Migraine Headaches

Condition Basics

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 aren't able to do your usual activities. But migraines can be treated. And even though they make you feel bad, they don't cause long-term damage.

What causes them?

Experts aren't sure what causes migraines. They believe that changes in the activity of brain cells may lead to inflammation in certain nerves, which causes pain. Migraines often run in families, so genetics may play a role for some people. Some things, called triggers, can cause a migraine to start.

What can trigger a migraine headache?

Triggers are things that can cause a migraine headache to start. They include changes in daily routine, foods, hormones, and medicines. They can also include lights, odors, changes in the weather, or other things in the environment. Strong emotions, such as depression or anxiety, can also be triggers. Triggers are different for each person.

What are the symptoms?

The most common symptom of a migraine headache is a throbbing pain on one side of your head or behind an eye. Some people have an aura shortly before or during the headache. During an aura, you may see spots or flashing lights. Other symptoms of migraine include nausea, vomiting, and sensitivity to light.

How are they diagnosed?

To diagnose migraines, your doctor will ask about your personal and family history and examine you. Your doctor will ask how many headaches you have, how long they last, and what symptoms you have. You may get tests if your doctor thinks your symptoms may be caused by another disease.

How are migraine headaches treated?

You can't cure migraines, but medicines and other treatments may help you feel better. Avoiding triggers can help too. You may be able to treat your headaches with over-the-counter pain medicine. If that doesn't work, your doctor can prescribe stronger medicine. You may also try medicine to help prevent migraines.

What Increases Your Risk

You may be more likely to get migraines if you have a family history of migraines. Females are more likely to get migraines than males. You may also be at higher risk if you are a teenager or young adult. Migraines often start during these years but may peak in your 30s.

Prevention

You can do things to help prevent migraine headaches. Try these tips.

• Keep a daily headache diary.

  It can help you find out what triggers your migraines.

• Avoid your migraine triggers.

  Triggers include changes in daily routine, foods, hormones, medicines, lights, odors, or other things in the environment. Triggers add up. So the fewer triggers you have at one time, the better your chance of preventing a migraine.

• Live a healthy lifestyle.
  • Get regular sleep.
  • Eat healthy foods at regular times.
  • Avoid alcohol and drugs.
  • Avoid foods that may trigger your headaches.
• Get regular exercise.

  But be careful to not push yourself too hard. It may trigger a headache.

• Take medicines that prevent migraines.
• Don't take medicine for headache pain too often.

  Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking medicine too often may cause medicine-overuse headaches.

• Find healthy ways to cope with stress.

  Migraines are most common during or right after stressful times. Try finding ways to reduce stress like practicing mindfulness or deep breathing exercises.

• Ask your doctor about trying herbs and supplements.

  Some people find that magnesium and riboflavin (vitamin B2) help prevent migraine headaches.

• Try acupuncture or biofeedback.

  Some people find that these can help reduce how many migraines they have or how bad the migraines are.

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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.

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

• Depressed or cranky.
• Very happy, very awake, or full of energy.
• Very sleepy.

Some people have an aura. It may happen shortly before or during the headache. Some people may have an aura without the headache. During an aura, you may see spots, wavy lines, or flashing lights.

When the headache starts, symptoms can include:

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

You may have muscle aches or feel very tired for up to a day after your migraine ends.

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What Happens

Migraines sometimes start with an aura of spots, wavy lines, or flashing lights about 30 minutes before the headache begins. Without treatment, a migraine headache can last from 4 to 72 hours. Muscle aches or feeling very tired may last for up to a day after the migraine ends.

When To Call

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 or worse nausea and vomiting, or you cannot keep down food or fluids.

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

• Your headache wakes you up.
• Your headaches get worse, happen more often, or change in some way.
• You have new symptoms.
• You have any problems with your medicine, your medicine isn't helping your headaches, or you are using your medicine more often than prescribed.
• Your headaches occur after physical exercise, sexual activity, coughing, or sneezing. Or your pain gets better or worse if you lie down or stand up.
• Your life is disrupted by your headaches. For example, you often miss work, school, or other activities.
• You are not getting better as expected.

Watchful waiting

Watchful waiting is a wait-and-see approach. Trying it may be fine if you have recently been diagnosed with migraines and over-the-counter medicines are controlling your pain.

Exams and Tests

To diagnose migraines, your doctor will do an exam and ask questions about your personal and family history. Your doctor will ask how many headaches you have, how long they last, and what symptoms you have. There are no tests that can diagnose migraines.

Migraines can be hard to diagnose. 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.

Your doctor will decide if you need to have tests to find out if your headaches are caused by another health problem. You may have an MRI, a CT scan, or a lumbar puncture.

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Treatment Overview

You can't cure migraines. But you can use medicines and other treatments to feel better. Finding and avoiding the things that trigger your headaches may also help.

The goal of treatment is to reduce how often you get migraines and to stop the headaches with the fewest drug side effects.

For mild to moderate migraines, you may first want to try over-the-counter pain relievers. They have fewer side effects. And they cost less than other medicines. But if they don't help, you may need prescription medicines.

Your doctor may prescribe medicines to stop or to prevent a migraine.

If treatment doesn't help your migraines, you and your doctor may make changes. You may try different medicines, a new mix of medicines, or different doses. Sometimes, treatments that don't use medicines are tried. It may take some time to find the right treatment to help you.

Self-Care

There are some things you can do when you feel a migraine starting.

• 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. Keep your medicine with you at all times so you are ready when a headache starts.

• Rest in a quiet, dark room until your headache is gone.

  Close your eyes, and try to relax or go to sleep. Don't watch TV or read.

• Put a cold, moist cloth or cold pack on the painful area.

  Leave it there for 10 to 20 minutes at a time. Put a thin cloth between the cold pack and your skin.

• Relax your muscles.

  Have someone gently massage your neck and shoulders.

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you aren't taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Don't take medicine for headache pain too often.

  Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches.

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Medicines

Two kinds of medicines are used to treat migraines. There are medicines to stop a migraine and medicines to prevent migraines.

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 medicine that causes the fewest side effects. Medicines may be prescribed based on your type of migraine.

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. Take them as prescribed by your doctor. Read and follow all instructions on the label.

Medicines to stop a migraine

These are sometimes called abortive medicines. They 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.

If your migraines are mild to moderate, you may need only an over-the-counter medicine to stop the pain. Most doctors recommend that you try these medicines first. That's because they may have fewer side effects than prescription medicines. But if they 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.

Medicines used to stop a migraine include:

• Over-the-counter medicines. Examples include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve). Some over-the-counter medicines combine acetaminophen, aspirin, and caffeine.
• Triptans (serotonin receptor agonists). Examples are sumatriptan and zolmitriptan.
• Ergotamine derivatives. An example is dihydroergotamine.

Medicines such as ubrogepant may be tried if you can't take other medicines or the medicines did not work.

Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches.

If you have nausea or vomiting during migraine attacks, your doctor also may prescribe medicine to help with these symptoms.

Medicines to prevent a migraine

These medicines are often called preventive medicines. You get most of them with a prescription, but some over-the-counter herbs and supplements may be tried too. You take these every day or whenever your doctor tells you to.

Medicines used to prevent migraines include:

• Anticonvulsants, such as topiramate.
• Antidepressants, such as amitriptyline.
• Beta-blockers, such as propranolol.
• CGRP antagonists, such as erenumab.
• Botulinum toxin, such as Botox. This is used for prevention if you have chronic migraines.

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

• You use medicines to stop headaches more than twice a week.
• Medicines to stop migraines aren't working well for you.
• You have four or more headaches a month that keep you from doing your daily activities.
• You have menstrual migraines.
• You have uncommon migraine symptoms. These may include a long period with aura or numbness during your headache.

Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more—the side effects of the medicine or your migraines.

Medicines may not prevent every migraine. So you may still need to take another kind of medicine that can stop a migraine after it has started. But prevention medicines can reduce how many migraines you get, reduce how long they last, and make your symptoms less severe.

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