WebMD

What Is Migraine?

Overview: Migraine is a brain and nervous system disorder whose symptoms almost always include intense headaches. You get these headaches repeatedly, in episodes that can last anywhere from 4 to 72 hours. Along with head pain, they include other symptoms like nausea and sensitivity to light. Migraine vs. headache Many people use the word "migraine" to describe the headache itself. But head pain is just one symptom of migraine. And headaches can be caused by many other things. Some typical characteristics of migraine headaches include: The pain is throbbing or pounding and feels worse when you move around. You feel it mostly on one side of your head. You also have at least one of these symptoms: sensitivity to light and/or sound, nausea , and vomiting.

Symptoms: For many people, a migraine episode happens in stages. Symptoms you may have during these stages include: Migraine prodrome Hours or days before a headache, about 60% of people who have migraine notice symptoms like: Sensitivity to light, sound, or smell. Levels of light and sound that don't usually bother you may feel uncomfortable or even painful. Odors like those of cigarette smoke, car exhaust, perfume, and cleaning products may seem especially unpleasant. Fatigue for no known reason. You might also yawn a lot. Food cravings or lack of appetite. You may crave a particular food like sweets or feel hungrier in general. Or you might not feel much like eating. Mood changes, such as irritability or sadness. Feeling thirsty and peeing more often. Digestive problems like feeling bloated or having constipation or diarrhea . Experts say it's possible to mistake symptoms of prodrome for things that trigger an attack. For example, a craving for sweets might lead you to eat chocolate, which you then blame for causing your headache. Migraine aura Up to 25% of people with migraine have what's called auras shortly before after a headache starts or at the same time as a headache. These symptoms stem from your nervous system and often involve your vision . They usually start gradually, over a 5- to 20-minute period and last less than an hour. You may have: Vision problems like black dots, wavy lines, flashes of light, or tunnel vision Tingling or numbness in your face, hands, and/or limbs Trouble speaking clearly. You might mumble or slur your words. Ringing in your ears, called tinnitus Weakness on one side of your face or body Migraine attack Also called the headache phase, this stage is usually characterized by head pain. This pain may: Begin as a dull ache and then become throbbing Get worse during physical activity Affect one side of your head or move from one side to the other, be in the front of your head, or affect your entire head During the headache, you may also: Have nausea (About 80% of people with migraine do, and about half vomit.) Be pale and clammy Feel faint or dizzy Have neck pain or stiffness Feel anxious or depressed Have a runny nose or feel stuffed up Be sensitive to light (Noise or odors might also bother you.) Have trouble sleeping and feel fatigued How long do migraines last? Often, it's about 4 hours, but serious ones can go for more than 3 days. Some people get them almost every day, while others get them once or twice a year. Migraine postdrome This stage can last up to a day after a headache. About 80% of people with migraine have postdrome . Symptoms include: Feeling tired , wiped out, or cranky Feeling unusually refreshed or happy Muscle pain or weakness Food cravings or lack of appetite Trouble concentrating Migraine vs. tension headache Tension headaches , often caused by tight muscles or stress, are the most common type of headache. The pain of a tension headache usually affects both sides of your head and feels steady instead of throbbing. Tension headaches don't usually cause nausea, vomiting, or light sensitivity. Migraine vs. cluster headache Cluster headaches tend to begin quickly with no warning. The pain is intense and sharp or burning. You usually feel it around or behind one of your eyes. Cluster headaches can cause these symptoms in the affected eye: Redness or watering An eyelid that looks droopy or swollen A smaller pupil Each headache lasts between 15 minutes and 3 hours, and you can have several in 1 day. You tend to get them in "clusters"—weeks or months in which you have them often. These periods are followed by weeks or months in which you're headache-free. Cluster headaches aren't considered migraines.

Causes: Doctors don’t know exactly what causes migraines, though they seem to be related to your genes, as well as to changes in your brain . Your genes may even influence what triggers your headaches, whether it's fatigue , bright lights, or weather changes. For many years, scientists thought people got migraine attacks because of changes in blood flow in the brain. Most now think this contributes to the pain but isn't what starts it. Some experts now believe an attack starts due to chemical changes in your brain. Overactive nerve cells send out signals that lead to changes in the levels of certain chemical compounds in your body, such as serotonin and calcitonin gene-related peptide ( CGRP ). CGRP makes blood vessels around your brain swell, while serotonin causes them to shrink. An imbalance in these chemicals causes inflammation and pain.

Diagnosis: Before making a diagnosis, your doctor will ask about your health history and your symptoms. It may help if you keep track of your symptoms and any triggers you've noticed. Write down or enter into a tracking app: What symptoms you have, including where it hurts How often you have them How long they last Other family members who have migraine All the medicines and supplements you take, even over-the-counter (OTC) ones Other medicines you remember taking in the past Your doctor may order tests to rule out other things that could cause your symptoms. These may include: Blood tests Imaging tests like MRI or CT scans Electroencephalogram (EEG)

Treatment: There's no cure for migraine, but there are many ways to treat it. Some treatments stop attacks after they start, some prevent them, and some can do both. Migraine medications Common migraine treatments include: OTC pain relievers. These drugs often work well for headaches. The main ingredients are often acetaminophen, aspirin, caffeine, and ibuprofen. Never give aspirin to anyone under age 19 because of the risk of Reye's syndrome . If you use OTC pain medications too much, you can get rebound headaches or become dependent on them. If you're taking them more than 2 days a week, talk to your doctor about prescription drugs that may work better. Celecoxib (Celebrex, Elyxyb). This is a prescription nonsteroidal anti-inflammatory drug that stops your body from making certain hormones that can cause pain when they reach high levels in your bloodstream. You take it to stop a migraine. Celebrex come as a tablet that you take once or twice a day. Elyxyb is a liquid you take by mouth once a day. Triptans. These drugs balance the chemicals in your brain to stop the pain. You might get a pill to swallow, tablets you dissolve on your tongue, a nasal spray, or a shot. Examples include: Almotriptan (Axert) Eletriptan (Relpax) Rizatriptan (Maxalt) Sumatriptan (Imitrex) Zolmitriptan (Zomig) Ditans. Lasmiditan (Reyvow) is a tablet that eases pain, nausea, and sensitivity to light or sound. It comes in pill form. It interferes with the release of CGRP. Triptans with NSAIDS. Several medications combine these two drug classes, which may work better for acute migraine than either drug alone. They include: Sumatriptan-naproxen (Treximet). This is the best-studied combination drug. It’s more effective than taking either the triptan or NSAID separately. Rizatriptan-meloxicam ( Symbravo ). Human studies found that this may ease more migraine pain and for longer than taking either drug alone or an inactive medicine. Other triptan-NSAID combinations include Frovatriptan (Frova) plus the painkiller dexketoprofen or rizatriptan (Maxalt) with acetaminophen (Tylenol and other brands). Side effects for these combo drugs may include dizziness, nausea, drowsiness, and pain or discomfort in your neck, jaw, and elsewhere. Gepants. Your doctor might give you rimegepant (Nurtec) or ubrogepant (Ubrelvy) if other treatments don't help. You'll take them in tablet form. Another type, zavegepant (Zavzpret) comes as a nasal spray. These medications work in a different way to suppress CGRP. Ergotamine (Cafergot, Ergomar, Migergot). This also works on the chemicals in your brain . Nausea medicine. Your doctor can prescribe medication if you get nausea with your migraine. Preventive medicines. If other treatments don't work, your headaches are serious, or you have four or more headache days a month, your doctor may suggest these. You take them regularly to make your headaches less painful or frequent. They include: Seizure medicines Blood pressure medicines like beta-blockers and calcium channel blockers Some antidepressants Medications that help stop the action of CGRP can also work to prevent migraines. These include: Atogepant (Qulipta) Eptinezumab (Vyepti) Erenumab (Aimovig) Fremanezumab (Ajovy) Galcanezumab (Emgality) Migraine devices The FDA has approved several devices to treat or prevent migraine symptoms. They use magnetic or electrical energy to target nerves or nerve activity involved in head pain, an approach called neuromodulation. You might try them if medications don't work well for you, or use them together with medication. The devices include: Single-pulse transcranial magnetic stimulation (eNeura). To use this prescription device, you place it on the back of your head. It sends a pulse of magnetic energy that affects electrical signaling in your brain, which may stop or reduce pain. It's used both to treat and prevent attacks. External trigeminal nerve stimulation (Cefaly). This nonprescription device targets the trigeminal nerve , which provides sensation to parts of your head and face. It delivers stimulation through electrodes you place on your forehead. You can use it to treat or prevent headaches. You might also hear this type of device called a transcutaneous electrical nerve stimulation unit. Noninvasive vagal nerve stimulator (Gammacore). This type works on your vagus nerve, a long nerve that's a key player in your nervous system. To use it, you hold it in your hand and place it against your neck. It's approved to both stop and prevent headaches and requires a prescription. Remote electrical neuromodulator (Nerivio). You also need a prescription for this device, which you apply to your upper arm and control with a phone app. It stimulates nerves in your arm that are part of a pathway for pain signals. It's used to get rid of migraine pain once it starts. Combined occiputal and trigeminal neurostimulation (Relivion). This headband-like device stimulates the trigeminal nerve as well as the occipital nerve that runs along the back of your head. This can help stop an attack. The device, which is available by prescription, is controlled via a phone app. Botox for migraine If you have chronic migraine, shots of botulinum toxin type A ( Botox ) can help reduce the frequency of your headaches. The toxin is thought to interrupt the pain signals in your head. You'll get several shots in your head and neck. Each treatment lasts up to 12 weeks. Migraine surgery Some people have surgery for migraine when other treatments don't work. But this approach hasn't been well-studied, and it's controversial. The American Headache Society doesn't recommend surgery unless it's done as part of a research study. The two main types of migraine surgery are: Nerve decompression surgery. In this operation, a surgeon removes tissue that's putting pressure on and irritating nerves that are thought to be trigger points for migraine. Neurectomy. This involves cutting the end of a nerve in the area where your pain starts. Cognitive behavioral therapy for migraine A therapist can teach you how your actions and thoughts affect how you sense pain. They can also teach you ways to reduce stress, a known trigger for migraine attacks .

When to call a doctor: See your doctor any time a headache doesn't go away or keeps coming back. Get medical help right away if you have an intense headache and: A stiff neck with fever, nausea, and vomiting Numbness or weakness in your limbs Trouble speaking or slurred speech It happened very suddenly It's the first really bad headache you've ever had and keeps you from doing your daily activities You got it right after a head injury, exercise, or sex Confusion or memory loss It gets worse over a day It's the worst one you've ever had You have it in just one eye along with redness in that eye You're also having vision problems and it hurts to chew You're over 50 and this is the first time you've had this type of head pain

Medically reviewed by

Poonam Sachdev, MD

Review date

Mar 14, 2024