A migraine headache is a type of headache that tends to recur and causes moderate to severe pain. The pain is often described as throbbing or pulsing and usually begins on one side of the head. Migraine headaches are worsened by physical activity, light, sound or physical movement. The pain typically last from 4 hours up to 3 days. You may be sensitive to light, sound and even smell. And you may also experience nausea and/or vomiting.
The National Headache Foundation estimates that nearly 12% of the population experience migraine headaches. This means that nearly 40 million people in the United States have migraines. Women are about three times more likely than men to experience migraines.
Yes, migraines have a tendency to run in families. As many as four out of five people with migraine have a family history of migraines. If one parent has a history of migraines, the child has a 50% chance of developing migraines. And if both parents have a history of migraines, the risk jumps to 75%.
Migraine headache pain results from signals interacting among your brain, blood vessels and surrounding nerves. During a headache, specific nerves of the blood vessels are activated and send pain signals to the brain. It’s not clear, however, why these signals are activated in the first place.
There is a migraine “pain center,” or generator, in the mid-brain area. A migraine begins when overactive nerve cells send out impulses to your blood vessels. This causes the release of prostaglandins, serotonin and other substances that cause swelling of the blood vessels in the vicinity of the nerve endings, resulting in pain.
The symptoms of migraine include:
About 30% of people who have migraines develop symptoms several hours up to 2 days before their headache starts. This early stage of migraine is called a prodrome. During this stage, you can experience vague symptoms including anxiety, mood changes (depression, hyperactivity, irritability, euphoria), tiredness, increased thirst, food cravings and neck stiffness and pain
Migraine attacks can be triggered by a variety of factors. Triggers include:
An aura is a symptom or “warning signal” that a migraine is about to begin. An aura can also appear during or after the headache pain. Auras can last from 15 to 60 minutes. About 15 to 20% of people who experience migraines have auras. Auras can affect vision, producing symptoms such as:
Auras can affect your other senses too. Other auras may include ringing in the ears (tinnitus), tingling in the arm or face, speaking difficulties, changes in smell (such as strange odors) or taste, or simply having a “funny feeling.”
Some rare migraines, with specific neurological auras, include:
Hemiplegic migraine. You'll have temporary paralysis (hemiplegia) or neurological or sensory changes on one side of the body. The onset of the headache may be associated with temporary numbness, dizziness or vision changes.
Retinal migraine. You may notice temporary, partial or complete loss of vision in one of your eyes, along with a dull ache behind the eye that may spread to the rest of your head.
Migraine with brainstem aura. With this is migraine, you'll have accompanied vertigo, slurred speech, double vision or loss of balance, which occur before the headache. The headache pain may affect the back of your head. These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in the ears and vomiting.
Status migrainosus. This is a rare and severe type of migraine that can last longer than 72 hours. The headache pain and nausea can be extremely severe. Certain medications, or medication withdrawal, can cause you to have this type of migraine syndrome.
To make the diagnosis of migraine, your doctor will conduct a thorough medical history. In addition, they'll ask you to:
Your doctor may also order blood tests and imaging tests (such as a CT scan or MRI) to make sure there are no other causes for your headache. An electroencephalogram (EEG) may be ordered to rule out seizures.
There are two main treatment approaches – abortive and preventive.
Abortive medications are most effective when you use them at the first sign of a migraine. By stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
Preventive (prophylactic) medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraine from occurring.
Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain-relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine. Be cautious when taking over-the-counter pain-relieving medications. Sometimes they can contribute to a headache or their overuse can cause analgesic-rebound headaches or a dependency problem. If you're taking any over-the-counter pain medications more than two to three times a week or daily, see your healthcare provider. They may suggest prescription medications that may be more effective.
Prescription drugs include the triptan class of drugs (such as sumatriptan, zolmitriptan, naratriptan and many others), ergotamine, steroids, beta blockers (such as atenolol, propranolol, nadolol and others), antidepressants (such as amitriptyline, nortriptyline and doxepin), antiseizure drugs (such as valproic acid, gabapentin, topiramate), calcium channel blockers (such as verapamil and nifedipine), and calcitonin gene-related peptide (CGRP) monoclonal antibodies (such as erenumab).
Drugs to relieve migraine pain come in a variety of formulations including, pills, tablets, injections, suppositories and nasal sprays. You and your doctor will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.
Drugs to relieve nausea are also prescribed, if needed.
All medications should be used under the direction of a headache specialist or physician familiar with migraine therapy. As with any medication, it's important to carefully follow the label instructions and your physician’s advice.
Other migraine management methods include:
Other drug and non-drug treatments. Botulinum toxin type A may help reduce the number of migraine attacks. Vitamins and minerals, including riboflavin or magnesium, may be helpful. Herbal products, including feverfew and butterbur, have been studied for the treatment of migraine headache. Ask your doctor about the benefits and/or precautions before taking any of these products.
There is no cure for migraine headaches. But you can take an active role in reducing how often your get migraines and how severe they are by following these tips:
Migraines are unique to each individual. Likewise, how migraines are managed is also unique. The best outcomes are usually achieved by learning and avoiding personal migraine triggers, managing symptoms, practicing preventive methods, following the advice of your doctor and reporting any significant changes to your doctor as soon as they occur.
Call 911 if:
Schedule a visit with your doctor if:
© Copyright 1995-2020 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 08/07/2018