Migraine is far more than a bad headache. It is a neurological condition that can cause intense throbbing pain, nausea, sensitivity to light and sound, and sometimes visual disturbances. It affects around one in seven people worldwide and is especially common in women. The good news is that treatment options have expanded significantly, and most people can reduce how often attacks happen and how severe they are.
How migraine differs from a regular headache
A migraine attack usually involves a moderate or severe headache that:
- Is often on one side of the head, though it can affect both sides
- Has a pulsing or throbbing quality
- Gets worse with routine physical activity
- Comes with nausea or vomiting, or sensitivity to light and sound
- Lasts from 4 hours to 3 days if untreated
The phases of a migraine
- Prodrome: hours to a day before, with yawning, food cravings, mood changes, neck stiffness or fatigue
- Aura (in about a quarter to a third of people): visual disturbances such as zigzag lines, flashing lights or blind spots, or tingling, usually lasting 5 to 60 minutes
- Headache: the main attack
- Postdrome: a “hangover” feeling of exhaustion or brain fog afterward
Common triggers
Triggers vary from person to person, and not every exposure causes an attack. Common ones include:
- Stress, or the let-down after stress
- Changes in sleep, too little or too much
- Skipping meals and dehydration
- Hormonal changes, especially around menstruation
- Alcohol, particularly red wine
- Caffeine, either too much or caffeine withdrawal
- Bright or flickering lights, strong smells and loud noise
- Weather changes
- Certain foods for some people, such as aged cheese or processed meats
A headache diary noting attacks, sleep, meals, periods and possible triggers helps identify your patterns.
Treating an attack
Treat early, ideally when pain is still mild.
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- Over-the-counter pain relievers: ibuprofen, naproxen, aspirin, or combinations of acetaminophen, aspirin and caffeine work for many people with mild to moderate attacks.
- Triptans, such as sumatriptan, rizatriptan and others, are prescription medicines that target migraine pathways. They come as tablets, dissolving tablets, nasal sprays and injections. They are not suitable for people with heart disease or uncontrolled high blood pressure.
- Gepants, such as ubrogepant, rimegepant and zavegepant, block the CGRP pathway and are an option for people who cannot take triptans.
- Lasmiditan is another non-triptan option.
- Anti-nausea medicines can help with nausea and improve how well other medicines work.
Avoid medication overuse
Using pain relievers too often can cause medication overuse headache, making headaches more frequent. As a general guide, limit simple painkillers to fewer than 15 days a month and triptans or combination medicines to fewer than 10 days a month. If you need acute medicine more often than that, talk to your doctor about prevention.
Preventing migraines
Preventive treatment is worth considering if you have four or more migraine days a month, or if attacks are severe or disabling.
Traditional preventive medicines include beta blockers (propranolol, metoprolol), topiramate, amitriptyline and some blood pressure medicines such as candesartan.
CGRP-targeting medicines were developed specifically for migraine:
- Monthly or quarterly injections: erenumab, fremanezumab, galcanezumab, and eptinezumab (an IV infusion every three months)
- Daily or every-other-day tablets: atogepant and rimegepant
These medicines are generally well tolerated and can significantly reduce migraine days for many people.
Botox injections every 12 weeks are approved for chronic migraine (15 or more headache days a month).
Devices that use nerve stimulation can help some people.
Lifestyle strategies
- Keep regular sleep and meal times
- Stay hydrated
- Exercise regularly
- Manage stress with relaxation techniques or CBT
- Limit alcohol and keep caffeine consistent
- Track and manage your triggers
Headache red flags
Seek emergency care for:
- A sudden, severe “thunderclap” headache that peaks within a minute
- Headache with fever, stiff neck, confusion or a rash
- Headache after a head injury
- New weakness, numbness, trouble speaking or loss of vision
- A new headache after age 50, or one that is changing in pattern
- Headache with seizures or fainting
Migraine with aura is linked to a slightly higher risk of stroke, especially in women who smoke or take estrogen-containing birth control. Discuss contraception choices with your doctor if you have migraine with aura.
The bottom line
Migraine is a real neurological condition, not “just a headache.” Treat attacks early, avoid overusing painkillers, and ask your doctor about preventive treatment if migraines are frequent. New CGRP-targeting medicines have given many people fewer and milder attacks.
This article is for general information and does not replace medical advice.