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.

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.

There is no cure for migraine, but treatments and lifestyle approaches can help minimize the number of attacks a person has and shorten or reduce the severity of those that do occur.

Types of Migraine

There are two main types of migraine: with or without aura. Migraine with aura is further divided into four subtypes: migraine with typical aura, migraine with brain stem aura, hemiplegic migraine, and retinal migraine. And some of these subtypes have sub-subtypes of their own. A person can have more than one type of migraine simultaneously as well as other types of headaches.

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.

An estimated 144 million people worldwide — and 3 to 7 million Americans — have chronic migraine. As with episodic migraine, chronic migraine is up to 3 times more common in women than men.

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

Migraine with aura, formerly called classic migraine, occurs in up to 30 percent of people who have migraine.It usually causes the same symptoms as migraine without aura, except that the headache phase of the migraine attack is preceded by neurologic disturbances that may include visual, speech, or sensory changes.
Examples of visual aura include seeing stars, zigzags, or flashing lights; blurred vision; temporary blind or colored spots; and tunnel vision.

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

This type of migraine, formerly known as basilar-type migraine, is a rare type of migraine with aura. It usually includes neurologic symptoms such as double vision, problems speaking and hearing, dizziness, and loss of balance and coordination.

Hemiplegic Migraine

This type of migraine comes in two forms: familial hemiplegic migraineand sporadic hemiplegic migraine.Both are characterized by aura, fever, and hemiplegia (paralysis on one side of the body). Both are relatively rare.

Retinal Migraine

Retinal migraine is an extremely rare cause of temporary visual loss in one eye. It’s diagnosed when a person has repeated attacks of one-sided visual disturbance — including the types of visual symptoms commonly seen in migraine aura — or blindness associated with migraine headache. These symptoms tend to evolve over five or more minutes, may last as long as an hour, and may be accompanied or followed by a headache.

Chronic Migraine

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.

According to The International Classification of Headache Disorders, keeping a detailed headache diary for at least month may be necessary to determine what sort of headache — or headaches — a person is experiencing.

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.

Abdominal Migraine This type of episodic migraine is diagnosed mostly in children. Symptoms include abdominal pain, nausea, and vomiting.Kids who experience abdominal migraine often don’t have attacks involving headache in adolescence but go on to develop them as adults.

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.

Studies have linked changes in the brain stem and the trigeminal nerve, which mediates pain, to migraine.
Chemical imbalances in the brain may also be involved. Depression and anxiety have long been associated with migraine — depression affects 25 percent of people with migraine, and 50 percent have anxiety, according to the American Migraine Foundation.A study published in Headache found that migraine frequency was associated with the severity of depression and anxiety.
Researchers have found that serotonin levels drop during migraine attacks, causing the trigeminal system to release substances called neuropeptides, which cause headache pain.
A change in the weather or barometric pressure, which can cause imbalances in brain chemicals, may prompt a migraine attack.

Researchers have identified several key risk factors for developing migraine, including the following.

Heredity

The Migraine Research Foundation in New York City reports that approximately 90 percent of people with migraine have a family history of the condition.

Age

People with migraine typically experience their first symptoms during adolescence. Most people who have migraine have their first attack before they reach age 40.But migraine can start at any time in life, depending on other factors.

Gender

During childhood, migraine typically affects boys more than girls, but this trend reverses during adolescence. In adulthood, women are much more likely than men to experience migraine. It seems that hormonal changes, specifically involving estrogen, play a role.

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.

The frequency, severity, and duration of migraine may change during pregnancy or menopause. Some women report that they experience their first migraine attack during pregnancy or that their attacks worsen during pregnancy, while others experience fewer headaches.
The above observations suggest that hormonal fluctuations of estrogen and progesterone are factors in some women with migraine. Migraine tends to be less common and severe after menopause for some women, when hormone levels are more consistent.

Learn More About Migraine Causes and Risk Factors

Duration of Migraine

A migraine attack will typically last from 4 to 72 hours.But an attack can go on for several days.

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.

A newer category of abortive migraine treatments is the calcitonin gene-related peptide (CGRP) receptor antagonists, which include the oral medicines Ubrelvy (ubrogepant), approved by the Food and Drug Administration (FDA) in 2019,and Nurtec ODT (rimegepant), approved by the FDA in 2020.(In June 2021, Nurtec ODT was additionally approved to prevent episodic migraine.)

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.)

Four newer drugs that were developed specifically to lower the frequency of migraine include Aimovig (erenumab),Ajovy (fremanezumab), Emgality (galcanezumab-gnlm), and Vyepti (eptinezumab). All four are CGRP antibodies, which block the action of CGRP, and all have been shown to reduce migraine days in both episodic and chronic migraine. Aimovig and Emgality are injected subcutaneously monthly, Ajovy is injected subcutaneously either monthly or every three months, and Vyepti is administered intravenously every three months.

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.

The available external devices target, respectively, the upper branch of the trigeminal nerve, on the forehead; the vagus nerve, via the neck; the occipital nerve, on the back of the head; and the peripheral nerves in the upper arm. An implanted device also targets the occipital nerve.

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

Bright lights — whether natural, such as sun glare, or the flickering of a fluorescent bulb — are known to trigger migraine in many people with the condition.

Loud noises and strong smells (from perfume, cleaning products, or secondhand smoke) are also associated with migraine onset.

In some cases, however, heightened sensitivity to light, sound, and smell are the early signs of an oncoming attack — rather than light, sound, or smell triggering the attack.

Medications

Oral contraceptives (birth control pills) and vasodilators, such as nitroglycerin, have been linked to migraine. Overusing certain medications can also lead to headache.

Dehydration

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.

Disrupted Sleep

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

Everyday stress can trigger a migraine attack, as can the relaxation that may occur following stress. The American Migraine Foundation reports that stress is a trigger for 70 percent of individuals with migraine.In turn, the chronic pain of migraine can cause stress. It’s important to find healthy ways to reduce or avoid stressors, at work and at home, when possible.

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.

Also, taking a combination of certain migraine medicines, such as triptans and antidepressants, can cause your serotonin levels to rise and lead to a condition called serotonin syndrome. Symptoms include confusion, agitation, sweating, diarrhea, muscle twitching, and rapid heart rate. This condition can be very serious, even life-threatening, if it’s not treated.
Rarely, some people with migraine experience a migrainous infarction, which is a type of stroke that happens at the same time as a migraine with aura.

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.

According to an article published in 2018 in the journal Headache, the prevalence of migraine or severe headache in 2015 was highest in American Indian or Alaska Natives (18.4 percent) compared with white, Black, or Hispanic Americans, with the lowest prevalence in Asian Americans (11.3 percent).
These percentages are based on data from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey, and the National Ambulatory Medical Care Survey. The NHIS performed a separate study on 3,197 households that identified as Native Hawaiian and Pacific Islander and found that 13.2 percent of respondents experienced migraine or severe headache.

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.”

In a 2021 interview with the American Migraine Foundation, Jessica Kiarashi, MD, assistant professor at the University of Texas Southwestern Medical Center in Dallas and chair of the American Headache Society’s Underserved Populations in Headache Medicine Special Interest Section, identified other racial disparities in migraine care:
  • 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

Related Conditions

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

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

iHeadache

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.

Migraine Buddy

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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