What Are Migraines?
Symptoms, Causes & Treatments
Migraines are not just “regular” headaches – they’re actually a complex neurological condition. A migraine typically involves intense throbbing or pulsing pain on one side of the head, often accompanied by nausea and extreme sensitivity to light and sound. Migraine attacks can last for hours or even days, and the pain can be severe enough to interfere with daily activities. This condition is very common, affecting about 1 in 5 women and 1 in 16 men, as well as many children. Women are three times more likely to have migraines than men, possibly due to hormonal factors. Migraines tend to run in families, so genetics play a role in who gets them. If you suffer from migraines, you know it’s not “all in your head” – it’s a real neurological disorder that can be debilitating, but there are ways to manage it and get relief.
Symptoms of Migraines
Migraine symptoms often go through stages: prodrome, aura, the attack itself, and postdrome. Not everyone experiences all stages. Common migraine signs and symptoms include:
Severe Headache Pain: Intense throbbing or pounding head pain, usually on one side of the head. The pain may worsen with physical activity or movement.
Nausea and Vomiting: Many people feel sick to their stomach or vomit during a migraine attack.
Sensitivity to Light and Sound: Bright lights, loud sounds, or strong smells can feel overwhelming during a migraine. Sufferers often want to lie down in a dark, quiet room.
Aura (in some cases): About one-third of people with migraines experience an aura before or during the headache. Auras are temporary neurological disturbances that can include seeing flashing lights, zigzag patterns, blind spots, or experiencing tingling/numbness in the face or hands. Some even have trouble speaking clearly during an aura.
Prodrome and Postdrome: A day or two before a migraine, you might notice subtle warnings (prodrome) like mood changes, neck stiffness, food cravings, fatigue, or frequent yawning. After the migraine pain subsides, you may feel drained, exhausted or groggy for up to a day (postdrome).
Each person’s migraines can look a little different. For example, some people get migraines with aura, while others never have auras. The frequency also varies – some might get a migraine once or twice a year, while others have chronic migraines multiple times a month. If you frequently have severe headaches with these symptoms, talk to a healthcare provider for proper diagnosis. Migraines are usually diagnosed based on the pattern of symptoms since there’s no definitive blood test or scan to “prove” a migraine.
Causes and Triggers
The exact cause of migraines isn’t fully understood, but it’s believed to involve a combination of genetic and environmental factors. Migraines run in families, so you may inherit a tendency to get them. Researchers think changes in the brainstem and how it interacts with the trigeminal nerve (a major pain pathway) could be involved. Brain chemical imbalances also play a role – for example, serotonin levels drop during migraines, which may trigger the trigeminal nerve to release neuropeptides that cause pain. A chemical messenger called CGRP (calcitonin gene-related peptide) is one key culprit that can cause inflammation and pain in migraines. In fact, new treatments targeting CGRP have been developed (more on that shortly).
Even though the underlying brain mechanisms are complex, most people with migraines can identify certain triggers that bring on an attack. Common migraine triggers include:
Hormonal changes: Fluctuations in estrogen can trigger migraines in women. Many women report migraines around their menstrual period, during pregnancy, or perimenopause.
Stress: High stress levels at work or home are a well-known trigger for migraines. Often a migraine hits after a stressful event as your body relaxes.
Sleep changes: Too little sleep, jet lag, or even too much sleep can provoke a migraine in someone prone to them.
Sensory stimuli: Bright or flickering lights, loud noises, or strong odors (like perfume, smoke, or certain chemicals) can set off a migraine.
Dietary triggers: Skipping meals or becoming dehydrated may prompt a migraine. Certain foods and drinks can be triggers as well – common ones include aged cheeses, processed meats, red wine, caffeine (or caffeine withdrawal), chocolate, and food additives like MSG or aspartame.
Alcohol: Especially red wine and alcoholic beverages are frequent migraine triggers for some people.
Weather changes: Shifts in barometric pressure or drastic changes in weather have been linked to migraines in some individuals. For example, some people get headaches before storms or with sudden humidity changes.
Physical exertion: Very intense exercise or even activities like coughing or sexual activity can rarely trigger a migraine in predisposed individuals.
It’s important to remember that triggers are not the fundamental cause of why someone has migraines – they simply set off an attack in a person who already has that underlying migraine condition. Avoiding known triggers (when possible) and maintaining a healthy lifestyle with regular sleep, exercise, and meals can help reduce the frequency of migraines for many people.
Migraine Treatment and Management
There is good news: Migraines can be managed, and there are more treatment options available now than ever before. Treatment for migraines aims to stop the symptoms during an attack and prevent future attacks. Most people benefit from a combination of medication and lifestyle measures. Here’s an overview of current migraine treatments:
Acute Pain-Relief Medications
These are taken at the first sign of a migraine to reduce the pain and other symptoms:
Over-the-counter pain relievers: For mild migraines, drugs like ibuprofen (Advil, Motrin), aspirin, or acetaminophen (Tylenol) can help some people. There are also combo medications specifically for migraines (e.g. Excedrin Migraine) which combine acetaminophen, aspirin, and caffeine. Caution: Using pain relievers too frequently can lead to rebound headaches, so discuss safe use with your doctor.
Triptans: These are prescription migraine-specific meds that block pain pathways in the brain. Triptans (like sumatriptan, rizatriptan, zolmitriptan, etc.) often come as pills, nasal sprays, or injections and can effectively relieve migraine pain for many people. However, they’re not recommended for those with certain cardiovascular risks.
Anti-nausea medications: If your migraine comes with significant nausea or vomiting, doctors may add an anti-nausea medicine (such as metoclopramide or prochlorperazine) to help you keep medication down and feel better.
Dihydroergotamine: This medication (Migranal) is an older migraine treatment, available as a nasal spray or injection. It can be effective if taken early in a migraine that tends to last a long time, but it’s generally avoided in people with heart disease or high blood pressure.
Newer acute treatments: In recent years, lasmiditan (Reyvow) and a class of drugs called “gepants” have been approved for migraine relief. Lasmiditan is an oral tablet for treating migraine attacks and can help with pain, but it may cause drowsiness (so patients are advised not to drive for 8 hours after taking it). Gepants are oral calcitonin gene-related peptide antagonists; examples include ubrogepant (Ubrelvy) and rimegepant (Nurtec) which can effectively relieve migraine pain and other symptoms within a couple of hours. There’s even a nasal spray gepant (zavegepant, brand Zavzpret) that works quickly through the nose. These newer options are useful especially for those who can’t take triptans, and they do not cause the blood vessel constriction that triptans do.
Opioids or barbiturates: In cases where typical migraine meds can’t be used, doctors might resort to opioid painkillers or barbiturate combinations. However, these are last-resort options due to their risks. They can be addictive and often are less effective than migraine-specific treatments, so they are generally avoided unless absolutely necessary.
Preventive (Preventative) Medications
If you have frequent, long-lasting or very severe migraines, you might benefit from daily or regular preventive treatment to reduce how often migraines occur and how bad they get. Preventive options include:
Blood pressure medications: Certain blood pressure meds, especially beta blockers like propranolol and metoprolol, can significantly cut down migraine frequency. Some calcium channel blockers (like verapamil) are also used, particularly for migraines with aura.
Antidepressants: Tricyclic antidepressants such as amitriptyline can prevent migraines in some people (even if they aren’t depressed). Another antidepressant, venlafaxine (an SNRI), is sometimes used as well.
Anti-seizure drugs: Medications for epilepsy, like topiramate (Topamax) or valproate (Depakote), can stabilize nerve activity and help prevent migraines. These can have side effects and are contraindicated in pregnancy, but they have helped many migraine patients have fewer attacks.
CGRP monoclonal antibodies: This is one of the exciting new developments in migraine prevention. These are monthly or quarterly injections specifically designed to block the migraine-triggering molecule CGRP. Four medications are available (brand names Aimovig, Ajovy, Emgality, and Vyepti) and studies show they can substantially reduce migraine days for chronic sufferers. They’re generally well tolerated; the main side effect can be injection site reactions.
Oral gepant for prevention: In addition to acute treatment, one of the gepant drugs (atogepant, brand Qulipta) is approved as a daily pill to prevent migraines. Interestingly, rimegepant (Nurtec) is a unique medication that can be used both to treat an attack and to prevent migraines if taken regularly.
Botox injections: OnabotulinumtoxinA (Botox) is approved for preventing chronic migraines (people who have migraines many days per month). Botox is injected in small doses around the head/neck every 12 weeks and can reduce headache frequency for some patients.
Neuromodulation devices: Non-drug options have expanded too – there are devices that stimulate certain nerves or regions to prevent or abort migraines. For example, external vagus nerve stimulators or transcranial magnetic stimulation devices can modulate pain pathways in the brain. These are typically reserved for people who can’t tolerate medications or want to avoid medications, and they require guidance from a specialist.
Lifestyle and Self-Care
Lifestyle adjustments are an important part of migraine management. Keeping a migraine diary to track triggers, symptoms, and treatments can help you and your doctor identify patterns. Many doctors recommend the “SEEDS” approach for lifestyle: Sleep, Exercise, Eat, Diary, Stress management. This means maintaining a consistent sleep schedule, getting regular exercise (which can reduce stress and frequency of migraines), eating regular healthy meals and staying hydrated, tracking your migraines in a diary, and using stress-reduction techniques (like relaxation, meditation, or biofeedback) to manage stress triggers.
During a migraine attack, it helps to rest in a quiet, dark room and apply gentle ice or heat to your head or neck. Some people find relief from relaxation exercises or caffeine at the start of an attack (caffeine can help pain relievers work better, but be cautious not to overuse it).
Outlook
Migraines can be painful and disruptive, but with the right approach, most people can find significant relief. It often requires a bit of trial and error to figure out which medications and strategies work best for you. Don’t lose hope – medicines combined with self-help remedies and lifestyle changes can make migraines much less painful and frequent. It’s also important to address any stigma: migraine is a legitimate neurological condition, not “just a headache”, so don’t feel guilty about seeking the care and support you need. Work with a healthcare professional (often a neurologist or headache specialist) to create a personalized treatment plan. With newer therapies like CGRP blockers and proven strategies like trigger avoidance and healthy habits, many people with migraines are able to reduce their attacks and improve their quality of life.
Remember, if you experience new or extremely severe headache symptoms (like “the worst headache of your life”), or symptoms like high fever, stiff neck, weakness, or confusion, seek medical attention immediately – not all severe headaches are migraines. Otherwise, for known migraine sufferers, staying proactive and committed to your treatment plan can help you head off the pain and keep migraines under better control.