Migraine is a neurological condition that can cause multiple symptoms. It’s frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages.
The diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headache are those without aura (previously known as common migraines) and those with aura (previously known as classic migraines).
Migraines can begin in childhood or may not occur until early adulthood. Women are more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.
Migraine symptoms may begin one to two days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
- food cravings
- depression
- fatigue or low energy
- frequent yawning
- hyperactivity
- irritability
- 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 a migraine can vary from person to person. Some symptoms may include:
- increased sensitivity to light and sound
- nausea
- 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
- vomiting
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 is skipped and it’s possible that a migraine attack occurs without causing a headache.
People describe migraine pain as:
- pulsating
- throbbing
- perforating
- pounding
- debilitating
It can also feel like a severe dull, steady ache. The pain may start out as mild, but without treatment will 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 migraines 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 migraines with aura, pain may overlap with an aura or may never occur at all.
Migraines can’t be cured, but your doctor can help you manage them so you get them less often and treat symptoms when they occur. Treatment can also help make the migraines you have less severe.
Your treatment plan depends on:
- your age
- how often you have migraines
- 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 these:
- self-care migraine remedies
- lifestyle adjustments, including stress management and avoiding migraine triggers
- OTC pain or migraine medications, such as NSAIDs or acetaminophen (Tylenol)
- prescription migraine medications that you take every day to help prevent migraines and reduce how often you have headaches
- prescription migraine medications that you take as soon as a headache 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
- counseling
You can try a few things at home that may also help remedy the pain from your migraines:
- Lie down in a quiet, dark room.
- Massage your scalp or temples.
- Place a cold cloth over your forehead or behind your neck.
Researchers haven’t identified a definitive cause for migraines. However, they have found some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in levels of the brain chemical serotonin.
Other factors that may trigger a migraine include:
- bright lights
- severe heat, or other extremes in weather
- dehydration
- changes in barometric pressure
- hormone changes in women, such as 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, such as oral contraceptives or nitroglycerin
- unusual smells
- certain foods
- smoking
- alcohol use
- traveling
Certain foods or food ingredients may be more likely to trigger migraines than others. These may include:
- alcohol or caffeinated drinks
- food additives, such as 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. This includes foods like some aged cheeses, sauerkraut, and soy sauce. However, ongoing research is looking more closely at the role of tyramine in migraines. It may be a headache protector in some people rather than a trigger.
There are many types of migraines. Two of the most common types are migraine without aura and migraine with aura. Some people have both types.
Many individuals with migraines have more than one type of migraine.
Migraine without aura
This type of migraine used to be called common migraine. Most people with migraine don’t experience an aura.
According to the International Headache Society, people who have migraine without aura have had at least five attacks that have these characteristics:
- Headache attack usually lasting 4 to 72 hours if it’s not treated or if treatment doesn’t work.
- Headache 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
- Headache 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
- Headache isn’t caused by another health problem or diagnosis.
Migraine with aura
This type of migraine used to be called classic migraine, complicated migraine, and hemiplegic migraine. Migraine with aura occurs in 25 percent of people who have migraines.
According to the International Headache Society, you must 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, such as 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
- hypacusis (problems hearing)
- diplopia (double vision)
- ataxia or an inability to control body movements
- decreased consciousness
- 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 five or more minutes
- each symptom of the aura lasts between five minutes and one hour (if you have three symptoms, they may last up to three 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 headache or one hour before the headache begins
- Headache isn’t caused from 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 headache starts. Alternatively, an aura may start at the same time as the headache does.
Chronic migraine used to be called combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine and can be caused by medication overuse.
People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura.
Compared to people who have acute migraines, people with chronic migraines are more likely to have:
- severe headaches
- more disability at home and away from home
- depression
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), such as high blood pressure
- previous head or neck injuries
Children can have many of the same types of migraines as adults. Children and teens, like adults, can also experience depression and anxiety disorders along with their migraines.
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 migraines tend to last 2 to 72 hours.
A few migraine variants are more common in children. These include abdominal migraine, benign paroxysmal vertigo, and cyclic vomiting.
For many women, their migraines improve during pregnancy. However, they may become worse following delivery due to sudden hormonal shifts. Headaches during pregnancy need special attention to make sure that the cause of the headache is understood.
Research is ongoing, but a recent small study showed that women with migraine during pregnancy experienced a higher rate of having:
- preterm or early delivery
- preeclampsia
- a baby born with low birth weight
Certain migraine medications may not be considered safe during pregnancy. This can include aspirin. If you have migraines during pregnancy, work with your doctor to find ways to treat your migraine that won’t harm your developing baby.
You may want to take these actions to help prevent a migraine:
- Learn what triggers your migraines and avoid those things.
- Stay hydrated. Per day, Men should drink about 13 cups of fluids and women should drink 9 cups.
- Avoid skipping meals.
- Get quality sleep. A good night’s sleep is important for overall health.
- Quit smoking.
- Make it a priority to reduce stress in your life and learn to cope with it in helpful ways.
- Learn relaxation skills.
- Exercise regularly. Exercise may help you not only reduce stress but also lose weight. Experts believe obesity is linked to migraines. Be sure to start exercising slowly to warm up gradually. Starting too fast and intensely can trigger a migraine.
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