Migraines: Causes, symptoms and treatments

More than 10% of people worldwide suffer from a medical condition called migraine, a type of headache that can cause intense, throbbing pain, sensitivity to light and sound, nausea and vomiting and other symptoms. Often people feel the migraine on one side of their head or eye pain behind one eye. While they can be extremely painful and affect your quality of life, migraines are not a serious threat to health in many cases. Learn more about migraines, including signs of a migraine and migraine remedies, here.

A migraine is a neurological headache condition that can cause debilitating symptoms such as nausea and/or vomiting or sensitivity to light and/or sound. The headache must have occurred on at least five occasions and lasted for 4–72 hours (when not treated) each time. In addition to the headache, you must also have two of the following symptoms: moderate or severe pain, pain on only one side of the head, a pulsing or throbbing sensation or pain that's made worse by movement or physical activity. If your headaches meet those criteria, you may be suffering from migraines.

The exact cause of migraines is still not known but several factors may contribute to migraines, including genetics. You are more likely to get migraines if a close biological family member gets them. 

It's believed that migraines stem from irregular changes of certain substances in the brain. When the levels of these substances increase, it can cause inflammation in blood vessels in the brain. These swollen vessels may press on surrounding nerves, which can lead to pain.

Yes, genes seem to play a role in migraines. People with migraines may have atypical genes that control the function of certain brain cells. In fact, 80% of people who have migraines also have family members who get migraine headaches.

In addition, certain factors increase your risk of migraines. Women are more likely than men to suffer from migraines. About 75% of people who suffer from migraines are women. People with certain medical issues, including depression, anxiety, bipolar disorder, epilepsy or sleep problems, seem to be more likely to get migraines.

Certain situations or factors can trigger a migraine headache in people with the condition. Note that specific triggers are different for each person and can change over time. Keeping a migraine diary can help you identify triggers and track the duration and frequency of migraine attacks. Migraine triggers can include:

• Stress and anxiety: A stress migraine may be brought on by work or life stress, for instance
• Hormonal changes in women. Menstruation migraines may occur before or during your period. If you have hormonal migraines triggered by menstruation, symptoms may improve after menopause. Migraines and pregnancy also appear to be linked. You may experience your first migraine during pregnancy, or if you had migraines before becoming pregnant, they may worsen or get better during pregnancy.
• Loud noises
• Strong smells, such as perfume, cigarette smoke or gasoline
• Bright or flashing lights
• Allergies
• Medication overuse, such as taking migraine pills too often
• Too little or too much sleep
• Sudden weather or environmental changes
• Missing meals
• Exercising too much
• Tobacco
• Caffeine or caffeine withdrawal
• Alcohol
• Additives and foods that cause migraines, such as chocolate, aged cheese, nitrates (found in cured or processed meats), fermented and pickled foods, certain fruits and nuts, yeast, artificial sweeteners and monosodium glutamate (MSG)
• Dehydration

How do you tell the difference between a migraine vs. other kinds of headaches? Migraines are often accompanied by other symptoms and usually have pain occurring on one side of the head. To understand migraine symptoms, it helps to know the stages of migraine. Keep in mind that not all people with migraines experience all four stages.

1. Prodrome (or Premonition)

One or two days before a migraine starts, you may start to notice prodromal migraine symptoms that may signal a migraine is coming. These can include neck stiffness, food cravings, constipation, frequent yawning, increased thirst and urination, and mood swings.

2. Aura

An aura is a nervous system symptom that tends to present as a visual problem, but it can also cause sensory (touch), motor (movement) or verbal (speech) issues. An aura can occur before or during a migraine, but most people with migraines don't experience them at all. If you have a migraine with aura, you may see flashes of light or have wavy vision or short-term vision loss. You may experience other neurological symptoms at the same time as the aura, although they are less common. They may include a temporary change in speech, muscle weakness, a pins-and-needles feeling in your arm or leg, uncontrollable movements or hearing noises or music. Aura symptoms usually develop gradually over a few minutes and may last 20–60 minutes.

3. Attack or headache stage

The migraine attack or headache stage often lasts between 4–72 hours when not treated. Symptoms of a migraine attack include:

• Pain on one or both sides of your head
• A throbbing or pulsing sensation
• Eye pain
• Nausea and vomiting
• Sensitivity to light, sound, smell or touch
• Blurred vision

4. Post-drome

After the migraine attack is over, you may feel drained or ecstatic. For about 24 hours, it's common to also have fatigue, dizziness, confusion, and weakness.

Migraines can last from hours to days. They tend to start in the morning and often come on at predictable times, such as after stressful periods at work or before menstruation.

There are several different kinds of migraines:

While there's no cure for migraines at this time, migraine treatments can help. Migraine treatment focuses on prevention and the acute management of symptoms once the attack starts.

Acute migraine treatment

Over-the-counter (OTC) migraine medication, such as acetaminophen (Tylenol), a combination of acetaminophen, aspirin and caffeine (Excedrin), naproxen (Aleve) and ibuprofen (Advil, Motrin), may help ease mild to moderate migraines. These OTC pain relievers work best when taken as early as possible after the onset of migraine symptoms. However, you should not use them too often or for long periods of time because these medications can lead to ulcers, gastrointestinal bleeding and medication-overuse headaches. Your pharmacist or healthcare provider can help you decide what to take for a migraine and tell you how to use the medication correctly and safely.

If an OTC pain reliever does not help or you have more severe migraines, your healthcare provider may prescribe medications to specifically treat migraine headaches or the pain or nausea and/or vomiting caused by the migraine. For example, if you have nausea, your provider may prescribe anti-nausea medication, such as metoclopramide (Reglan) or prochlorperazine (Compazine) to help ease that symptom. For many people, a combination of different medicines are needed to get migraine relief. Know that migraine medications come in many forms, including pills, nasal sprays and injections.

Migraine prevention

Your provider may recommend that you take prescription migraine medication daily to reduce the number and severity of the migraines. Several types of medications are used to prevent migraines. Examples include beta blockers and other cardiovascular medications such as verapamil for migraines; antidepressants such as amitriptyline for migraines; anti-seizure medications such as topiramate; and calcitonin gene-related peptide monoclonal antibodies or CGRP antagonists, a medicine that blocks a protein known for causing migraines. Your provider may recommend botulinum (Botox) injections for migraines if you have chronic migraines. Botox for migraines appears to be ineffective for episodic migraines.

Complementary and alternative migraine prevention and treatment

Some people may be curious about home remedies for migraines. Limited studies show that butterbur, magnesium, feverfew, coenzyme Q10, riboflavin and other supplements may be beneficial in migraine prevention. However, it's important to note that many of these studies were small and results were inconsistent. It isn't known for sure if these supplements can help with migraines and what dose of the supplement you would need to take to see a potential benefit.

There is some evidence that supports acupuncture for migraine prevention. In acupuncture, a provider inserts thin needles through the skin to stimulate certain pressure points in the body. There are claims that inner ear piercing, specifically tragus piercing and daith migraine piercing, work to help with migraines in a similar way as acupuncture, by applying pressure to certain points in the body. However, there is no scientific evidence showing these piercings aid in migraine prevention or treatment. Talk to your healthcare provider before trying any OTC medications, supplements, essential oils like peppermint oil or alternative treatments for migraines.

Lifestyle changes

Making changes to your daily routine may also help to keep migraines at bay. Try to:

• Get enough sleep
• Exercise regularly
• Eat regular meals, and do not skip meals
• Drink plenty of water
• Take actions to reduce stress
• Avoid migraine triggers

If you believe you're suffering from migraines, see your healthcare provider. Diagnosing migraines involves ruling out other medical conditions that may be causing your symptoms. If your provider diagnoses you with migraines, work together to find the treatment that works best for you.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI December 2023.