of the skin at defined points to help relieve pain.
- Biofeedback - a relaxation technique with special equipment to teach how to monitor and control certain physical responses related to stress, such as muscle tension.
- Cognitive behavioral therapy - a type of psychotherapy that teaches how behaviors and thoughts affect perception of pain.
- Herbs, vitamins and minerals – the herbs feverfew and butterbur are thought to potentially help relieve or reduce migraines, although they should be used with caution due to safety concerns. Vitamins may include a high dose of riboflavin (vitamin B-2), Coenzyme Q10 supplements, or magnesium supplements.
Clinical trials are helping medical researchers better understand, diagnose and treat migraines in the future. Learn more.
1. Harvard Health Publishing
2. Mayo Clinic
3. Stanford University Headache Clinic
Living with Migraines - Resources
Migraine can have a significant impact on your ability to work, attend school, and engage in social activities. When they become chronic, they can start to feel like they are taking over your life. Over time, they can make you feel anxious, depressed or isolated. Here are some helpful resources to help you learn more about ways to manage, and cope with, migraines.
- Headache: Hope Through Research – Information about headaches, including migraines, compiled by the National Institute of Neurological Disorders and Stroke (NINDS).
- iHeadache - an online and mobile app for tracking migraines.
- MigraineMonitor - designed by neurologists, this app tracks your triggers and treatments, records your symptoms and connects you anonymously with other migraine patients.
- Migraine World Summit - a virtual program of videos by experts on migraine, covering a wide range of topics to help you learn about migraines and how to manage them.
- Living With Migraine – available on the Migraine Trust’s website, this resource offers a wealth of information and tips to help manage migraines more effectively.
- Migraine 101: A 3-Step Guide to Managing Headaches – A video about managing migraines narrated by migraine sufferer and director of the Stanford Headache Clinic, Dr Robert Cowan.
- Impact of Migraine: Explaining Your Migraine to Your Children – helpful information to help you communicate with your children about your migraines.
Clinical Trials — Learn More
Clinical trials are investigating potential treatments for people with migraines. They are often seeking volunteers to take part.
If you are eligible and choose to participate, you will receive all study-related care and study medication at no cost during your participation.
Have you considered taking part in a clinical trial for people with migraines?
Potential benefits of participating in a clinical trial include:
- Close care and monitoring by a study doctor and staff throughout the study
- No cost for study treatment, related tests and procedures
- Contribute to our understanding of the treatment options for migraines in the future
If you would like to be considered for an upcoming clinical trial for people with migraines, take our survey.
Please take some time to answer a few questions and be considered for an upcoming clinical trial for people with migraines. We also invite you to join our Migraine Team community to connect with others affected by the disease.
Thank you for sharing with us.
If you would like to be notified about an upcoming clinical trial, you may sign up at the end of our survey.