Overview

A migraine is a headache that can cause intense throbbing pain or a pulsing feeling, usually on one side of the head. It often happens with nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so bad that it interferes with your daily activities.

For some people, a warning symptom known as an aura occurs before or with a migraine. An aura can include visual changes, such as flashes of light or blind spots. The aura also can cause tingling on one side of the face or in an arm or leg and trouble speaking.

Medicines can help prevent some migraines and make them less painful. Combining medicines with self-help remedies and lifestyle changes also might help.

Symptoms

Migraines can affect children and teenagers as well as adults. A migraine can progress through four stages that have different symptoms: prodrome, aura, attack and postdrome. Not everyone who has migraines goes through all stages.

Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

  • Constipation.
  • Mood changes, from depression to elation.
  • Food cravings.
  • Neck stiffness.
  • Increased urination.
  • Fluid retention.
  • Frequent yawning.

Aura

An aura might occur before or during migraines for some people. Auras are reversible symptoms of the nervous system. They're usually visual but also can include other disturbances. Each symptom usually begins gradually and builds up over several minutes, up to 60 minutes.

Examples of migraine auras include:

  • Visual changes, such as seeing shapes, bright spots or flashes of light.
  • Vision loss.
  • A feeling of pins and needles in an arm or leg.
  • Weakness or numbness in the face or one side of the body.
  • Trouble speaking.

Attack

A migraine usually lasts 4 to 72 hours if it's not treated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

  • Pain that's usually on one side of your head, although it can occur on both sides.
  • Pain that throbs or pulses.
  • Sensitivity to light, sound, and sometimes smell and touch.
  • Nausea and vomiting.

Postdrome

After a migraine attack, you might feel drained, confused and worn out for up to a day. Some people report feeling elated. Sudden head movement might briefly bring on the pain again.

When to see a doctor

Migraines are often not diagnosed or treated. If you regularly have symptoms of migraines, keep a record of your attacks and how you treated them. Then make an appointment with your healthcare professional to discuss your headaches.

If you have a history of headaches, see your healthcare professional if the pattern changes or your headaches suddenly feel different.

See your healthcare professional right away or go to the emergency room if you have any of the following symptoms. They could be caused by a more serious medical issue.

  • An abrupt, very bad headache like a thunderclap.
  • Headache with a fever, stiff neck, confusion, seizures, double vision, or numbness or weakness in any part of the body. These symptoms could be a sign of a stroke.
  • Headache after a head injury.
  • A chronic headache that is worse after coughing, exertion, straining or sudden movement.
  • New headache pain after age 50.

Causes

Though migraine causes aren't fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. Imbalances in brain chemicals also might be involved — including serotonin, which helps regulate pain in your nervous system. Researchers are studying the role of serotonin in migraines.

Other chemical messengers play a role in migraine pain, including calcitonin gene-related peptide, also known as CGRP.

Migraine triggers

There are a number of things that can bring on a migraine, including:

  • Hormonal changes. Fluctuation in estrogen levels seems to trigger headaches in many people. This can happen before or during menstrual periods or during pregnancy and menopause. Hormonal medicines, such as oral contraceptives, also can worsen migraines. Some people, however, find that their migraines occur less often when taking hormonal contraceptives.
  • Alcohol and caffeine. Alcohol, especially wine, and too much caffeine, such as in coffee, can trigger a migraine.
  • Stress. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells can trigger migraines in some people. These smells can include perfume, paint thinner, secondhand smoke and other triggers.
  • Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
  • Physical strain. Intense physical exertion, including sexual activity, might provoke migraines.
  • Weather changes. A change of weather or barometric pressure can prompt a migraine.
  • Medicines. Oral contraceptives and vasodilators, such as nitroglycerin (Nitrostat, Nitro-Dur, others), can aggravate migraines.
  • Foods. Aged cheeses and salty and processed foods might trigger migraines. Skipping meals also can bring on a migraine.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate, also called MSG. These additives are found in many foods.

Risk factors

Several risk factors make you more prone to having migraines, including:

  • Family history. Having a family member with migraines means you have a higher chance of developing them yourself.
  • Age. Migraines can begin at any age, though the first often occurs when you're a teenager. Migraines tend to peak during your 30s and then gradually become less frequent.
  • Sex. Women are three times more likely than men to have migraines.
  • Hormonal changes. Migraines might begin just before or shortly after your first menstrual period. They also might change during pregnancy or menopause. Migraines generally improve after menopause.

Complications

A complication for some people with migraines is medication overuse headaches. Taking painkillers too often can trigger these headaches. Medication overuse headaches may occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month. Or they can occur if you take medicines known as triptans for more than nine days a month. The risk seems to be highest with medicines that combine aspirin, acetaminophen and caffeine.

Medication overuse headaches can lead to a painful cycle. If medicines stop relieving pain and begin to cause headaches, you might then try taking more pain medicine to find relief.

By Mayo Clinic Staff