Understanding Migraine: Knowledge is Your Best Defense

Migraine is a complex neurological condition that often involves a severe headache. It is generally characterized by moderate to severe throbbing, and pulsating pain on one side of the head. People with migraine often experience recurrent episodes.

In 2021, researchers found that approximately 4.3% of adultsTrusted Source over the age of 18 in the United States had experienced a migraine episode or a severe headache within the last 3 months.

This research also found that migraine affects just over 7.4% of females versus 2.5% of males. Episodes often occur in people ages 18–44 years, but they can happen at any time, including during childhood.

Untreated episodes of migraine can last anywhere from 4–72 hoursTrusted Source. For many people, migraine may be worse in the morning. Some may also experience an episode at a predictable time, such as during menstruation or at the weekend following a stressful working week.

While most people may feel weak or exhausted following a migraine episode, they generally experience times being symptom-free in between episodes.

Research data on race and ethnicity

Migraine can be a debilitating condition that is underdiagnosed and challenging to treat. This can be seen especially in BIPOC populations. Minorities are less likely to receive the diagnosis of migraine and the treatment than white people.

A study from 2017 using survey information from 2006–2013 notes that among the 50 million people who visited a healthcare professional for migraine-related issues between those years, 41.3% were African American. However, of those numbers, 47.3% received no abortive treatment for the condition.

Other research from 2021 found that Latino people are 50% less likely to receive a formal migraine diagnosis than white people. These disparities can impact treatment and therapies.

While these figures could lead to the conclusion that white people experience more migraine episodes than other groups, an analysis from 2015Trusted Source of nine studies looking at the average prevalence of severe headaches or migraine from 2005–2012 in the U.S. found that the prevalence rates of episodes across all groups were similar:

• 17.7% of Native American people
• 15.5% of white people
• 14.5% of Hispanic people
• 14.45% of Black people
• 9.2% of Asian people

Furthermore, females in all groups were approximately twice as likely to experience migraine episodes than males.

Overall, studies that discuss migraine and use racial and ethnic differences for clarity often do not consider contributing factors. Further research is warranted, and this should consider behavioral, environmental, genetic, and socioeconomic factors, as well as access to healthcare.

Symptoms of migraine tend to occur in stages:

Before the headache: According to a 2023 review of migraine, around 77% of peopleTrusted Source with migraine experience symptoms that start hours or days before the headache.

At this stage, a person might experience a “prodrome,” which may involve emotional changes, specifically depression and irritability. A prodrome can also include yawning, dizziness, thirst, frequent urination, and sensitivity to light and sound.

Sometimes an aura can occur. This involves physical or sensory symptoms, such as flashing lights in the field of vision.

During the headache: Alongside a mild to severe, throbbing or pulsing headache, symptoms may include nausea, vomiting, neck pain, dizziness, and nasal congestion.

Resolution: After the headache, tiredness and irritability may last another few days. This is sometimes called the “migraine hangover.” Officially, it is known as the postdrome phase.

Other common features of migraine are:

• head pain that worsens during physical activity or straining
• an inability to perform regular activities due to the pain
• increased sensitivity to light and sound that can sometimes be relieved by lying quietly in a darkened room

Other symptoms may include sweating, feeling unusually hot or cold, a stomachache, and diarrhea.

Find out what else can cause a headache, nausea, and fatigue.

A migraine episode is different from a typical headache. The experience is different, and they can have different causes.

Writing down the symptoms and when they occur can help a person and their healthcare professional identify migraine episodes. Examples of what to note include:

• the time that symptoms start
• possible triggers, such as stress or menstruation
• the nature of the headache
• any other symptoms
• how long symptoms last
• any noticeable indicators of migraine, such as an aura
• any medications and their effects

Learn more about the differences between migraine and a headache.

The exact causeTrusted Source of migraine is not fully understood. However, there are certain factors that experts believe may contribute to the development of the condition.

Genetic features may also play a role — having a family history of migraine is a common risk factorTrusted Source.

Migraine triggers vary from person to person. However, there are certain factors that are common triggers.

Many people find that hormonal changes, such as those related to menstruation, can trigger migraine headaches.

There are various emotional triggers, that include:

• stress
• depression
• anxiety
• excitement

Certain dietary factors can trigger migraine, including:

• alcohol
• caffeine
• chocolate
• nuts
• cheese
• citrus fruits
• foods containing the additives tyramine and monosodium glutamate (MSG)

Some people may find certain medications a triggering factor, such as:

• sleeping pills
• hormone replacement therapy (HRT)
• some birth control pills

Various environmental factors can potentially trigger migraine, including:

• flickering screens
• strong smells
• secondhand smoke
• loud noises
• humidity
• stuffy rooms
• temperature changes
• bright lights

Some other possible triggers include:

• tiredness
• a lack of sleep
• shoulder and neck tension
• poor posture
• physical overexertion
• low blood sugar
• jet lag
• irregular mealtimes
• dehydration

Avoiding triggers, when possible, may help reduce the frequency of migraine episodes.

Risk factors

Anyone can develop migraine. However, there is a slightly higher risk for people with:

• depression
• bipolar disorder
• fibromyalgia
• irritable bowel syndrome
• overactive bladder
• sleep disorders
• obsessive-compulsive disorder (OCD)
• anxiety

There is no cure for migraine. However, medications can help manage the symptoms when they arise, and people can take steps to reduce the frequency and severity of episodes.

However, it is important to keep in mind that these medications can have side effects.

Medications

Pain relief and other types of medication can often help. Taking medication as soon as symptoms start may keep them from becoming severe.

Some over-the-counter (OTC) pain relief medications that may benefit people with migraine include:

• naproxen (Aleve)
• ibuprofen (Advil)
• acetaminophen (Tylenol)

Other options include:

• triptans, such as sumatriptan (Imitrex), to help reverse the brain changes that occur during an episode
• antiemetics to manage any nausea and vomiting
• gepants to block a protein involved in inflammation and pain, called calcitonin gene-related peptide (CGRP)
• ditans, which interact with 5-HT1F receptors on the sensory nerves and blood vessels

It is important to avoid overusing medication because overuse can cause a rebound headache. A healthcare professional can help inform an individual how much of each medication is safe and effective.

Find some tips for instant migraine relief.

Some home care strategies that can help relieve migraine symptoms include:

• using flexible cold packs or masks
• staying in a quiet, darkened room
• sleeping, when necessary

The following supplements might help prevent migraine. However, there is limited evidence that they work, and not much is known about their side effects:

• herbal extracts, such as feverfew
• magnesium
• coenzyme 10
• butterbur
• riboflavin

Other nondrug approaches may include acupunctureTrusted Source, neck exercises, or physical therapy.

Before trying any of these, speak with a healthcare professional. Research has not shown that these approaches work.

Anyone looking for an alternative therapy, such as acupuncture, should go to a qualified and experienced professional.

What are some natural remedies for a headache?

While it is not always possible to prevent migraine episodes, there are ways to reduce their frequency and severity.

Medications

The following prescription drugs may help reduce the number of episodes that a person with severe migraine experiences:

• topiramate (Trokendi XR), an antiseizure drug
• propanolol (Inderal), for treating high blood pressure
• antidepressant medications
• Botox
• gepants and CGRP inhibitors

It may take several weeks to see an improvement.

The best treatment in children or adolescents may be different from that in adults. A healthcare professional can help recommend the most effective approach.

Identifying and avoiding triggers

A migraine episode sometimes happens in response to a trigger. To identify a trigger, a person might keep a diary and record how they felt and what they did, ate, and drank before the symptoms appeared.

It may be particularly helpful to avoid:

• low blood sugar
• physical overexertion
• stress
• certain foods, such as chocolate and any that contain tyramine or MSG
• certain medications, including HRT and some birth control pills
• bright lights and flickering screens

The following strategies may help reduce the frequency of migraine episodes:

• getting enough sleep
• reducing stress
• drinking plenty of water
• having healthy posture
• avoiding known dietary triggers
• getting regular physical exercise

If making these changes does not ease the severity and frequency of migraine episodes, a healthcare professional may suggest medication or other options.

There are various types of migraine. A major distinguishing factor is whether they involve aura-sensory changes.

Migraine with aura

Aura is a disturbance of the senses in the early stages of a migraine episode.

Aura can involve:

• having confusing thoughts or experiences
• seeing strange, sparkling, or flashing lights that are not there
• seeing zig-zagging lines of light
• having blind spots or blank patches in the field of vision
• having a pins and needles sensation in an arm or leg
• having difficulty speaking
• having weakness in the shoulders, neck, or limbs
• seeing things that are not there out of one eye, such as transparent strings of objects
• not being able to see part of something clearly
• having part of the field of vision disappear, then reappear

A visual aura may feel like the aftermath of a very bright camera flash, but the visual changes may last for several minutes or up to 1 hour.

Anyone experiencing an aura for the first time should contact a healthcare professional to rule out serious neurological problems, such as a stroke or a brain tumor.

Find out more about migraine aura.

Migraine without aura

More commonly, a person experiences no sensory disturbances before an episode. This type of migraine accounts for around 70–80% of cases.

Other types

Some other types of migraine include:

• Chronic migraine: This involves having an episode on more than 15 days per month.
• Menstrual migraine: This occurs in a pattern that follows the menstrual cycle.
• Hemiplegic migraine: This causes temporary weakness on one side of the body, and it is very rare.
• Abdominal migraine: This involves migraine episodes with irregular function in the gut and abdomen, often with nausea or vomiting. It also typically involves abdominal pain. It mainly affects children under 14 years of age.
• Vestibular migraine: Severe vertigo is a symptom of this type.
• Basilar migraine: This rare type is also called “migraine with brainstem aura,” and it can affect neurological functions, such as speech.

Anyone who may be experiencing any new neurological symptoms should seek medical attention. People who need treatment for migraine should consult a healthcare professional.

Diagnosis

The International Headache Society recommends the “5, 4, 3, 2, 1” criteria to diagnose migraine without aura. These numbers stand for:

• having 5 or more episodes, each lasting 4 hours to 3 days
• having a headache with at least 2 of the following qualities:
  • occurring on one side
  • pulsating
  • causing moderate-to-severe pain aggravated by activity
• having at least 1 additional symptom, such as:
  • nausea
  • vomiting
  • sensitivity to light
  • sensitivity to sound

A healthcare professional may recommend imaging or other tests to exclude other causes of the symptoms, such as a tumor, meningitis, or a stroke.

A person should consult a healthcare professional if they experience:

• what seems like a first migraine episode
• worsening or unusual migraine symptoms
• severe symptoms

If any of the following occur, seek immediate medical help:

• an unusually severe headache
• visual disturbances
• a loss of sensation
• difficulty speaking

These could indicate another condition that may need urgent attention, such as a stroke.

Migraine is a medical condition that involves a headache and other symptoms. It is not just a bad headache and it can have a significant impact on daily life, making it difficult to work and do everyday activities.

Identifying and avoiding triggers can often help reduce the frequency or severity of episodes, though it is not always possible to prevent them.

Medication and other treatments can help manage migraine symptoms. Anyone who has concerns should contact a healthcare professional.