Migraine

Overview

Migraine is more than a bad headache. People with migraine have attacks of moderate to severe throbbing or pulsing pain, often on one side of the head. Nausea, vomiting, and sensitivity to light, sound, and smells are common.

Some people have an aura before the headache: seeing flashing lights, zigzag lines, or blind spots, or feeling tingling. Many things can trigger an attack, like stress, poor sleep, skipped meals, and hormone changes. Treatments can stop attacks and make them less frequent.

Symptoms

A migraine attack can have up to four phases, but not everyone has all of them.

• Throbbing or pulsing headache, often on one side
• Sensitivity to light, sound, or smells
• Nausea or vomiting
• Pain that gets worse with movement

Less common

• Aura: flashing lights, zigzag lines, or blind spots before the headache
• Tingling or numbness, or trouble speaking, during an aura
• Pain behind one eye or in the temples
• Food cravings, yawning, or mood changes a day or two before
• Feeling drained or foggy for a day after

How it usually goes

• Up to 2 days before: Early signs: food cravings, mood changes, yawning, or needing to pee more.
• Aura (some people): Vision changes or tingling, lasting up to an hour before the headache.
• Headache: Throbbing pain with nausea and sensitivity to light and sound, for 4 to 72 hours.
• After: Tired, weak, or foggy for up to a day.

When to get medical care

Causes

Migraine is a brain condition that often runs in families. Doctors think attacks start with changes in nerve signals and chemicals in the brain.

Common triggers include stress, too much or too little sleep, skipped meals, bright or flashing lights, loud noises, strong smells, weather changes, alcohol, caffeine or caffeine withdrawal, and hormone changes, like around a period.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Family history of migraine
• Women, often linked to hormone changes
• Depression, anxiety, or sleep problems

Possible complications

• Medication-overuse headache: From taking headache medicine more than 3 days a week
• Chronic migraine: Headaches on 15 or more days a month
• Stroke: Slightly higher risk with aura, especially with smoking or estrogen birth control

Diagnosis

A healthcare professional can usually diagnose migraine from your symptoms and family history, plus a physical and nerve exam. There's no test for migraine itself.

Questions you may be asked

• What your headaches feel like and where
• How long they last and how often they happen
• Whether you have nausea, sensitivity to light or sound, or an aura
• What seems to trigger them
• Whether others in your family get migraines, and which medicines you've tried

The exam

They'll do a physical exam and a nerve exam, checking your vision, strength, coordination, reflexes, and balance.

Tests

Tests aren't usually needed. Your healthcare professional may order them if your headaches are unusual or your exam isn't normal:

• MRI or CT scan: To look for other causes when there are warning signs, like a sudden or changed headache.

Treatment

Treatment has two parts: medicine to stop an attack when it starts, and steps to prevent future attacks. Medicine works best when taken at the first sign of a migraine.

Self-care

• Rest in a quiet, dark room with your eyes closed
• Put a cool cloth or ice pack on your forehead
• Drink fluids, especially if you've been vomiting
• Take your medicine early, at the first sign of an attack
• Keep a migraine diary to learn your triggers

Medicines

Some medicines stop an attack; others prevent attacks. Talk with your healthcare professional about which are right for you.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

If you have frequent or severe migraines, your healthcare professional may suggest a daily medicine to prevent them. Options include some blood pressure medicines, antidepressants, anti-seizure medicines, and CGRP medicines. Botox shots can help people with migraines on 15 or more days a month.

How it compares

Prevention

Healthy routines can make attacks less frequent:

• Go to bed and wake up at the same time every day
• Eat regular meals, and drink enough water
• Exercise regularly
• Learn ways to manage stress, like relaxation or biofeedback
• Track and avoid your triggers
• Don't smoke

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a neurologist (brain and nerve doctor).

Living with it

• Keep a headache diary to find triggers.
• Keep a steady sleep, meal, and caffeine routine.
• Take pain medicine early in an attack, but not more than 2 to 3 days a week.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• American Migraine Foundation: Doctor finder and tips for living with migraine.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Children and teens: About 1 in 10 children ages 5 to 15 have migraines. Children often feel pain on both sides, attacks may be shorter, and some have belly pain instead. Regular sleep, meals, and water help.
• Women and pregnancy: Migraines often change with periods, pregnancy, and menopause. Some migraine medicines aren't safe during pregnancy; ask your healthcare professional.
• Migraine with aura: It slightly raises the risk of stroke. Don't smoke, and ask whether estrogen birth control is safe for you.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Migraine has no cure, but most people can lower how often and how badly attacks happen. Many women have fewer migraines after menopause.

Myths and facts

Getting ready for your visit

A migraine diary is the most helpful thing to bring.

What to bring

• A diary of your attacks: when they started, how long they lasted, and possible triggers
• Every medicine you've tried and how often you take it
• Whether family members have migraines
• Whether you take birth control pills or are pregnant

Questions to ask

• Which medicine should I take when an attack starts?
• Should I take a daily medicine to prevent migraines?
• Which of my habits might be triggers?
• Is my birth control safe with my migraines?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Migraine