Migraine

Overview

A person with migraine episodes has repeated attacks of moderate to severe throbbing and pulsating pain, usually on one side of the head. However, sometimes, migraine can occur without a headache. People who have migraine episodes can also have visual problems, nausea, vomiting, or constipation. There is currently no cure for migraine, but treatments can help manage symptoms.

Signs and Symptoms

Migraine episodes usually occur in several phases. They are:

• Prodrome: This phase can happen a few hours to a few days before a headache starts. Symptoms can include food cravings, unexplained mood changes, uncontrollable yawning, swelling, or needing to urinate more often than usual.
• Aura: Only some people living with migraine episodes experience an aura. Auras appear about 10 minutes to an hour before a headache and usually last no more than an hour. Symptoms of an aura include vision changes, trouble speaking, tingling in the hands or face, and confusion. Some people see flashing or bright lights, have muscle weakness, or feel a sensation of being touched or grabbed.
• Headache: Pain from a migraine headache usually starts slowly and gets more intense. The pain is usually felt on one side of the head. Other common symptoms that can occur with pain include nausea, vomiting, constipation, confusion, blurred vision, mood changes, fatigue, or sensitivity to light, smell, and sound. This phase can last from hours to days.
• Postdrome: People are usually exhausted or confused after a migraine episode. They might have a hard time concentrating, feel dizzy, or have mood changes. The postdrome period may last up to two days before people feel healthy again.

In between migraine episodes, people may also have a hard time concentrating or experience depression, anxiety, tiredness, trouble sleeping, or body chills.

Types of Migraine

• Migraine without aura is the most common type of migraine.
• Migraine with typical aura involves vision changes, other sensory changes, and/or difficulty speaking. These changes go away after the migraine episode.
• Migraine with brainstem aura includes at least two of these symptoms during a migraine episode: a spinning feeling (vertigo), seeing double, trouble with balance or movement, slurred speech, ringing in the ears, hearing problems, and fainting.
• Chronic migraine happens when migraine headaches occur on at least 15 days of the month for more than three months.
• Menstrual migraine is a migraine episode that occurs around the first day of a menstrual cycle, typically in at least two out of three cycles.
• Hemiplegic migraine is a rare and severe form that causes temporary paralysis on one side of the body, which can sometimes last several days. Symptoms may include vertigo, a pricking or stabbing sensation, and trouble seeing, speaking, or swallowing.
• Status migrainosus is a rare but serious condition in which a migraine episode causes debilitating pain and nausea for longer than three days. This condition sometimes requires hospitalization.

Related Health Effects

People living with migraine more commonly experience mental health problems such as depression and anxiety. They are also more likely to have a sleep disorder compared to people without migraine. Other health conditions more common in people living with migraine include bipolar disorder and epilepsy.

Causes and Risk Factors

Many people with migraine have a family history of it. In addition, women experience migraine more often than men. One important reason why is hormone changes that happen during the menstrual cycle or pregnancy. Most women have fewer migraine episodes after menopause. However, removing the ovaries (“surgical menopause”) can make migraine episodes worse. Using birth control can also change how often migraine episodes happen and how severe they are.

Numerous other factors can trigger a migraine episode or increase a person’s risk of having one:

• Sudden changes in weather or environment
• Too much or not enough sleep
• Strong smells
• Emotional stress that affects mood and well-being
• Physical strain on the body
• Loud or sudden noises
• Motion sickness
• Low blood sugar or skipped meals
• Tobacco
• Drinking too much alcohol
• Some medicines
• Hormonal changes
• Bright or flashing lights

These foods or ingredients may also trigger migraine episodes:

• Aged cheeses
• Aspartame, a sugar substitute used in some zero-sugar drinks and foods
• Chocolate
• Cured or processed meats (such as deli meats)
• Monosodium glutamate (MSG), a substance used to enhance flavor, especially in processed or packaged foods
• Nuts, especially salted ones
• Wine and other types of alcohol
• Caffeine consumption or caffeine withdrawal

Diagnosis

To diagnose the possible cause of migraine, a doctor or other healthcare provider will review a person’s health history and do physical and neurological exams. They may also ask specific questions about headaches, such as when they start, how long they last, what they feel like, what triggers them, along with any other symptoms like nausea or vision changes.

Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT), are not usually used to diagnose migraine. A doctor might order one of these scans if they suspect a person might have another condition that causes headaches or other symptoms of migraine.

Keeping a Headache Journal

A headache journal can help a doctor better diagnose the type of headache and find the best treatment. After each headache, write down:

• The time of day when it happened
• How intense it was and how long it lasted
• Any sensitivity to light, smells, or sound
• Any activity right before the headache started
• Any medicines taken, including both prescription and over the counter
• The quality and length of the previous night’s sleep
• Any stress or strong emotions before developing symptoms
• The weather or changes in daily routine
• Food and drinks consumed in the previous 24 hours
• Any other health conditions

People who menstruate can record the days of their periods. Notes about other family members who have a history of headache conditions or other health conditions are also helpful. This information can find patterns to help make a headache management plan.

Asking a child with a headache to draw a picture of where the pain is and how it feels can make it easier for a doctor or other healthcare provider to make a diagnosis.

Treatment and Management

The goal of migraine treatment is to relieve symptoms and prevent additional episodes.

Short-Term Treatment

Quick steps to ease symptoms may include napping or resting in a quiet, darkened room, placing a cool cloth or ice pack on the forehead, and drinking lots of fluid. Small amounts of caffeine may help relieve symptoms during a migraine’s early stages.

Several medicines used to treat migraine target the brain chemical serotonin. Some people with migraine have lower levels of serotonin. Medicines may also target a protein called calcitonin gene-related peptide (CGRP), which plays a role in how people feel pain.

Acute (short-term) treatment for migraine may include:

• Triptan medicines, such as sumatriptan and zolmitriptan, are a common treatment for migraine. They act like serotonin in the brain to relieve symptoms.
• Ergot derivative medicines, such as ergotamine and dihydroergotamine, work best when taken during the early stages of a migraine episode. They help narrow widened blood vessels and affect nerve signals linked to pain.
• CGRP medicines, such as atogepant, are used to prevent pain or for acute pain. They block pain signals in the brain linked to migraine.
• Over-the-counter medicines, such as ibuprofen, aspirin, and acetaminophen, can ease the pain of migraine headaches.
• Nausea relief medicines, such as chlorpromazine and metoclopramide, can help ease nausea caused by migraine.

Always talk with a doctor before giving headache medicines to a child.

Long-Term Treatment and Prevention

Medicines that can help prevent migraine include:

• Anticonvulsants: Reduce pain signals in the brain.
• Beta-blockers: Used to treat high blood pressure by relaxing blood vessels
• Calcium channel blockers: Help control the flow of calcium in and out of blood vessels, which helps them function properly
• Antidepressants: Balance brain chemicals related to migraine
• Botulinum toxin type A (commonly known as Botox®): A long-term treatment for chronic migraine that works by blocking pain signals

Important Safety Note: Routine overuse of headache medicines can actually worsen headaches and their symptoms because the brain starts to adapt to frequent use. A doctor or other healthcare provider can help make a plan for safe medicine use and identify effective treatments. It is important to adhere to the plan or dosage regimen provided by your healthcare provider.

Non-Medicine Approaches

Changes to everyday habits can reduce or prevent migraine episodes in some people. These include exercising, avoiding food and beverages that trigger headaches, eating regular meals, drinking enough water, stopping certain medicines, and going to bed and waking up at the same time every day.

Many dietary supplements and other complementary health approaches have been studied to see whether they might be helpful for treating migraine or other types of headaches. It is particularly important to talk with your doctor or other healthcare provider if you take medicine and are considering trying any of these substances, since combinations of some drugs and supplements can cause unwanted, even dangerous, side effects.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on migraine.

Community Support

Some people find headache support groups helpful for learning how others cope with headache pain and discomfort. Turning to helpful coping strategies when facing life’s stressors can help manage headache pain.

The following organizations provide information and support for people with headache and migraine conditions:

• American Headache Society (AHS)
• American Migraine Foundation
• American Chronic Pain Association (ACPA)
• National Headache Foundation

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Understanding Migraine

NIH funded researchers are investigating the role of brain circuits and the immune system on migraine. Researchers are also studying how health conditions like obesity, depression, and sleep problems may influence migraine and its severity.

In addition, NIH-supported scientists are identifying and testing new medicines and other treatment options for migraine. One example is medicines that target a brain pathway linked to stress.

Other NIH-funded research is studying how to treat migraine headaches without medicines, including using different types of lighting and changes in diet. Cognitive-behavioral therapy (CBT) is also being tested as a way to treat chronic headaches in young people.

Migraine Trainer is a mobile app developed by NIH researchers. It helps people 13 and older understand possible causes of their migraine episodes and creates a personalized migraine management plan.

NIH is also studying mindfulness meditation as a possible treatment for migraine.

Coordinating Pain Research

Several NIH activities on pain research are focused on coordinating efforts across NIH and with other federal agencies:

• The NIH Pain Consortium is a collaboration between 25 NIH Institutes and Centers that helps identify, coordinate, and promote funding opportunities.
• The Interagency Pain Research Coordinating Committee (IPRCC) is a federal advisory committee created by the Department of Health and Human Services (HHS) to better understand and treat pain.
• The Helping to End Addiction Long-term® or NIH HEAL Initiative® is a major NIH-wide effort launched in April 2018 that focuses on improving prevention, treatment, and pain management strategies and also supports migraine research.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.