This sometimes-disabling neurological disorder affects more than 1 billion people worldwide, according to a consensus statement published in Nature Reviews Neurology. In the United States, approximately 15 percent of people experience migraines. These severe headaches can disrupt a person’s daily activities and develop complications.

What Are the Common Types of Migraines?

According to Cleveland Clinic, more than 150 types of headaches are divided into two groups: primary and secondary.

Migraine headaches are primary headaches, meaning another condition does not cause them. In contrast, secondary headaches are the result of another condition. There are three main types of migraines: migraine without aura, migraine with aura, and chronic migraine. An aura is one or more sensory disturbances that occur before migraine onset.

Without Aura (Common)

When the aura phase of a migraine does not occur, it is considered a migraine without aura. Some characteristics of this type of migraine are:

• Pain on one side of the head
• Throbbing pain
• Moderate to severe intensity
• Sensitivity to light
• Nausea
• Vomiting

With Aura (Complicated)

Migraines that contain the aura stage are migraines with aura. About 15 to 20 percent of people who have migraines will experience an aura. Auras can happen before you experience a migraine or during the migraine.

Besides the characteristics of the aura phase, more specific characteristics of auras are:

• Visual disturbances, such as shapes or colors, that can last for minutes or hours
• Numbness in the arms and legs, which can be gradual
• Vertigo

Chronic

Chronic means long-lasting. In this case, a chronic migraine lasts more than 15 days per month for over three months.

People with a headache disorder, such as migraines, may develop chronic migraines due to the overuse of headache medication.

Other

Less common types of migraines include:

• “Silent” migraine: This is a type of headache with auras but without pain.
• Hemiplegic migraine: This migraine features momentary paralysis or sensory changes on one side of the body. This can be confused with stroke symptoms.
• Ocular migraine: Ocular migraines cause some or complete vision loss in one eye and pain behind the affected eye.
• Migraine with brainstem aura: This migraine results in sudden symptoms of loss of balance, impaired speech, and double vision.
• Abdominal migraine: According to the National Institute of Neurological Disorders and Stroke, this is abdominal pain that occurs most often in children, lasts one to 72 hours, and may or may not have a headache. They cause severe abdominal pain with nausea, vomiting, and loss of appetite. Young children are more inclined to experience these and will likely experience migraines when they are older.
• Basilar-type migraine: Occurs most often in teenage girls and is sometimes associated with menstruation, according to the National Institute of Neurological Disorders and Stroke. Symptoms include vision, speech, balance disturbances, and poor muscle coordination.
• Menstrual migraine: According to the National Institute of Neurological Disorders and Stroke, these affect women and occur around menstruation.
• Status migrainosus: This rare migraine lasts more than 72 hours with extreme pain and nausea.

What Are the Symptoms of Migraines?

Symptoms of migraine headaches can differ among the types of migraines. The most common symptoms (pdf) include:

• Throbbing head pain
• Nausea
• Vomiting
• Light sensitivity
• Visual disturbances
• Headache that worsens with activity
• Disruptions in smell, taste, and touch

When to See a Doctor

If you are experiencing headaches, it is always best to see your health care provider to be diagnosed and eliminate any contributing conditions. According to Mayo Clinic, if you are experiencing any of these symptoms, see your health care provider soon, as a more severe condition may exist:

• An abrupt, intense headache
• Physical changes including fever, stiff neck, numbness, weakness
• Confusion, seizures, or changes in vision
• Headache occurring after a head injury like a concussion
• A chronic headache worsened by straining, coughing, or exertion
• Changes in your headaches after the age of 50

This list is not all-inclusive. If you experience any new or changed symptoms with your migraines, it is best to see your doctor for further guidance and to ensure another serious condition doesn’t exist.

Migraines Affect People Differently

Migraines do not affect everyone the same. How a person experiences migraines can be affected by age, gender, and physiology.

Older People

Older people more often have migraine aura without headache and more secondary headaches because of existing comorbidities and adverse events. Migraine symptoms change with age, as well. Older people are less likely to have nausea and vomiting but more likely to have neck pain. When people over 55 experience migraines, considering their comorbidities and medications is necessary to make a diagnosis.

Children

For children experiencing migraines, bed rest may be enough to manage the migraine. Their attacks are often shorter, less pulsating, with prominent gastrointestinal disturbances. Children who experience migraines may see an increase in prevalence when they reach adolescence.

Although medications may help to manage migraines in children, consult a health care professional before administering any medications.

Women

Due to various hormonal changes, women may experience migraines during menstruation, pregnancy, postpartum, menopause, and when taking oral contraceptives.

During pregnancy and when breastfeeding, women should avoid preventive treatment. Preventive medications carry to risk of harming the fetus or infant. While NSAIDs are considered safe during the second trimester of pregnancy, some health authorities also consider them safe during the first trimester. Consult your physician about taking medication while pregnant. According to the Nature Reviews Neurology consensus statement, migraine medications contraindicated during pregnancy are:

• Topiramate
• Candesartan
• Sodium valproate

Women with menstrual migraines may benefit from long-acting NSAIDs or triptans when acute therapies are unsuccessful. Taking these daily for five days, starting two days before an expected period, may prevent the occurrence of menstrual migraines.

According to the Nature Reviews Neurology statement, women who experience migraine with aura should not take combined hormonal contraceptives. Doing so may increase the risk of stroke.

What Causes a Migraine?

According to the American Medical Association (AMA), the exact cause of migraine headaches has yet to be confirmed. However, specific neurological issues are believed to contribute to migraines.

Issues in the nervous system may be a cause of migraines. According to Nature Reviews Neurology, migraines involve the peripheral and central activation of the trigeminovascular system. Changes in brain activity can lead to inflamed blood vessels surrounding the brain. Sudden changes in your body or environment may also cause migraines.

In contrast to migraines, secondary headaches occur because of another condition. The following conditions can sometimes be mistaken for migraines:

• Subarachnoid hemorrhage: Potentially life-threatening, this causes a thunderclap headache.
• Transient ischemic attack (TIA): This results in an unusual aura.
• Meningitis: Potentially life-threatening, meningitis may be present when an unexplained fever accompanies a migraine.
• Intracranial lesion: This lesion may be indicated with a progressive migraine.
• Medication overuse: This results from the overuse of acute medications used for migraine relief.

Common Migraine Triggers

Triggers do not cause migraines. Instead, they activate the processes that cause migraines. When exposed to triggers, people prone to migraines may experience one soon after exposure. Not every trigger affects everyone prone to migraines, nor will everyone prone to migraines experience the same trigger. Possible triggers include:

• Barometric pressure changes
• Changes in altitude
• Tiredness
• Changes in sleep patterns
• Perfumes
• Smoke
• Skipping meals
• Changes in estrogen levels
• Diet
• Dehydration
• Loud noises
• Some medications

What Are the Stages of a Migraine?

A migraine has four stages, which Cleveland Clinic depicts in a helpful graphic:

1. Prodrome
2. Aura
3. Attack
4. Postdrome

Prodrome

Before a migraine occurs, even days before, you may experience changes to your body and personality. These can be warnings of an impending migraine and can include:

• Gastrointestinal disruptions
• Mood disruptions
• Food cravings
• Stiff neck
• Frequent urination
• Fluid retention
• Yawning

Aura

Auras may or may not occur with a migraine. When they do occur, they can happen before or during the migraine. An aura may include:

• Visual disturbances
• Tinnitus
• A sensation of pins and needles in the arms and legs
• Numbness on one side of the face
• Speech disturbances

Attack

The attack is an active migraine. During this stage, you may experience any previously discussed symptoms, which may last for hours up to several days.

Postdrome

Symptoms occurring after the attack comprise the migraine’s postdrome, or final phase. These may include:

• Feeling drained
• Confusion
• Exhaustion
• Euphoria

Who Is More Likely to Develop Migraines?

UC Berkeley states that migraines typically occur in people between 15 and 55. Women are three times more likely to experience migraines than men, and 70 to 80 percent of sufferers are likely to have a family history of migraines.

Additionally, people who experience high stress levels are more at risk of experiencing migraines.

How Are Migraines Diagnosed?

While health care providers can diagnose migraines, it is best to prepare for your appointment first to make the diagnosis process easier. Prepare by keeping a headache journal, documenting your history of migraines in a calendar, and recording any family history of migraines. When documenting your headaches, include intensity, frequency, and duration.

Headaches can be secondary, so this possibility must first be ruled out. To do this, your doctor will need a complete health history and may occasionally request neuroimaging.

Tests

The primary tool for diagnosing migraines is the patient’s headache history. Migraines are a clinical diagnosis, so there are no tests explicitly used to diagnose them.

To exclude causes of secondary non-migraine headaches, neuroimaging such as computed tomography (CT) scans or magnetic resonance imaging (MRI) may be used. For the same reason, a physician may order blood tests. The physician may also order an electroencephalogram (EEG) to rule out seizures.

What Are the Complications of Migraines?

Certain auras may also indicate migraine complications. An aura that persists for over a week but shows no signs of infarction is a persistent aura without infarction. On the other hand, a migrainous infarction is a condition in which a migraine lasts longer than one hour and shows correlating areas of infarction on CT scans or an MRI and would be associated with stroke symptoms. This is in contrast to the temporary, though often prolonged, one-side weakness seen in hemiplegic migraine that does not ultimately result in stroke. An emergent medical evaluation is needed to determine the difference.

While no causal link between seizures and migraines exists, some research suggests a relationship. People who have migraines are more likely also to have epileptic seizures.

The symptoms of migraines can also cause complicate a person’s daily life. This may come in the form of lost hours at work or a person being atypically inactive. The following complications can arise from chronic migraines:

• Depression and anxiety: People with migraines are five times more likely to develop depression than those who don’t.
• Vertigo: Migraines can cause one to feel dizzy, like their surroundings are spinning, or like they can’t balance properly.
• Insomnia: The persistent and intense pain of migraines can disrupt one’s sleep.
• Serotonin syndrome: Triptans, migraine medication, can interact with some antidepressants and cause a buildup of serotonin, which can be life-threatening.
• Stomach problems: The constant use of over-the-counter (OTC) NSAIDS to relieve migraine symptoms can lead to stomach problems, such as ulcers or bleeding.
• Rebound headaches: Also known as medication overuse headaches, these result from overusing medications used to treat migraines.

What Are the Treatments for Migraines?

There is no cure for migraines. Treatments for migraines help ease the symptoms, shorten the duration, or prevent frequent attacks. The most common treatments are medication and lifestyle changes.

Migraine treatment rarely requires the care of a specialist. For chronic migraines, a referral to a specialist may be necessary, as management of such migraines can be quite challenging.

Common Medications

According to the Nature Reviews Neurology paper, several medications are commonly used to treat migraines. Three lines of treatment divide these medications.

First-line: First-line medications for treating migraines are often OTC drugs. These can be taken two to three days before an anticipated migraine, as in menstrual migraines, or at the onset. Drugs used in this line include acetaminophen and NSAIDs like ibuprofen. Taking these at the start of the migraine may head off intensity and duration.

Second-line: Second-line medications are most often prescribed medications called triptans. They are most effective when taken early during an attack.

Triptan drugs include:

• Sumatriptan
• Zolmitriptan
• Naratriptan

Also in this line is the combination of NSAIDs and triptans. If the single use of either of these drugs is not successful, combining them may be.

Third-line: When first- and second-line drugs are unsuccessful or contraindicated, third-line drugs are an option. This line contains ditans and gepants. Lasmiditan is the only ditan currently approved for acute migraine use. Ubrogepant and rimegepant are the only two gepants approved for the same use.

Other medications, such as antiemetics, treat nausea and vomiting that some people may experience with migraines. Many studies suggest that antiemetics such as metoclopramide also successfully relieve acute migraine pain.

How Does Mindset Affect Migraines?

Stress is a known trigger for migraines. Those under extreme stress or unable to manage stress may experience migraines. The experience of the migraine itself may cause emotional distress and suffering.

A person who experiences frequent migraines may become frustrated, sad, angry, or depressed. It is best to seek the help of a health care professional when experiencing these feelings.

What Are the Natural Approaches to Migraines?

While there are claims that some natural remedies may help manage migraines, the evidence is lacking. More research is required, but there are a few promising options.

Riboflavin

Riboflavin, or vitamin B2, has been studied as a measure to decrease the frequency of migraines. Data are sufficient enough that the American Academy of Neurology and the American Headache Society believe riboflavin effectively prevents migraines.

The dose of riboflavin generally given is 400 milligrams daily for adults to prevent migraines. Consult your health care provider before taking this vitamin supplement to ensure you receive the correct medication and dose.

Feverfew

Feverfew is another natural remedy thought to prevent migraines. Though the data supporting this are lacking, preliminary studies are encouraging. Further research is needed to support the preliminary findings.

Feverfew is not recommended for pregnant women or those taking NSAIDs.

Magnesium

The American Headache Society and the American Academy of Neurology suggest magnesium may prevent migraines.

Magnesium in tablet form is available OTC. It can be a good preventative measure for those who experience migraine with aura, may be pregnant, or menstrually related migraine. The dosage is typically 400 to 600 milligrams per day. Consult your health care provider before taking magnesium to prevent migraines.

Butterbur

Butterbur may reduce the frequency of migraines in adults and children, according to the National Center for Complementary and Integrative Health (NCCIH). However, its safety is uncertain.

It is best to be safe and discuss using butterbur with your health care provider to ensure it is safe.

Coenzyme Q10

The NCCIH also says that coenzyme Q10 shows promising preliminary data suggesting it decreases the number of migraine attacks in one month. Although it appears to have minimal risks, further research is needed.

Coenzyme Q10 may interact with medications such as insulin, anticoagulants, and chemotherapeutic drugs. As with all natural remedies, consult your primary physician before using coenzyme Q10.

Ginger

Using ginger does not prevent migraines. However, it may minimize pain and reduce nausea. As such, it may be good to use ginger when these symptoms are present with a migraine.

Coping and Support

While migraine prevention is possible, there remains no cure. People who experience migraines may learn to cope with the condition and seek support from health care professionals, family, and friends.

Common ways to cope with migraines include:

• Resting in a dark, quiet room.
• Altogether avoiding exposure to screens, including cellphones.
• Applying a cold compress.
• Getting a scalp massage.
• Practicing tai chi and yoga.
• Practicing meditation.
• Acupuncture.
• Chiropractic treatment.
• Biofeedback therapy.

How Can I Prevent Migraines?

Preventing migraines is not always possible, but medications and lifestyle changes can reduce their occurrence.

The Nature Reviews Neurology paper states that prevention medication follows a three-step approach when treating migraines.

First-Line

Beta blockers, anticonvulsives, and angiotensin II receptor blockers (ARBs) are classifications of drugs used in the first-line prevention of migraines. These medications include:

• Topiramate
• Candesartan
• Atenolol
• Metoprolol
• Bisoprolol
• Propranolol

Take these medications daily to decrease the number of migraines you experience. Not all people will have the same experience when using these.

Second-Line

Anticonvulsants are also a classification used for second-line prevention of migraines, but the specific drug used is not the same as that in the first-line prevention medications. Along with anticonvulsants are antidepressants and calcium antagonist drug classes. Also taken daily, second-line prevention medications include:

• Sodium valproate
• Amitriptyline
• Flunarizine

Third-Line

Third-line migraine prevention medications are the last resort for decreasing migraine occurrence. This group has two classes of drugs: botulinum toxin and calcitonin gene-related peptide (CGRP) monoclonal antibodies. Medications from these two classes used for migraine prevention are:

• OnabotulinumtoxinA
• Erenumab
• Fremanezumab
• Galcanezumab
• Eptinezumab

These medications are all injections, and the frequency with which they’re taken differs. Some are taken monthly, while others quarterly. People using these often do not see results immediately.

Your health care provider will sometimes pause medication use after six or 12 months to prevent overuse.

Lifestyle Factors

One way to manage living with migraines is to make lifestyle changes. Adjusting your lifestyle does not guarantee the frequency of migraines will decrease. Some adjustments may help, while others may not.

Lifestyle changes include:

• Significantly decreasing screen time
• Practicing relaxation techniques
• Getting massages
• Hydrating
• Keeping consistent sleep patterns
• Exercising
• Eating regularly
• Improving posture
• Managing stress

Medically reviewed by Beverly Timerding, MD.