Migraine Headaches

Topic Overview

Is this topic for you?

This topic is about migraine headaches. If you are looking for information about tension headaches, see Tension Headaches.

If you are looking for information about headaches in children, see Headaches in Children.

What are migraine headaches?

Migraines are painful, throbbing headaches that last from 4 to 72 hours. When you have a migraine, it may be so painful that you are not able to do your usual activities. But even though migraines make you feel bad, they don't cause long-term damage.

Migraines are a health problem that can be treated. Talk to your doctor about your migraines.

What causes migraines?

Experts are not sure what causes migraines.

Migraines run in families, but it isn't clear why some people get migraines and others don't.

Some things can cause a migraine to start. These are called triggers. Your triggers may be different from someone else's. Some common triggers include:

• Stress.
• Not eating.
• Poor sleep habits.
• A change from your normal routine.
• Red wine.
• Monosodium glutamate (MSG).
• Strong odors.
• Chocolate.

What are the symptoms?

The main symptom of a migraine is a throbbing headache on one side of your head. You also may feel sick to your stomach and vomit. Activity, light, noise, or odors may make the migraine worse. The pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Different people have different symptoms.

Some people have an aura before the migraine begins. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before the headache. But most people don't have auras.

How are migraines diagnosed?

A doctor can usually tell if you have a migraine by asking about your symptoms and examining you. You probably will not need lab tests, but your doctor may order some if he or she thinks your symptoms are caused by another disease.

How are they treated?

You can't cure migraines. But medicines and other treatments may help you feel better and limit how often you get migraines.

At first, your doctor may want you to try an over-the-counter pain medicine, such as acetaminophen, aspirin, ibuprofen, or naproxen. Brand names include Advil, Aleve, Bayer, and Tylenol. Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine. Be safe with medicines. Read and follow all instructions on the label.

If these medicines don't work, your doctor can prescribe stronger medicine to stop the migraine. Your doctor also may prescribe medicine to prevent migraines.

You may not be able to use some medicines if you are pregnant or have other health problems, such as heart problems.

If the first medicine doesn't work, ask your doctor if you can try something else. It may take time to find what works best for you.

Some people also use other kinds of treatments, such as acupuncture. These may help reduce the pain or the number of migraines you have.

When you feel a migraine coming on:

• Stop what you are doing, and take your medicine. Don't wait for the migraine to get worse. Take your medicine exactly as your doctor told you to.
• Rest in a quiet, dark room. Close your eyes, and try to relax or go to sleep. Don't watch TV or read. Put a cold pack or cool cloth on the painful area.

Be careful when you use your migraine medicines. Taking them too often can cause you to get another headache when you stop taking the medicine. This is called a rebound headache. If you are taking headache medicine more than 2 days a week, or if you get more than 3 headaches a month, talk to your doctor.

Frequently Asked Questions

Cause

Experts aren't sure what causes migraines.

They run in families, and experts have found a genetic link. But it isn't clear why some people get migraines and others don't.

Certain things can bring on a migraine. These are called triggers. Your triggers may be different from someone else's. Having several triggers increases the chance you will get migraines.

Some common triggers include:

• Stress.
• Not eating.
• Poor sleep habits.
• A change from your normal routine.
• Red wine.
• Monosodium glutamate (MSG).
• Strong odors.
• Chocolate.

Symptoms

The most common symptom of a migraine headache is a throbbing pain on one side of your head. You also may have other symptoms before, during, and after a migraine. Different people have different symptoms.

Symptoms before the migraine begins

A day or two before a migraine starts, you may feel:

• Depressed or cranky.
• Very happy, very awake, or full of energy.
• Restless or nervous.
• Very sleepy.
• Thirsty or hungry, or you may crave certain foods. Or you may not feel like eating.

Symptoms of an aura

About 1 out of 5 people has a warning sign of a migraine called an aura. It usually starts about 30 minutes before the headache starts. During an aura, you may:

• See spots, wavy lines, or flashing lights.
• Have numbness or a "pins-and-needles" feeling in your hands, arms, or face.

Symptoms when the headache starts

Symptoms can include:

• Throbbing pain on one side of the head. But you can have pain on both sides.
• Pain behind one of your eyes.
• Moderate to very bad pain. The pain may be so bad that you can't do any of your usual activities.
• Pain that gets worse with routine physical activity.
• Nausea, vomiting, or both.
• Pain that gets worse when you're around light, noise, and sometimes smells.

Less common symptoms include:

• Problems speaking.
• Tingling in your face, arms, and shoulders.
• Short-term weakness on one side of your body.

If you have these less-common symptoms and have not had them before, call your doctor right away so that he or she can make sure you aren't having a transient ischemic attack (TIA), stroke, or other serious problem.

Without treatment, a migraine headache can last from 4 to 72 hours.

Symptoms after the headache

After the headache stops, you may have muscle aches or feel very tired. These symptoms may last up to a day after your migraine ends.

Types of migraines and their symptoms

You may have one or more types of migraine headache. Each type has its own features. For example, some people get migraines with an aura. Some get them without an aura. Some women get menstrual migraines, which happen before, during, or shortly after their menstrual period.

It can be hard to tell the difference between a migraine and another type of headache, such as a tension or sinus headache. You may think that you have sinus headaches. But it's more likely that they are migraine headaches if they happen often and interfere with your daily life.

Migraines can occur along with many other health problems, such as asthma or depression. More serious conditions, such as tumors or infections, can also cause migraine symptoms. But most headaches are not caused by serious health problems.

What Increases Your Risk

You may be more likely to get migraines if you:

• Have a family history of migraines.
• Are female. Women are 3 times more likely than men to get migraines.
• Are a teenager or young adult. Migraines often begin during these years.
• Have depression, anxiety, asthma, or epilepsy.

When to Call a Doctor

Call 911 or other emergency services if:

• You have a sudden, severe headache that is different from past headaches.
• You have symptoms of a stroke, such as:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.

Call your doctor now or go to the emergency room if:

• You have a fever and a stiff neck.
• You have new nausea and vomiting, or you cannot keep food or liquids down.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your headache does not get better within 24 hours.
• Your headache wakes you up at night.
• Your headaches get worse or happen more often.
• You develop new symptoms.
• You have any problems with your medicine, or your medicine isn't helping your headaches.
• You have new, different, or more frequent headaches.
• Your headaches occur after physical exercise, sexual activity, coughing, or sneezing.
• Your life is disrupted by your headaches (for example, you often miss work or school).

Watchful waiting

Watchful waiting is a period of time during which you and your doctor watch your symptoms or condition without using medical treatment. Watchful waiting may be fine if you have recently been diagnosed with migraines and over-the-counter medicines are controlling your pain.

Who to see

Health professionals who may diagnose and treat your migraines include the following:

• Family medicine physician
• Internist
• General practitioner
• Nurse practitioner
• Physician assistant
• Neurologist

If you think your headaches might be linked to depression or anxiety, talk to your doctor.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor will diagnose a migraine by examining you and asking questions about your health and lifestyle. There are no tests that can prove that you have migraines.

Migraines can be hard to diagnose, because their symptoms are like those of other types of headaches. For example, many people have been diagnosed with sinus headaches when they actually have migraines.

It's likely that you are having migraine headaches if they happen often and interfere with your daily life.

Symptoms used in diagnosis

Your doctor may use the International Headache Society's guidelines to diagnose migraines. You may be diagnosed if ALL of these are true:^{footnote 1}

• You have 5 or more headaches without an aura (or 2 headaches with an aura).
• The headaches last from 4 to 72 hours without treatment.
• You have nausea, you vomit, or your headache gets worse when you're around light or noise.

Tests you might have

Your doctor will check your symptoms and decide if you need to have tests to find out if your headaches are caused by another health problem. Tests may include:

• MRI or CT scan. These imaging tests may be used to look for tumors or bleeding in the brain. But most headaches aren't caused by anything serious, so you probably won't need to have imaging tests.

  Headaches: Should I Have Imaging Tests to Find Out What's Causing My Headaches?

• Lumbar puncture (also called a spinal tap). This may be done if your doctor thinks that you might have a problem such as meningitis or bleeding in the brain.
• Sedimentation rate (a blood test). This test can find out if another health problem is causing inflammation related to your headaches.

Treatment Overview

You can't cure migraines, but you can use medicines and other treatments to feel better.

The goal of treatment is to reduce how often you get migraines and to stop the headaches with the fewest drug side effects. Your doctor may have you try several types of medicines and may adjust the doses to manage your migraines.

Find and avoid migraine triggers

You can reduce how many migraines you have by finding your migraine triggers and avoiding them. For more information on triggers, see Prevention.

Keeping a headache diary(What is a PDF document?) is a good way to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. You look for patterns to your headaches. This information can help you know what to avoid to prevent a migraine.

Take medicines

You may take:

• Medicines to stop a migraine. These are sometimes called abortive medicines. These may be over-the-counter or prescription medicines. If you take the medicine at the first sign that you're about to get a migraine, you may keep the headache from starting or from getting bad.
• Medicines to prevent migraines. These drugs are often called preventive medicines. You get them with a prescription. You take these every day or whenever your doctor tells you to.

For mild to moderate migraines, you may first want to try over-the-counter pain relievers that have fewer side effects and cost less than other medicines. But if they don't help, you may need prescription medicines. Be safe with medicines. Read and follow all instructions on the label.

If medicines to stop a migraine don't give you enough relief, or if you're taking them more than 2 times a week, talk to your doctor about whether you should take medicines to prevent a migraine.

Try other treatments

You may want to try complementary treatments along with medicines. These may include:

• Acupuncture.
• Biofeedback.
• Herbs such as feverfew.

For more information, see Other Treatment.

If you decide to try one or more of these treatments, make sure your doctor knows. He or she may have advice on how to use other treatments safely.

Reduce stress

How you think can affect how you feel. So finding ways to relax and change your negative or worrisome thoughts may help prevent headaches.

You may want to try:

• Positive thinking techniques.
• Progressive muscle relaxation.
• Ways to manage your time.
• Breathing exercises.
• Guided imagery.
• Meditation.
• Yoga.

For more information, see Living With Migraine Headaches.

Treatment if your headaches get worse

If treatment doesn't stop your migraines, you and your doctor may make changes. You may try different medicines, a new mix of medicines, or different doses.

If you have already tried several types of medicine, your doctor may want you to have tests (such as an MRI or CT scan) to look for any other cause for your headaches.

It is possible to be diagnosed with migraines when you really have another type of headache. (But it's more common for a person to be diagnosed with another type of headache when he or she really has migraines.)

It can be hard to tell the difference between migraines and other types of headaches such as sinus, tension, or cluster headaches. The symptoms can be the same. And you may have more than one kind of headache. Different types of headaches need different treatment.

Other things to think about

• Even with treatment, you may still get migraines.
• It may take some time to find the right medicines to help you.
• Using medicines too often can cause rebound headaches. These are different from migraine headaches. They occur after pain medicine has worn off, which leads you to take another dose. After a while, you get a headache whenever you stop taking the medicine. Be sure to take your medicine only as your doctor prescribes.
• If you think your headaches could be caused by depression or anxiety, be sure to let your doctor know. Treatment for these health problems may get rid of your headaches or reduce how often you have them.
• If you think your headaches are related to stress, talk to your doctor about getting help to cope better with stress.

Prevention

You may be able to have fewer migraines by finding out what brings on (or triggers) your headaches and then avoiding those triggers.

Migraine triggers include certain foods and stress. Some common triggers are:

• Stress.
• Not eating.
• Poor sleep habits.
• A change from your normal routine.
• Heat, high humidity, or changes in the weather.
• Red wine.
• Monosodium glutamate (MSG).
• Strong odors.
• Chocolate.

Keeping a headache diary(What is a PDF document?) can help you find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. This information can help you find and avoid your triggers.

Having a daily routine is one of the best ways to avoid migraines. For example, try to eat at the same times every day, and go to sleep at a regular time. Changes from your routine, such as skipping meals or staying up really late, could lead to a migraine.

Triggers add up, so the fewer triggers you have at one time, the better your chance of preventing a migraine. That doesn't mean that you can't go outside if hot weather often triggers your migraines. But on a hot day, you might avoid red wine or chocolate if those also are triggers for your headaches.

Migraines: Finding and Avoiding Triggers.

Your doctor may also prescribe drugs to help prevent migraine headaches.

Living With Migraine Headaches

You may have fewer migraines-and less pain when you do get them-by trying to:

• Find and avoid triggers for your headaches.
• Keep a headache diary to find out what triggers your migraines.
• Take medicine as your doctor advises to prevent and stop migraines.
• Take your medicine right away when you think that you are getting a migraine.
• Reduce stress with relaxation and positive-thinking methods.
• Get help from your doctor and a counselor if you think that your migraines may be linked to depression or anxiety. Treating these health problems may reduce how often you get migraines.

Headaches: Managing Headaches.

Find and avoid migraine triggers

You can reduce how many migraines you have by finding out what triggers your migraines and avoiding those things. Triggers may include food, alcohol, hot weather, and changes to your routine.

Migraines: Finding and Avoiding Triggers.

Keep a headache diary

Keep a headache diary(What is a PDF document?) to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. This information can help you find and avoid the things that bring on your headaches.

The information you put in your headache diary can also help your doctor find the best treatment for you. Finding the right treatment can help you have fewer headaches. And the headaches you do get may not be as bad.

Take your medicines as directed

One Woman's Story: Carole, 41 "I always used to wait too long to take my medicine. Now I take it as soon as I start to feel the twinges of pain."-Carole Read more about how Carole changed the way she treated her migraines.

The best way to stop a migraine is to take your medicine at the first sign of a headache. You might think you can stop the migraine by lying down and being quiet or doing relaxation exercises. But if a migraine has started, it's probably too late for those other methods to work by themselves.

• Keep your medicine with you at all times so that you're ready when a headache starts.
• Don't take the medicine too often. Talk to your doctor if you're taking your medicine more than 2 days a week, or if you get more than 3 headaches a month. Too much medicine-over-the-counter or prescription-can lead to more headaches. These are called rebound headaches.

You may be able to have fewer headaches by taking prescription medicine to prevent migraines. But taking this medicine doesn't mean that you'll never get a migraine.

Headaches: Should I Take Medicine to Prevent Migraines?

Reduce stress

Migraine headaches are more common during stressful times or right after a stressful time ends.

You can lower your stress with positive thinking and relaxation methods. Research shows that you can change how you think. And how you think affects how you feel. Try these techniques on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy.

Doing Progressive Muscle Relaxation

Managing Your Time

Reducing Stress by Being Assertive

Breathing Exercises for Relaxation

Doing Guided Imagery to Relax

Doing Meditation

Practicing Yoga to Relax

You also can learn to stop thinking all the time about things that bother you.

Stop Negative Thoughts: Getting Started

Get help from your doctor or counselor

A doctor or counselor, or both, can help you if a problem like depression or anxiety makes your migraines worse. Treating these health problems may reduce how many migraines you get.

Anxiety: Stop Negative Thoughts

Depression: Stop Negative Thoughts

Medications

Two kinds of medicines are used to treat migraines:

• Medicines to stop a migraine. These are sometimes called abortive medicines. These may be over-the-counter or prescription medicines. If you take the medicine at the first sign you're getting a migraine, you may stop the headache before it starts.
• Medicines to prevent migraines. These drugs are often called preventive medicines. You get them with a prescription. You take these every day or whenever your doctor tells you to.

Finding the right mix of medicines for you may take some time. So work closely with your doctor to try different medicines and doses.

In most cases, your doctor will first prescribe a drug that causes the fewest side effects. Drugs may be prescribed based on your type of migraine.

Medicine choices

Medicines can help you feel better. But they can also be dangerous, especially if you don't take them the right way. Be safe with medicines. Read and follow all instructions on the label.

Medicines to stop a migraine

If your migraines are mild to moderate, you may need only an over-the-counter drug to stop the pain. Most doctors recommend that you try these drugs first, because they may have fewer side effects than prescription drugs. If over-the-counter drugs don't stop your headaches, your doctor may prescribe other medicine.

Your doctor may suggest that you take a mix of medicines to stop a headache. For example, you may take acetaminophen or naproxen along with a prescription medicine, such as a triptan.

Drugs used to stop a migraine include:

• Over-the-counter medicines like acetaminophen (Tylenol, for example) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Brand names for NSAIDs include Advil, Aleve, and Bayer. Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine.
• Triptans (serotonin receptor agonists), such as sumatriptan (Imitrex) and zolmitriptan (Zomig).
• Ergotamine derivatives, such as Cafergot.

Medicines to prevent a migraine

Drugs used to prevent migraines include:

• Anticonvulsants, such as topiramate.
• Antidepressants, such as amitriptyline.
• Antihistamine, such as cyproheptadine.
• Beta-blockers, such as propranolol.
• Botulinum toxin, such as Botox.
• Calcium channel blockers, such as verapamil.

You may want to try medicine to prevent a headache if:

• You are using medicines to stop headaches more than twice a week.
• Medicines to stop migraines aren't working well for you.
• You have two or more headaches a month that keep you from doing your daily activities.
• You have uncommon migraine symptoms, such as a long period with aura or numbness during your headache.

Headaches: Should I Take Medicine to Prevent Migraines?

Rebound headaches

Taking medicine too often to stop a migraine can cause more headaches. These rebound headaches are different from migraine headaches. They usually start after pain medicine wears off, which leads you to take another dose. After a while, you get a headache whenever you stop taking the drug.

Talk to your doctor if you are taking headache medicine more than 2 days a week. Take your medicine as prescribed by your doctor.

Other things to think about

• Depression and migraines. Many people who have migraines also have depression. Taking prescription medicine for both problems is common.
  • Make sure all your doctors know about all the medicines that you take. In very rare cases, a serious condition called serotonin syndrome may happen when a person takes a triptan for migraines and an SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) for depression. But most people have no problems when they take these medicines together. Talk to your doctor if you are concerned about this problem.
• Antinausea medicine. If you have nausea or vomiting during migraine attacks, your doctor also may prescribe medicine to help with these symptoms.

Other Treatment

Some people find that complementary treatments reduce how many migraines they have or how bad the migraines are.

If you are thinking about trying a complementary treatment, get the facts first. Discuss these questions with your doctor:

• Is it safe? Talk with your doctor about the safety and potential side effects of the treatment. This is especially important if you are taking medicines for migraines or another health condition. Some complementary treatments in combination with medicines can be quite dangerous.
• Does it work? You may find it hard to judge whether a particular treatment is really working. Keep in mind that if you get better after using a certain treatment, the treatment isn't always the reason for the improvement.
• How much does it cost? An expensive, unproven treatment that may or may not help you may not be worth its cost. Beware of therapy providers or products that require a large payment at the beginning of a series of treatments.
• Will it improve my general health? Even if they aren't effective in treating migraines, some complementary practices (such as acupuncture, massage, or yoga) may lead to healthy habits that improve your overall well-being. These might be worth trying.

Talk to your doctor if you decide to try:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Research shows that acupuncture can help prevent some headaches.^{footnote 2}
• Biofeedback. This is a way to control a body function-such as muscle tension-that you don't normally control.
• Feverfew. This is an herb that-some small studies show-may help prevent migraines in some people.^{footnote 3}
• Magnesium. Studies have found that some people with migraines have low levels of magnesium in the brain. Taking magnesium may help prevent migraines.^{footnote 3}
• Menthol. There is some evidence that a menthol solution rubbed on the forehead can stop or reduce migraine headache pain.^{footnote 4}
• Riboflavin (vitamin B2). This vitamin may help prevent migraines.^{footnote 3}
• Coenzyme Q10. In a small study, this supplement worked to reduce the number of migraines for some people.^{footnote 3}

For people who haven't been able to reduce the number of or control their headaches with medicine, stimulation of certain nerves in the head with mild electric current may help. If you have severe and frequent migraines and have not been able to control them with medicine, you may want to ask your doctor if this kind of treatment is available in your area.