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What is migraine?
It’s common to hear migraine attacks referred to as “migraines” or “migraine headaches.” In this articlewe use "migraine" to describe an ongoing health condition with a complex set of symptoms. We use "migraine attacks" to describe short-term attacks as part of this ongoing health conditionwhich often includes other symptoms.
Migraine is a health condition that is more than just a bad headache. The symptoms of migraine are different from person to personbut often include headaches that keep coming back. They can also include nauseavomitingchanges in moodextreme tirednessand sensitivity to lightnoiseand smells. These symptoms can happen all at once during a migraine attackor they can happen separately in between migraine attacks. Migraine attacks may last from hours to days and make it hard to do everyday activities.
One of the most common symptoms of a migraine attack is moderate to severe throbbing pain that usually happens on one side of the head. Current research shows that this head pain happens when there is abnormal activity among nerve signalschemical signalsand blood vessels in the brain.
Some people have migraine attacks at predictable times—such as before their period (menstrual cycle) or on weekends following a stressful week. In between attackspeople living with migraine may also experience symptoms like having a hard time concentratingdepression and anxietytirednessdifficulty sleepingand/or body chills.
There are different types of migraine. Migraine with aura happens in some people living with migraine. Aura symptoms are usually changes in vision—like seeing dotszigzagsor sparks—but can also include changes in a person’s ability to speak. They might also include feelings of pins and needles in different body parts.
There is currently no cure for migrainebut treatments can help manage symptoms.
Several factors can trigger a migraine attack or increase a person’s risk of having one. These factors vary from person to personand include:
Phases of migraine attack
Migraine attacks happen in phases.
Prodrome
The prodrome phase is the beginning of a migraine attack. This phase can happen a few hours to a few days before a headache starts. Symptoms can include food cravingsunexplained mood changes such as feeling unexpectedly sad or very happyuncontrollable yawningfluid retentionor increased urination.
Aura
Only some people living with migraine experience aura. Auras appear about 10 minutes to an hour before the actual headacheand usually last no more than an hour. Classic aura symptoms include vision changestrouble speakingtingling in the hands or faceand confusion. Some people will perceive flashing or bright lightsexperience muscle weaknessor the sensation of being touched or grabbed.
Headache
A headache during a migraine attack usually starts gradually and gets more intense. Headache pain may happen without warningand is usually felt on one side of the head. Other common symptoms include nauseavomitingsensitivity to lightsmelland soundconfusionblurred visionmood changesand fatigue. This phase can last from hours to days. It's also possible to have a migraine without a headache. In these casesa person may have visual problems or other symptoms like nauseavomitingor constipation.
Postdrome
People are usually exhausted or confused after a migraine. They might have a hard time concentratingfeel dizzyor experience mood changes. The postdrome period may last up to two days before people feel healthy again.
Types of Migraine
The most common type of migraine is migraine without aura. There are other types of migraine that affect some people. Those include:
Migraine with aura
Migraine with aura can be broken up into different subtypes:
- Migraine with typical aura is when a person has vision changesother sensory changes (like tingles)and/or difficulty speaking. These symptoms go away after the migraine attack. A typical aura does not have brainstem aura (see below)movementor vision symptoms.
- Migraine with brainstem aura includes at least two of these symptoms during an attack: vertigodouble visionpoor muscle coordination (such as shakiness)slurred speechringing in the earshearing lossand fainting.
- Hemiplegic migraine is a rare and severe form of migraine. It causes temporary paralysis—sometimes lasting several days—on one side of the body. The paralysis happens before or during a headache. Symptoms may include vertigo (a feeling of dizziness or losing balance)a pricking or stabbing sensationand problems seeingspeakingor swallowing. These symptoms may start before the headache painand usually stop shortly after. The disorder is called familial hemiplegic migraine (FHM) when it runs in families. Though rareresearchers have identified at least three distinct genetic forms of FHM. These genetic mutations make the brain more sensitive or increase neuronal activitymost likely by increasing levels of a brain chemical called glutamate. Glutamate transports messages between nerve cells and other cells. Too much glutamate has been linked to increased sensitivity to pain.
- Retinal migraine usually affects one eye and includes attacks of temporary vision loss or changes in eyesight. These attackslike the more common visual aurasare usually linked with headaches.
Other types of migraine
- Chronic migraine happens when headaches – either the kind experienced in a migraine attack or a tension-type headache – happen on at least 15 days of the month for over three months. They can either happen with or without auras.
- There can be complications of migraine. One rare but serious complication is status migrainosus. In this casea migraine attack causes debilitating pain and nausea for longer than 72 hours. The pain and nausea may be so intense that people need to be hospitalized.
- In some casespeople might experience syndromes associated with migraine. This can include attacks of abdominal symptomsvertigoor (in children) twisted neck.
- Menstrual migraine affects people who menstruate around the first day of their menstrual cycle for at least two out of three cycles. People living with menstrual migraine can have migraine attacks at other times of the month (menstrually related migraine) or only during the beginning of the cycle. Symptoms may include migraine with or without aurapulsing pain on one side of the headnauseavomitingand increased sensitivity to sound and light.
- In addition to migraine as a main health conditionmigraine attacks can also be a part of other health conditions. This is called probable migraine.
Who is more likely to have migraine?
Several factors contribute to whether or not a person will have migraine.
Migraine is a genetic disordermeaning most people with migraine have a family history of the disorder.
Migraine happens in both children and adults. Clues to watch for in children who are not able to describe their symptoms include sensitivity to light and noise. For examplethey may refuse to watch television or use the computer—or they may stop playing to lie down in a dark room.
In generalmigraine affects adult females/women more often than males/men. Hormone changes that happen with the menstrual cycle or pregnancy seem to be one important cause of this disparity. Headaches may begin when a woman's first period beginsor during pregnancy. Most women see improvement in migraine attacks after menopausealthough surgical removal of the ovaries (oophorectomy) usually worsens migraine attacks. Using birth control (contraception) can also affect their frequency and severity.
Other migraine disparities exist. Native Americans are more likely to have migraine than other racial/ethnic groups. People who are unemployed and are experiencing poverty are also more likely to have migraine.
Living with a chronic medical condition can weigh on a person’s wellbeing and quality of life. People living with migraine more commonly experience mental health concerns (like depression and anxiety) and sleep disorders than the general population. Other medical conditions that are more common in people living with migraine include bipolar disorder and epilepsy.
How is migraine diagnosed and treated?
Diagnosing migraine
To diagnose the possible cause of migrainea doctor will review medical history and do physical and neurological exams. They may also do a screening test or ask questions to understand a person’s symptoms.
Neuroimaginglike an MRI or CT scanis not usually used to diagnose migraine. A doctor might order one if they suspect the person might have another condition that causes headaches and other symptoms of migraine.
Keeping a headache journal can also help a doctor better diagnose migraine and find the best treatment. They might ask a person to include things like when the migraine attack happenedhow intense it wasany activity before it startedand the symptoms a person experienced.
Treating migraine
The goal of migraine treatment is to relieve symptoms and prevent additional attacks. Quick steps to ease symptoms may include:
- Napping or resting in a quietdarkened room
- Placing a cool cloth or ice pack on the forehead
- Drinking lots of fluidespecially if a migraine attack includes vomiting
Small amounts of caffeine may help relieve symptoms during a migraine's early stages.
Medicines for migraine include short-term medicines to treat attacks and longer-term medicines to prevent them. Acute or "abortive" medicines are taken as soon as symptoms happen to relieve pain and restore function. Preventive treatment involves taking medicines every day to make future attacks less severe or keep them from happening. It’s important for people to work with their doctor when using headache medicinesas some of them may cause side effects.
Several medicines used to treat migraine target a chemical called serotonin in the brain. Serotonin has been shown to be lower in people with migraine. Medicines may also target a protein called calcitonin gene-related peptide (CGRP)which plays a role in how people feel pain.
Short-term treatment for migraine may include any of the following medicines:
- Triptan drugs (such as Sumatriptan and Zolmitriptan) are the standard treatment for migraine. They increase levels of serotonin in the brain.
- Ergot derivative drugs (such as ergotamine and dihydroergotamine) attach to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They work best during the early stages of migraine.
- Calcitonin gene-related peptide antibodies (CGRP) drugs (such as Atogepant) can be used for short or long-term migraine treatmentdepending on the type of drug. They prevent activation of specific nerves in the brain related to pain.
- Over-the-counter medicines (pain relievers such as ibuprofenaspirinor acetaminophen) can ease the pain of less severe migraines.
- Nausea relief drugs (such as chlorpromazine and metoclopramide) can ease queasiness brought on by various types of headacheincluding migraine.
Botulinum toxin type A (commonly known as Botox®) is a long-term treatment for migraineand may also help reduce migraine attacks if they happen more than 15 days a month.
Some people who get severe or frequent migraine attacks need preventive medicines. In generalif a person gets migraine attacks once a week or moretheir doctor should consider treatment to actively prevent attacks. If migraine attacks happen less often but are severe or disablingpreventive treatment may be appropriate. Preventive medicines also are recommended for people who take medicine for headaches more than three times a week.
Not every preventive migraine treatment works for every person. A person may need to try multiple medicines over the course of several months to find one that works and doesn’t cause problematic side effects.
Preventive approaches for migraine may include the following treatments:
- Anticonvulsants raise levels of certain brain chemicals and reduce pain signalsand were originally developed for treating epilepsy.
- Beta-blockers are used to treat high blood pressure and can help prevent migraine attacks.
- Calcium channel blockers help to stabilize blood vessel walls and are also used to treat high blood pressure. When blood vessels in the brain narrow or widenit can trigger or worsen migraine symptoms. These drugs prevent blood vessels from narrowing or widening.
- Antidepressants work to balance different chemicals in the brain related to migraineincluding serotoninnorepinephrineand dopamine.
Non-drug approaches for treating migraines
Many people take other steps to prevent and reduce their migraine attacks beyond medications. These can include special diets or supplementsmeditation or relaxation techniquescognitive-behavioral therapies for painmassageor acupuncture.
Changes to everyday habits can reduce or prevent migraine attacks in some people. These include exercisingavoiding food and beverages that trigger headacheseating regular mealsdrinking enough waterstopping certain medicinesand going to bed and waking up at the same time everyday.
Some people living with migraine have found supplements such as riboflavin (vitamin B2)magnesiumcoenzyme Q10and butterbur (a medicinal plant) to be helpful. Others have used biofeedback to manage their symptoms.
Biofeedback uses electrical and other monitors to assess a person’s heart ratebreathingand muscle movements as a way to understand how the body is working. Relaxation training is another way to help people cope with or control pain in the body and its response to stress.
The National Center for Complementary and Integrative Health (NCCIH) offers more information about non-drug approaches to treating migraine.
What are the latest updates on migraine?
NINDSa component of the National Institutes of Health (NIH)is the leading federal funder of research on the brain and nervous system—including research on migraine. NINDS supports new and innovative research to better understanddiagnoseand treat many pain conditionsincluding migraine. NINDS-supported research projects cover a wide range of topics on migrainesuch as understanding brain circuits involved in migrainepredicting attacksimproving current treatmentsand testing new potential medicines that can treat migraine.
Understanding migraine
NINDS-funded researchers are investigating the brain circuits of migraines to understand how they happen and how they work. This includes understanding the role of specific brain chemicals (neurotransmitters)hormonesand the influence of the immune system in migraine. They are exploring what happens in the bodies and brains of people that have migraine attacks. This will improve how we prevent and treat them—especially for womenwho are more likely to experience migraine.
Additionallyresearchers supported by NINDS are discovering how to more accurately predict migraine attacks. They are also investigating how health conditions like obesitydepressionand sleep disturbance may influence migraine and its severity. A new NIH-supported study shows how aura triggers a migraine attack.
NINDS funds several projects to model what headache pain and migraine looks like in animalswhich helps researchers better understand how headaches work and how to treat them. Scientists are using advanced imaging tools to detect disease processes and brain changes that happen in people with headaches.
The goal of these studies is to improve treatmentquality of lifeand wellbeing for people living with migraine.
Innovative therapies for migraine
Scientists funded by NINDS are identifying and testing new medicines and other treatment options. This includes potential medicines that block the action of the kappa opioid receptor in the brainwhich is linked to stress—a trigger of migraine attacks. Other NINDS-funded researchers are studying chemical communication between different types of cells in the body. These include cells that fight infections and cells that sense painwhich could lead to new ways to treat and prevent headaches.
Other NIH-funded research investigates how to relieve migraine headache without medicines. These studies look at things like using different colored room lightingand adding dietary changes like omega-3 polyunsaturated fatty acids to see if they work for treating migraine. More recent research supported by NINDS explores mind-body treatments in youthbehavior-based treatmentsand non-invasive brain stimulation. Researchers on these studies are trying to understand the ways migraine treatments affect how well a medicine works for a personand how effective these different treatments are. They are also studying biomarkers (biological signs of disease or disease progression) to predict and explain outcomes.
The NINDS-supported Childhood and Adolescent Migraine Prevention Study (CHAMP) compared two medicines doctors prescribe for migraine (amitriptyline and topiramate) to understand if they prevent repeated migraine attacks in children and adolescents. The research showed that migraine treatments that work for adults may not necessarily work in young people.
In 2019NINDS developed Migraine Traineran Android app to help people ages 13 and over understand possible causes of their migraine attacks. It also helps them take a bigger role in their treatment by creating a personalized migraine management plan with their parents and medical team.
NINDS also created and revised common data elements (CDE) guidelines for headache to make research studies on headache and migraine more effectiveefficientand standardized. NINDS encourages NINDS-sponsored researchers to use these data collection tools.
Coordinating pain research
Several NINDS activities on pain research—including migraine—are focused on coordinating efforts across NIH and with other federal agencies:
- The NIH Pain Consortium is a collaboration between 25 NIH institutes and centers that helps identifycoordinateand promote funding opportunities. It also supports pain research initiatives and activities at NIH.
- The Interagency Pain Research Coordinating Committee (IPRCC) is a Federal advisory committee created by the Department of Health and Human Services (HHS) to better understand and treat pain.
- The Helping to End Addiction Long-term® or NIH HEAL Initiative® is a major NIH-wide effort to quickly find scientific solutions for the national overdose and chronic pain public health crises. Launched in April 2018the initiative focuses on improving preventiontreatmentand pain management strategies as well as those for opioid misuseoverdoseand addiction. As part of NIH HEALNINDS aims to understand how pain happens in order to create effectivenon-addictive treatments for pain. The initiative also supports migraine research.
For research articles and summaries on migrainesearch PubMedwhich contains citations from medical journals and other sites.
How can I or my loved one help improve care for people with migraine?
Clinical trials increase our understanding of migraine with the goal of improving how doctors treat it. Consider participating in a clinical trial so clinicians and scientists can learn more about migraine and related conditions. Clinical research with human participants helps researchers learn more about a health condition and perhaps find better ways to safely detecttreator prevent disease.
All types of participants are needed—those who are healthy or may have a health condition—of all different agessexesracesand ethnicities. This helps to ensure that study results apply to as many people as possibleand that treatments will be safe and effective for everyone who will use them.
For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with migraine at Clinicaltrials.gov.
Where can I find more information about migraine?
Information may be available from the following resources: