A migraine is a type of headache that typically causes intense, throbbing pain usually in one area of the head. People can experience migraines once a year to multiple times a week. A person is considered to have chronic migraines if they experience 15 or more headache days a month with eight of those days involving migraine headaches. Migraines typically first start during a person's teens to early twenties, but they can begin anytime from early childhood to late-adulthood.

A migraine usually has three stages: the period leading up to the headache (known as the premonitory or prodromal phase), the migraine itself (the headache phase), and the period following the headache (known as the postdromal phase).

The premonitory phase can start from several hours up to several days before the headache appears. In this phase, affected individuals can experience extreme tiredness (fatigue), concentration problems, and muscle stiffness in the neck. A wide variety of additional signs and symptoms can occur including excessive yawning, food cravings, irritability, depression, sensitivity to light, and nausea. About one-third of people with migraine experience a temporary pattern of neurological symptoms called an aura. An aura typically develops gradually over a few minutes and lasts between 5 and 60 minutes. Auras commonly include temporary visual changes such as blind spots (scotomas), flashing lights, and zig-zagging lines of color. Additional features of aura can include numbness, difficulty with speech and language, episodes of extreme dizziness (vertigo), and double vision. During an aura, affected individuals might experience abnormal sensations including tingling or numbness, usually of the hands or mouth. An aura usually starts within one hour of the start of a migraine. In some cases, an aura can occur without a subsequent migraine.

In the headache phase, the pain may last from a few hours to a few days. Affected individuals tend to experience nausea, vomiting, dizziness, and sensitivity to light and sound in addition to headache. Some have changes in their vision or sensitivity to odors and touch.

The postdromal phase usually lasts a few hours but can linger for more than a day. In this phase, the headache pain is gone but individuals can experience fatigue, drowsiness, decreased energy, concentration problems, irritability, nausea, or sensitivity to light. Affected individuals may also have brief episodes of head pain when moving their head.

People with migraine, particularly women who have migraine with aura, have an increased risk of a type of stroke that is caused by a lack of blood flow to the brain (ischemic stroke), but this is a rare occurrence.

There are many migraine disorders that usually include additional signs and symptoms. For example, familial hemiplegic migraine and sporadic hemiplegic migraine are characterized by migraine with associated temporary weakness that affects one side of the body (hemiparesis). Additionally, cyclic vomiting syndrome is a migraine disorder usually found in children that causes episodes of nausea and vomiting in addition to headaches.

Migraine is a type of headache characterized by recurrent attacks of moderate to severe throbbing and pulsating pain on one side of the head. The pain is caused by the activation of nerve fibers within the wall of brain blood vessels traveling inside the meninges (three layers of membranes protecting the brain and spinal cord).

Untreated attacks last from four to 72 hours. Other common symptoms include:

• Increased sensitivity to light, noise, and odors
• Nausea
• Vomiting

Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain.

Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks.

A number of different factors can increase your risk of having a migraine. These factors, which trigger the headache process, vary from person to person and include:

• Sudden changes in weather or environment
• Too much or not enough sleep
• Strong odors or fumes
• Emotion
• Stress
• Overexertion
• Loud or sudden noises
• Motion sickness
• Low blood sugar
• Skipped meals
• Tobacco
• Depression
• Anxiety
• Head trauma
• Hangover
• Some medications
• Hormonal changes
• Bright or flashing lights

Migraine is the third most common disorder worldwide, affecting 1 in 7 people. Chronic migraines affect about 1 in 50 people worldwide. Women tend to be affected by migraines more frequently than men.

Migraine is a leading cause of disability in the United States. For a subset of people who have it, migraine can develop into a chronic condition, causing even more frequent pain, discomfort, and disruption to daily life. 

What is chronic migraine? 

Migraine attacks are headaches with migraine characteristics (such as dizziness, nausea, and intense pain that gets worse with activity) that last 4 to 72 hours. Chronic migraine develops over time as these headaches become increasingly frequent. Chronic migraine is defined as a history of 15 or more headache days a month, at least eight of which have migraine characteristics, for at least three months (though for many people with chronic migraine the number of headache days fluctuates from month to month).

How does migraine become chronic?

Factors that can make it more likely for migraine to become chronic include: 

• Ineffective treatment 
• Overuse of certain medications (for migraine and other conditions)
• Certain medical conditions (such as anxiety, sleep disorders, and chronic pain conditions)
• Stressful life events

What is the impact?

Migraine can interfere with work, school, and social life, but chronic migraine makes it even harder to participate in activities and to maintain relationships with friends and family. People with chronic migraine are also more likely to have other health conditions such as chronic pain, arthritis, and depression. 

What is the outlook? 

There’s no cure for migraine or for chronic migraine, but there are ways to find relief. It’s important for people with chronic migraine to: 

• Work with a health care professional to find the right approach
• Address symptoms as soon as they appear
• Identify migraine triggers and avoid them

With the right treatment plan, many people with chronic migraine can have a better quality of life with fewer and less severe symptoms.

What are migraines?

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

What causes migraines?

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include

• Stress
• Anxiety
• Hormonal changes in women
• Bright or flashing lights
• Loud noises
• Strong smells
• Medicines
• Too much or not enough sleep
• Sudden changes in weather or environment
• Overexertion (too much physical activity)
• Tobacco
• Caffeine or caffeine withdrawal
• Skipped meals
• Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include

• Alcohol
• Chocolate
• Aged cheeses
• Monosodium glutamate (MSG)
• Some fruits and nuts
• Fermented or pickled goods
• Yeast
• Cured or processed meats

Who is at risk for migraines?

About 12 percent of Americans get migraines. They can affect anyone, but you are more likely to have them if you

• Are a woman. Women are three times more likely than men to get migraines.
• Have a family history of migraines. Most people with migraines have family members who have migraines.
• Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

What are the symptoms of migraines?

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.

• Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
• Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
• Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
  • Increased sensitivity to light, noise, and odors
  • Nausea and vomiting
  • Worsened pain when you move, cough, or sneeze
• Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

How are migraines diagnosed?

To make a diagnosis, your health care provider will

• Take your medical history
• Ask about your symptoms
• Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

How are migraines treated?

There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.

There are also other things you can do to feel better:

• Resting with your eyes closed in a quiet, darkened room
• Placing a cool cloth or ice pack on your forehead
• Drinking fluids

There are some lifestyle changes you can make to prevent migraines:

• Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
• Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
• Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
• If you have obesity, losing weight may also be helpful

If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.

Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.

The two major types of migraine are:

1. Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache.
2. Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise.

Other types of migraine include:

• Abdominal migraine mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting one to 72 hours, with little or no headache. Additional symptoms include nausea, vomiting, and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life.
• Basilar-type migraine mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head.
• Hemiplegic migraine is a rare and severe form of migraine that causes temporary paralysis—sometimes lasting several days—on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families the disorder is called familial hemiplegic migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate.
• Menstrual migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura, pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light.
• Migraine without headache is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.
• Ophthalmoplegic migraine an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil, and double vision that may last for weeks, long after the pain is gone.
• Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches.
• Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that people need to be hospitalized.

Migraines occur in both children and adults but affect adult women three times more often than men. Migraines are genetic. Most migraine sufferers have a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are more common in individuals with migraine than in the general population. Individuals who have pre-migraine symptoms referred to as aura have a slightly increased risk of having a stroke.

Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives.

Migraines are thought to occur when blood flow in the brain is altered and certain nerves in the brain send abnormal pain signals throughout the head. These signals trigger the release of various brain chemicals (neurotransmitters) in the brain, which leads to inflammation, particularly of blood vessels and the membrane that covers the brain and spinal cord (meninges). This inflammation causes many of the signs and symptoms of a migraine, including the throbbing pain, nausea, and sensory sensitivities. However, it is unclear what leads to the abnormal nerve signaling.

Auras are thought to be caused by abnormal nerve signaling and associated changes in blood flow that spread across the brain. Additionally, the release of large amounts of the neurotransmitter glutamate is thought to contribute to aura. The causes of these imbalances are unclear.

Migraines result from a combination of genetic, environmental, and lifestyle factors, some of which have not been identified. Variations in many genes have been found to be associated with the development of migraines with or without aura. These genes likely have varying degrees of impact among affected individuals. Most of the associated genes are active in the muscles that surround blood vessels (vascular smooth muscle) within the brain. These genes help regulate blood flow by controlling the narrowing and expansion of blood vessels. Many variants likely disrupt blood flow in the brain, which can contribute to developing migraines. Changes in blood flow in the brain or in the balance between vascular injury and repair (vascular homeostasis) also likely underlie the increased risk of stroke in people with migraines. Variants in genes that regulate levels of glutamate or the activity (excitability) of certain nerve cells in the brain have also been found in people with migraines.

Nongenetic factors also play a critical role in developing a migraine. Migraine headaches can be triggered by skipping meals, caffeine or alcohol overuse, certain foods, poor sleep, emotional stress, hormonal changes, or minor head trauma. Excessive use of pain relief medications can also trigger or worsen migraines.

Migraine is divided into four phases, all of which may be present during the attack:

1. Premonitory symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination.
2. Aura—Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.
3. Headache—A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache.
4. Postdrome—Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy again.

How and under what circumstances a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note:

• The time of day when it occurred
• Its intensity and duration
• Any sensitivity to light, odors, or sound
• Activity immediately prior to the headache
• Use of prescription and nonprescription medicines
• Amount of sleep the previous night
• Any stressful or emotional conditions
• Any influence from weather or daily activity
• Foods and fluids consumed in the past 24 hours
• Any known health conditions at that time

Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorders. A pattern may emerge that can be helpful to reducing or preventing headaches.

Once your doctor reviews your medical and headache history and conducts physical and neurological exams, lab screening and diagnostic tests may be ordered to either rule out or identify conditions that might be the cause of your headaches.

Blood and urine tests can help diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system. Testing the fluid that surrounds the brain and spinal cord can detect infections, bleeding in the brain (called a brain hemorrhage), and measure any buildup of pressure within the skull.

Diagnostic imaging, such as with computed tomography (CT) and magnetic resonance imaging (MRI), can detect irregularities in blood vessels and bones, certain brain tumors and cysts, brain damage from head injury, brain hemorrhage, inflammation, infection, and other disorders. Neuroimaging also gives doctors a way to see what's happening in the brain during headache attacks. An electroencephalogram (EEG) measures brain wave activity and can help diagnose brain tumors, seizures, head injury, and inflammation that may lead to headaches.

Migraine treatment is aimed at relieving symptoms and preventing additional attacks. Quick steps to ease symptoms may include:

• Napping or resting with eyes closed in a quiet, darkened room
• Placing a cool cloth or ice pack on the forehead
• Drinking lots of fluid, particularly if the migraine is accompanied by vomiting

Small amounts of caffeine may help relieve symptoms during a migraine's early stages.

Drug therapy for migraine is divided into acute and preventive treatment. Acute or "abortive" medications are taken as soon as symptoms occur to relieve pain and restore function. Preventive treatment involves taking medicines daily to reduce the severity of future attacks or keep them from happening. The U.S. Food and Drug Administration (FDA) has approved the drugs enenmab (Aimovig) for the preventive treatment of headache and galcanezumab-gnlm (Emgality) injections to treat episodic cluster headache. The FDA also has approved lasmiditan (Reyvow) and ubrogepant (Ubrelvy) tablets for short-term treatment of migraine with our without aura. Headache drug use should be monitored by a physician, since some drugs may cause side effects.

Acute treatment for migraine may include any of the following drugs:

• Triptan drugs increase levels of the neurotransmitter serotonin in the brain. Serotonin causes blood vessels to constrict and lowers the pain threshold. Triptans—the preferred treatment for migraine—ease moderate to severe migraine pain.
• Ergot derivative drugs bind to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They are most effective during the early stages of migraine.
• Non-prescription analgesics or over-the-counter drugs such as ibuprofen, aspirin, or acetaminophen can ease the pain of less severe migraine headache.
• Combination analgesics involve a mix of drugs such as acetaminophen plus caffeine and/or a narcotic for migraine that may be resistant to simple analgesics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and alleviate pain.
• Nausea relief drugs can ease queasiness brought on by various types of headache.
• Narcotics are prescribed briefly to relieve pain. These drugs should not be used to treat chronic headaches.

Everyone with migraine needs effective treatment at the time of the headaches. Some people with frequent and severe migraine need preventive medications. In general, prevention should be considered if migraines occur one or more times weekly, or if migraines are less frequent but disabling. Preventive medicines also are recommended for individuals who take symptomatic headache treatment more than three times a week. Physicians also will recommend that a migraine sufferer take one or more preventive medications two to three months to assess drug effectiveness, unless intolerable side effects occur.

Several preventive medicines for migraine were initially marketed for conditions other than migraine.

• Anticonvulsants may be helpful for people with other types of headaches in addition to migraine. Although originally developed for treating epilepsy, these drugs increase levels of certain neurotransmitters and dampen pain impulses.
• Beta-blockers are used to treat high blood pressure and are often effective for migraine.
• Calcium channel blockers are used to treat high blood pressure treatment and help to stabilize blood vessel walls. These drugs appear to work by preventing the blood vessels from either narrowing or widening, which affects blood flow to the brain.
• Antidepressants work on different chemicals in the brain; their effectiveness in treating migraine is not directly related to their effect on mood. Antidepressants may be helpful for individuals with other types of headaches because they increase the production of serotonin and also may affect levels of other chemicals, such as norepinephrine and dopamine.

Natural treatments for migraine include riboflavin (vitamin B2), magnesium, coenzyme Q10, and butterbur (medicinal plant).

Non-drug therapy for migraine includes biofeedback and relaxation training, both of which help individuals cope with or control the development of pain and the body's response to stress.

Lifestyle changes that reduce or prevent migraine attacks in some individuals include exercising, avoiding food and beverages that trigger headaches, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Obesity increases the risk of developing chronic daily headache, so a weight loss program is recommended for obese individuals.

Thought there was no hope for treating your migraine headaches? Don’t give up.

Migraines are headaches with intense pulsing or throbbing pain in one area of the head, along with nausea or vomiting and sensitivity to light and sound. A migraine can last four to 72 hours when untreated. According to the National Institutes of Health, 12% of Americans (about 37 million people) have migraines. These debilitating headaches affect children and adults, and women are three times more likely to have migraines than men (about 18% of women have migraines).

About one-third of people with migraines experience an aura – visual disturbances such as dots, flashing lights or a blind spot – that signals the beginning of the headache.

Migraine Medicines

There are many medicines approved by the U.S. Food and Drug Administration to reduce migraine pain and symptoms. FDA-approved migraine medicines can prevent or treat migraines. They can be taken orally (by mouth), intranasally (inhaled through the nose), or injected by a health care professional.

Often migraines are not diagnosed at all, or migraine patients are prescribed a treatment that doesn’t work for them. If you have headaches, you should tell your doctor about them. Ask for a referral to a migraine specialist if the treatment is not working for you.

Since 2018 the FDA has approved several new prescription migraine medicines. Some of the newer FDA-approved migraine medicines are safe for people with certain heart conditions, unlike some previously approved treatments. Some newer medicines also are less likely to slow your heart rate (e.g. propranolol) or thinking (e.g. topiramate). If your current migraine medicine is not working well for you, talk to your health care professional about new treatment options that may be available.

These medicines, when they are taken regularly, may help to reduce the number of migraine headaches but rarely eliminate them completely.

Migraines and Medication Overuse Headaches

Migraine sufferers are at risk of developing a condition called medication overuse headache (MOH). This is a migraine-like daily headache, or marked increase in frequency of migraine attacks, caused by the overuse of certain medications.

Studies have shown that using certain pain medications for 10 or more days a month may cause MOH. These include:

• Aspirin
• Acetaminophen
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Combination pain relievers
• Opioids
• Triptans
• Ergotamines

That’s why the FDA has worked with companies to add a description of MOH to labels of nonprescription (over-the-counter, or OTC) oral pain medications used to treat migraines. Prescription migraine medication labels also have a similar warning.

Headaches caused by medication overuse usually stop when people stop taking the pain medication. Talk with your health care professional if you believe you have MOH. They can determine what is causing your headaches and can tell you the best way to cut back on headache medicine.

Some headache medicines can be stopped quickly, but some must be tapered down slowly. Some people may need additional treatment for withdrawal symptoms.

What’s the Bottom Line?

What do we know about the usefulness of complementary approaches for headaches?

Psychological and Physical Approaches

• Acupuncture can be helpful for headaches. Much of its benefit may be due to nonspecific factors including expectation, beliefs, and placebo responses rather than specific effects of needling.
• Some studies indicate that biofeedback-based techniques may be helpful for tension headaches and migraines, but not all research results agree.
• For massage, relaxation techniques, spinal manipulation, and tai chi, the evidence is too limited or inconsistent to allow conclusions to be reached.

Dietary Supplements

• Butterbur appears to help reduce the frequency of migraines in adults and children. In 2012, the American Academy of Neurology recommended its use for preventing migraines. However, the Academy stopped recommending it in 2015 because of serious concerns about possible liver toxicity.
• There is some evidence that coenzyme Q10, feverfew, magnesium, and the B vitamin riboflavin might be helpful for reducing the frequency of migraines. However, for all of these supplements, the amount of evidence is small. A recent study of foods rich in omega-3 fatty acids found that they may reduce the frequency and severity of migraines, but studies of omega-3 fatty acid supplementation have not shown the same effects.

What do we know about the safety of complementary approaches for headaches?

In general, the psychological and physical approaches discussed in this fact sheet have good safety records. However, that doesn’t mean that they’re risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.

Dietary supplements may have side effects, and some may have undesirable interactions with medicines. Talk with your health care provider if you are considering a dietary supplement for headaches.

Some Basics About Headaches

Headaches are the most common form of pain. They’re a major reason why people miss work or school or visit a health care provider. This fact sheet focuses on two types of headache: tension headaches and migraines. Researchers have studied complementary health approaches for both.

Tension Headaches and Migraines: What’s the Difference?

• Tension headaches—the most common type of headache—are caused by tight muscles in the shoulders, neck, scalp, and jaw. They may be related to stress, depression, or anxiety and may occur more often in people who work too much, sleep too little, miss meals, or drink alcoholic beverages.
• Migraine headaches—which affect about 12 percent of Americans—involve moderate to severe throbbing pain, often on one side of the head. During a migraine, people are sensitive to light and sound and may feel nauseated. Some people have visual disturbances before a migraine—like seeing zigzag lines or flashing lights, or temporarily losing their vision. Anxiety, stress, lack of food or sleep, exposure to light, or hormonal changes (in women) can trigger migraines. Genes that control the activity of some brain cells may play a role in causing migraines.

What the Science Says About Complementary Health Approaches for Headache

Research has produced promising results for some complementary health approaches for tension headache or migraine. For other approaches, evidence of effectiveness is limited or conflicting.

Psychological and Physical Approaches

Psychological and physical approaches that have been studied for headache include acupuncture, biofeedback, massage, relaxation techniques, spinal manipulation, and tai chi.

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin.

There have been many studies of acupuncture for headache. The combined results from these studies indicate that acupuncture may help relieve headache pain, but that much of its benefit may be due to nonspecific effects including expectation, beliefs, and placebo responses rather than specific effects of needling.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Biofeedback

Biofeedback measures body functions and gives you information about them so that you can become more aware of those functions and learn to control them. For example, a biofeedback device may show you measurements of muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them.

Several types of biofeedback have been studied for headaches, including techniques that help people learn to relax and more specific techniques that focus on changes that occur during headaches.

• Tension headaches. Many studies have tested biofeedback for tension headaches, and several evaluations of this research have concluded that biofeedback may be helpful. However, an evaluation that included only the highest quality studies concluded that there is conflicting evidence about whether biofeedback is helpful for tension headaches.
• Migraines. Studies have shown decreases in the frequency of migraines in people who were using biofeedback. However, it’s unclear whether biofeedback is better than a placebo for migraines.

Biofeedback generally does not have harmful side effects.

Massage

Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.

Limited evidence from two small studies suggests massage therapy is possibly helpful for migraines, but clear conclusions cannot be drawn.

Massage therapy appears to have few risks when performed by a trained practitioner. However, people with health conditions and pregnant women may need to avoid some types of massage and should consult their health care providers before having massage therapy.

Relaxation Techniques

Relaxation techniques—such as progressive muscle relaxation, guided imagery, and breathing exercises—are practices that can produce the body’s natural relaxation response. (Some types of biofeedback are also designed to help people learn relaxation; biofeedback is discussed in a separate section above.)

Although some experts consider relaxation techniques to be promising for tension headaches, there isn’t much evidence to support their effectiveness. An evaluation of high-quality studies on relaxation techniques found conflicting evidence on whether they’re better than no treatment or a placebo. Some studies suggest that relaxation techniques are less helpful than biofeedback.

Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.

Spinal Manipulation

Spinal manipulation is a technique in which practitioners use their hands or a device to apply a controlled force to a joint of the spine. Chiropractors or other health professionals may use this technique.

Spinal manipulation is frequently used for headaches. However, it’s uncertain whether manipulation is helpful because studies have had contradictory results.

Side effects from spinal manipulation can include temporary headaches, tiredness, or discomfort in the area that was manipulated. There have been rare reports of strokes occurring after manipulation of the upper (cervical) spine, but whether manipulation actually caused the strokes is unclear.

Tai Chi

Tai chi, which originated in China, combines meditation with slow, graceful movements, deep breathing, and relaxation.

One small randomized study has evaluated tai chi for tension headaches. Some evidence of improvements in headache status and health-related quality of life was found among patients on the tai chi program compared to others on a wait list. These data are too limited to draw meaningful conclusions about whether this practice is helpful for tension headaches.

Tai chi is generally considered to be a safe practice.

Dietary Supplements

Butterbur

Butterbur appears to help reduce the frequency of migraines in adults and children. In 2012, the American Academy of Neurology recommended its use for preventing migraines. However, the Academy stopped recommending it in 2015 because of serious concerns about possible liver toxicity. If you are considering using butterbur, discuss its risks and benefits with your health care provider.

Coenzyme Q10

A 2021 review of 6 studies (371 total participants) in which coenzyme Q10 was compared with a placebo (an inactive substance) showed that coenzyme Q10 may help reduce the duration and frequency of migraines but not their severity. Because both the amount of evidence and the size of the effects observed in the studies were small, there are still uncertainties about whether coenzyme Q10 is helpful for migraines.

No serious side effects of coenzyme Q10 have been reported. Coenzyme Q10 may interact with some medications, including the anticoagulant (blood-thinning) medication warfarin and the diabetes drug insulin.

Feverfew

A 2020 review that included 7 studies (634 participants) of feverfew for migraine prevention found that the results of the studies were inconsistent.

Side effects of feverfew may include digestive disturbances, skin rash, and inflammation of the mouth. Feverfew may interact with medications.

Magnesium

A 2018 review of 5 studies (253 participants) found that magnesium was possibly effective in reducing the frequency of migraines. Three of the five studies showed evidence of benefits.

High doses of magnesium from dietary supplements or medicines can cause diarrhea, nausea, and stomach cramps, and very large doses can cause serious toxicity. Magnesium can interact with medicines, including some antibiotics, diuretics, and drugs used to treat osteoporosis. Because the amounts of magnesium people take for migraines are greater than the largest daily intake of magnesium from supplements and medicines that is considered safe, magnesium supplements for migraine should be used only under the supervision of a health care provider.

Riboflavin

A 2017 review looked at 9 studies (546 participants) of riboflavin supplementation to prevent migraine. Some of these studies used a rigorous design in which riboflavin was compared with a placebo; others didn’t. Some but not all of the studies indicated that riboflavin was helpful. Riboflavin supplementation seemed to be more useful in adults than in children.

No harmful effects from the use of riboflavin have been reported, and riboflavin is not known to interact with drugs.

Omega-3 Fatty Acids

The results of a recent study indicated that diets high in omega-3 fatty acids may be helpful for migraines. Omega-3s in supplement form have not been shown to reduce the frequency or severity of migraines, but a small amount of evidence suggests that they might reduce the duration of migraine attacks.

• In a 2021 study conducted by researchers from the National Institutes of Health in cooperation with other investigators, 182 adults with frequent migraines were assigned to one of these three test diets for 16 weeks:
  • A diet high in omega-3 fatty acids from high-fat fish and low in linoleic acid (an omega-6 fatty acid found in corn, soybean, and other vegetable oils, as well as some nuts and seeds)
  • A diet high in omega-3s but with as much linoleic acid as in the average U.S. diet
  • A control diet containing omega-3s and linoleic acid in the amounts found in the average U.S. diet

Compared to participants receiving the control diet, those in the two groups receiving higher amounts of omega-3s had fewer hours of headaches and fewer hours of moderate-to-severe headaches per day, as well as fewer days per month with headaches. The group that received a diet low in linoleic acid and high in omega-3s showed a greater decrease in headache days per month than the group who received the diet with average amounts of linoleic acid and high amounts of omega-3s. There were no significant differences among the groups in scores on a questionnaire that evaluates migraine-related quality of life, however.

• An analysis published in 2021 took advantage of data collected during a large study (the VITamin D and OmegA-3 TriaL [VITAL]), in which more than 25,000 middle-aged or older people were randomly assigned to receive omega-3 fatty acid (fish oil) supplements or placebos for 5 years to test the effects of omega-3s on the risk of developing heart disease and cancer. A total of 1,032 of the study participants reported a history of probable migraine and answered questions about changes in the frequency and severity of their migraines. The results showed that omega-3 supplementation did not affect migraine frequency or severity.
• A 2018 review of 5 smaller studies (382 total participants), 4 of which evaluated omega-3 supplements and 1 of which evaluated foods rich in omega-3s, found no effect of omega-3s on the frequency of migraines. The 3 studies (119 participants) that looked at severity of migraines also found no effect of omega-3s. However, the 2 studies (134 participants) that looked at the duration of migraines found evidence that migraines were significantly shorter in people taking omega-3s.

Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.

More To Consider

• Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, consult your (or your child’s) health care provider.
• Be aware that some dietary supplements may interact with conventional medical treatments.
• If you’re considering a practitioner-provided complementary health practice such as biofeedback or acupuncture, ask a trusted source (such as your health care provider or nearby hospital) to recommend a practitioner. Find out about the training and experience of any complementary health practitioner you’re considering.
• Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

If you live with migraine, one of the best things that you can do is to identify your personal triggers. You can’t always avoid triggers, but understanding what they are and how they affect you is the first step to finding relief. Once you’ve isolated the trigger, you can try a coping strategy.

1. Stress. Stress is one of the most common triggers among people with migraine.
   • How to cope: Unfortunately, stress isn’t always avoidable, but stress-relieving activities such as exercise, meditation, or yoga can help. Therapy can also help you learn new strategies for coping with stress; if you aren’t currently working with a therapist, ask your primary care doctor for a referral.
2. Hormones. Changes in hormones over the menstrual cycle and during pregnancy can trigger migraine attacks for some people.
   • How to cope: If you think there’s a link between your migraine attacks and your hormones, bring it up with your doctor. Some people get migraine relief with hormonal treatments such as birth control and hormone replacement therapy.
3. What you eat. Fermented or pickled foods, aged cheeses, and processed or cured meats (like hot dogs and lunch meats) can all be triggers, and so can some preservatives that are found in many foods.
   • How to cope: Talk with your doctor about your trigger foods. If you know what they are, consider removing them from your diet (or cutting down on them). If you’re not sure, ask your doctor about trying an elimination diet (an eating plan that removes all the foods or food groups that could impact your migraine attacks). Cutting all the suspected culprits out of your diet for a few weeks, then reintroducing them one at a time, can help narrow down which foods are likely to be triggers.
   • You could also try eating new foods. According to NIH research, diets that are low in vegetable oils and high in Omega-3 fatty acids (such as those found in fish) may help control migraine.
4. When you eat. Eating meals at different times of day or skipping a meal may also trigger migraine attacks or make them worse.
   • How to cope: Eat at the same time every day and try not to skip meals.
5. What you drink. Alcoholic beverages―especially wine―can trigger migraine attacks in some people. Too much coffee and even caffeine withdrawal can also be a trigger.
   • How to cope: Alcohol and coffee can dehydrate the body, which can trigger migraine attacks or make them worse. Try avoiding alcohol and gradually reducing your caffeine intake. Stay hydrated, practice moderation, and know your personal limits.
6. The weather. Sudden changes in the weather such as temperature, atmospheric pressure, and even seasonal changes can all trigger migraine attacks.
   • How to cope: Keep an eye on the weather forecast and try to avoid your other triggers, especially when a big weather change is coming. If you get lots of migraines when it’s hot outside, stay inside where it’s cool, and try to hydrate by drinking plenty of liquids (always a good idea).
7. Your sleep. Not getting enough sleep or sleeping too much can be a migraine trigger. A serious medical condition called sleep apnea is also associated with migraine.
   • How to cope: Try to get between seven and nine hours of sleep each night and talk to your doctor if you have concerns about your sleep or think you might have sleep apnea.
8. Your environment. Bright lights, loud noises, and strong smells can all be triggers, and they can make symptoms worse during an attack.
   • How to cope: Avoid or reduce your exposure to these triggers when you can and ask the people around you to help. Ask your office mate to leave their perfume or cologne at home, block bright outdoor light with dark sunglasses, and try wearing earplugs or noise-canceling headphones to muffle loud sounds.
9. Medication overuse. Some medications, including ones used to treat migraine, can cause or worsen migraine symptoms if you take them too often.
   • How to cope: Make sure you know the recommended dose and frequency for any medications you’re taking. If a medication you take is causing an increase in your migraine attacks, talk with your doctor about switching to a different drug.
10. Smoking and tobacco. The nicotine in cigarettes and e-cigarettes constricts blood vessels in your brain by making them narrower and tighter, which can trigger migraine attacks.
    • How to cope: If you smoke or use tobacco products, make a plan to quit. If you don’t use tobacco products, it’s always a good idea to stay away from secondhand smoke.