Headaches are one of the most common pain-related health problems in both children and adults. They can cause tension and pain in the head, face, or upper neck and can vary in frequency and intensity. While almost everyone has experienced a headache, and many are nothing to worry about, some headaches, such as migraines, are recurring and can be extremely painful.

Migraine headaches are pulsing, throbbing sensations, usually on one side of the head or behind an eye. According to the U.S. Department of Health & Human Services (HHS), migraine pain and symptoms affect 29.5 million Americans. Headaches can last from 4 to 72 hours and are often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. People with migraines tend to have recurring attacks triggered by several different factors, including stress, anxiety, emotional strain, hormonal changes, sinus problems, certain foods and beverages, smells, bright or flashing lights, lack of sleep, and medications, or dietary substances.

There is no absolute cure for migraine headaches, however, there are ways it can be treated and managed to help you feel better.

Here are some tips to help stop a migraine after it starts:

• Apply a cold, moist cloth or ice pack to your forehead and temples.
• Rest in a quiet, comfortable, dark room.
• Rub or apply pressure to the spot where you feel pain.
• Take medications exactly as prescribed by your doctor.
• Begin relaxation techniques as soon as your headache starts.

Below are tips to help prevent migraine headaches:

• Schedule an appointment with your doctor to get a prompt diagnosis and treatment of symptoms.
• Identify and avoid your headache triggers.
• Sit and stand with good posture to avoid muscle tension in your neck, shoulders, and lower back.
• Reduce eye strain from computers, tablets, and phones.
• Get regular exercise, quality sleep, and eat healthy foods on a regular schedule.
• Avoid alcohol, tobacco, and drugs.
• Reduce stress and headache pain with methods such as meditation, yoga, or cognitive positive thinking.

Migraine is a medical condition. Most people who suffer from migraines get headaches that can be quite severe. A migraine headache is usually an intense, throbbing pain on one, or sometimes, both sides of the head. Most people with migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved. Besides pain, migraine also can cause nausea and vomiting and sensitivity to light and sound. Some people also may see spots or flashing lights or have a temporary loss of vision.

Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days. Some people get migraines once or twice a week. Others, only once or twice a year. Most of the time, migraines are not a threat to your overall health. But migraine attacks can interfere with your day-to-day life.

We don't know what causes migraine, but some things are more common in people who have them:

• Most often, migraine affects people between the ages of 15 and 55.
• Most people have a family history of migraine or of disabling headache.
• They are more common in women.
• Migraine often becomes less severe and less frequent with age.

Migraine pain and symptoms affect 29.5 million Americans. Migraine is the most common form of disabling headache that sends patients to see their doctors.

Yes. About three out of four people who have migraines are women. Migraines are most common in women between the ages of 20 and 45. At this time of life women often have more job, family, and social duties. Women tend to report more painful and longer lasting headaches and more symptoms, such as nausea and vomiting. All these factors make it hard for a woman to fulfill her roles at work and at home when migraine strikes.

Migraine is a neurological condition (meaning that it’s a disease of the nervous system) that is associated with severe headaches and other symptoms in the nervous system and body. Migraine headaches can be very intense, often causing pain that throbs and pulses. Headaches aren’t the only symptom that can affect people with migraine: unlike other kinds of headaches (for example, tension and sinus headaches), they often come with other symptoms such as nausea, vomiting, and dizziness.

Migraine is common―about 12% of Americans have this condition. Migraine attacks happen in several stages, and untreated attacks usually last between 4 and 72 hours. They can be debilitating and may interfere with all areas of life: home, work, school, and beyond.

Symptoms

Migraine symptoms are different for different people. Some common symptoms include: 

• Headache (often on one side of the head, but sometimes on both sides) 
• Pain that gets worse when you move
• Nausea and sometimes vomiting 
• Being unusually sensitive to light, sounds, and smells
• Feeling weak or dizzy

The two most common types of migraine are:

• Migraine with aura. Migraine auras can include changes to your visual field such as flashing lights, zigzag lines, or blind spots, as well as nonvisual symptoms such as brain fog, a numb or tingling sensation, or changes to your senses of smell, taste, and touch. 
• Migraine without aura. Migraine without aura is the most common type. In these kinds of migraine attacks, you won’t experience aura but will have other migraine symptoms (for example, headache and nausea).

Causes

We don’t know exactly what causes migraine, but genes probably play a big role―most people with migraine have a family member who also has it.

Some people with migraine have different triggers. Common ones include: 

• Stress and anxiety
• Certain foods and beverages
• Changes in hormone levels
• Not getting enough sleep
• Skipping meals
• Sudden weather changes
• Medication overuse, which can be caused by long-term use of certain over-the-counter and prescription medications

Who can have migraine?

Anyone can have migraine, including children. Women are three times more likely than men to experience it.

Most people with migraine:

• Have their first attack before age 40
• Have a family member who also has migraine

People with medical diagnoses such as depression, anxiety, sleep disorders, and epilepsy may also be more likely to have migraine.

Diagnosis

Talk to your doctor if you’re having migraine-like symptoms. Your doctor will ask about your symptoms, your medical history, and your family’s health history. They may do some tests to find out whether the headaches have a cause other than migraine (like a sinus infection, muscle tension, or another medical disorder).

There is no cure for migraine, but there are pharmacological (drug-based) and nonpharmacological ways to make living with migraine easier.

Prevention

Sometimes migraine attacks can be prevented before they happen with a combination of medications and lifestyle changes.

Talk to your doctor about medications and therapies to prevent migraine attacks. Your doctor might recommend migraine-specific medications or antidepressants, blood pressure medicines, and antiseizure medicines. These are usually medicines that you need to take every day. Your doctor may also suggest certain vitamins or minerals that might help. 

Keep a migraine diary. Knowing your triggers is a first step to learning how to cope with migraine. Use a diary to keep track of when you’re having migraine attacks and what’s happening around that time to identify your personal triggers. When you have a migraine attack, write down:

• When the pain started (day and time)
• What you were doing when the pain started
• What you ate and drank in the 24 hours before the attack
• How many hours you slept the previous night
• The symptoms you had during the attack
• What you did during the attack, including any medicines you took
• When the pain stopped

Treatment

Treating symptoms as soon as you feel an attack coming on can keep them from getting worse. Your doctor can help you find a treatment―or a combination of treatments―that works for you. 

• Over-the-counter pain relievers such as ibuprofen, acetaminophen, and aspirin can help with milder symptoms. 
• Prescription medicines, including medications that relieve or prevent migraine symptoms, may also be used to address migraine. The most common classes of drugs are called “triptans” and “CGRP antagonists” (CGRP stands for calcitonin gene-related peptide). These drugs come in different forms such as nasal sprays, dissolvable tablets, and shots.
• Medical devices such as peripheral nerve and vagus nerve simulators can help treat migraine by targeting the nerves that contribute to migraine symptoms.

Be aware that taking medications too frequently (more than twice a week) can make migraine worse.

You can also get relief during an attack by: 

• Resting in a quiet, dark room 
• Closing your eyes
• Cooling your forehead with a wet cloth or an ice pack
• Drinking lots of liquids

With the right combination of prevention and treatment, most people can find some relief.

By the numbers

• 1 billion people worldwide have migraine
  • 1 in 5 women
  • 1 in 16 men
  • 1 in 11 children

Yes, there are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.

Migraine with aura (previously called classical migraine). With a migraine with aura, a person might have these sensory symptoms (the so-called "aura") 10 to 30 minutes before an attack:

• Seeing flashing lights, zigzag lines, or blind spots
• Numbness or tingling in the face or hands
• Disturbed sense of smell, taste, or touch
• Feeling mentally "fuzzy"

Only one in five people who get migraine experience an aura. Women have this form of migraine less often than men.

Migraine without aura (previously called common migraine). With this form of migraine, a person does not have an aura but has all the other features of an attack.

The exact cause of migraine is not fully understood. Most researchers think that migraine is due to abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they can cause inflammation. This inflammation then causes blood vessels in the brain to swell and press on nearby nerves, causing pain.

Genes also have been linked to migraine. People who get migraines may have abnormal genes that control the functions of certain brain cells.

Experts do know that people with migraines react to a variety of factors and events, called triggers. These triggers can vary from person to person and don't always lead to migraine. A combination of triggers — not a single thing or event — is more likely to set off an attack. A person's response to triggers also can vary from migraine to migraine. Many women with migraine tend to have attacks triggered by:

• Lack of or too much sleep
• Skipped meals
• Bright lights, loud noises, or strong odors
• Hormone changes during the menstrual cycle
• Stress and anxiety, or relaxation after stress
• Weather changes
• Alcohol (often red wine)
• Caffeine (too much or withdrawal)
• Foods that contain nitrates, such as hot dogs and lunch meats
• Foods that contain MSG (monosodium glutamate), a flavor enhancer found in fast foods, broths, seasonings, and spices
• Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, and Chianti wine
• Aspartame (NutraSweet^® and Equal^®)

To pinpoint your migraine triggers, keep a headache diary. Each day you have a migraine headache, put that in your diary. Also write down the:

• The time of day your headache started
• Where you were and what you were doing when the migraine started
• What you ate or drank 24 hours before the attack
• Each day you have your period, not just the first day  (This can allow you and your doctor to see if your headaches occur at the same or similar time as your period.)

Talk with your doctor about what sets off your headaches to help find the right treatment for you.

More than half of migraines in women occur right before, during, or after a woman has her period. This often is called "menstrual migraine." But, just a small fraction of women who have migraine around their period only have migraine at this time. Most have migraine headaches at other times of the month as well.

How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because estrogen controls chemicals in the brain that affect a woman's pain sensation.

Talk with your doctor if you think you have menstrual migraine. You may find that medicines, making lifestyle changes, and home treatment methods can prevent or reduce the pain.

If your migraine headaches are closely linked to your menstrual cycle, menopause may make them less severe. As you get older, the nausea and vomiting may decrease as well. About two-thirds of women with migraines report that their symptoms improve with menopause.

But for some women, menopause worsens migraine or triggers them to start. It is not clear why this happens. Menopausal hormone therapy, which is prescribed for some women during menopause, may be linked to migraines during this time. In general, though, the worsening of migraine symptoms goes away once menopause is complete.

In some women, birth control pills improve migraine. The pills may help reduce the number of attacks and their attacks may become less severe. But in other women, the pills may worsen their migraines. In still other women, taking birth control pills has no effect on their migraines.

The reason for these different responses is not well understood. For women whose migraines get worse when they take birth control pills, their attacks seem to occur during the last week of the cycle. This is because the last seven pills in most monthly pill packs don't have hormones; they are there to keep you in the habit of taking your birth control daily. Without the hormones, your body's estrogen levels drop sharply. This may trigger migraine in some women.

Talk with your doctor if you think birth control pills are making your migraines worse. Switching to a pill pack in which all the pills for the entire month contain hormones and using that for three months in a row can improve headaches. Lifestyle changes, such as getting on a regular sleep pattern and eating healthy foods, can help too.

Yes. Stress can trigger both migraine and tension-type headache. Events like getting married, moving to a new home, or having a baby can cause stress. But studies show that everyday stresses — not major life changes — cause most headaches. Juggling many roles, such as being a mother and wife, having a career, and financial pressures, can be daily stresses for women.

Making time for yourself and finding healthy ways to deal with stress are important. Some things you can do to help prevent or reduce stress include:

• Eating healthy foods
• Being active (at least 30 minutes most days of the week is best)
• Doing relaxation exercises
• Getting enough sleep

Try to figure out what causes you to feel stressed. You may be able to cut out some of these stressors. For example, if driving to work is stressful, try taking the bus or subway. You can take this time to read or listen to music, rather than deal with traffic. For stressors you can't avoid, keeping organized and doing as much as you can ahead of time will help you to feel in control.

Women who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you're caught in a rebound cycle.

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.

Sometimes, headache can signal a more serious problem. You should talk to your doctor about your headaches if:

• You have several headaches per month and each lasts for several hours or days
• Your headaches disrupt your home, work, or school life
• You have nausea, vomiting, vision, or other sensory problems (such as numbness or tingling)
• You have pain around the eye or ear
• You have a severe headache with a stiff neck
• You have a headache with confusion or loss of alertness
• You have a headache with convulsions
• You have a headache after a blow to the head
• You used to be headache-free, but now have headaches a lot

Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:

In addition to my sinus symptoms, do I have:

1. Moderate-to-severe headache
2. Nausea
3. Sensitivity to light

If you answer “yes” to two or three of these questions, then most likely you have migraine with sinus symptoms. A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.

Compared with migraine, tension-type headache is generally less severe and rarely disabling. Compare your symptoms with those in this chart to see what type of headache you might be having.

Note: Rebound headache may have features of tension and/or migraine headache. Adapted from a table produced by the American Council for Headache Education.

Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body's hormone levels, and even changes in the weather.

There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension-type headaches for most people.

You can't tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.

If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:

1. How often you have headaches
2. Where the pain is
3. How long the headaches last
4. When the headaches happen, such as during your period
5. Other symptoms, such as nausea or blind spots
6. Any family history of migraine
7. All the medicines that you are taking for all your medical problems, even the over-the-counter medicines (better still, bring the medicines in their containers to the doctor)
8. All the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had

Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose migraine just from the information you provide.

You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches. Work with your doctor to decide on the best tests for you.

Migraine has no cure. But your migraines can be managed with your doctor's help. Together, you will find ways to treat migraine symptoms when they happen, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods.

Medicine. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called "abortive" or "acute" treatment) and prevention. Many people with migraine use both forms of treatment.

Acute treatment. Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don't work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:

• Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex^®), rizatriptan (Maxalt^®), zolmitriptan (Zomig^®), almotriptan (Axert^®), eletriptan (Relpax^®), naratriptan (Amerge^®), and frovatriptan (Frova^®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure.
• Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.

Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful “rescue” drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.

Prevention. Some medicines used daily can help prevent attacks. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Some examples are:

• Antidepressants, such as amitriptyline (Elavil^®) or venlafaxine (Effexor^®)
• Anticonvulsants, such as divalproex sodium (Depakote^®) or topiramate (Topamax^®)
• Beta-blockers, such as propranolol (Inderal^®) or timolol (Blocadren^®)
• Calcium channel blockers, such as verapamil

These drugs may not prevent all migraines, but they can help a lot. Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle. Ask your doctor about prevention drugs if:

• Your migraines do not respond to drugs for symptom relief
• Your migraines are disabling or cause you to miss work, family activities, or social events
• You are using pain-relief drugs more than two times a week

Lifestyle changes. Practicing these habits can reduce the number of migraine attacks:

• Avoid or limit triggers.
• Get up and go to bed the same time every day.
• Eat healthy foods and do not skip meals.
• Engage in regular physical activity.
• Limit alcohol and caffeine intake.
• Learn ways to reduce and cope with stress.

Alternative methods. Biofeedback has been shown to help some people with migraine. It involves learning how to monitor and control your body's responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling also can help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.

Some migraine medicines should not be used when you are pregnant because they can cause birth defects and other problems. This includes over-the-counter medicines, such as aspirin and ibuprofen. Talk with your doctor if migraine is a problem while you are pregnant or if you are planning to become pregnant. Your doctor might suggest a medicine that will help you and that is safe during pregnancy. Home treatment methods, such as doing relaxation exercises and using cold packs, also might help ease your pain. The good news is that for most women migraines improve or stop from about the third month of the pregnancy.

Ask your doctor about what migraine medicines are safe to take while breastfeeding. Some medicines can be passed through breast milk and might be harmful to your baby.

Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:

• If you take migraine medicine, take it right away.
• Drink fluids, if you don't have nausea during your migraine.
• Lie down and rest in a dark, quiet room, if that is practical.

Some people find the following useful:

• A cold cloth on your head
• Rubbing or applying pressure to the spot where you feel pain
• Massage or other relaxation exercises

The best way to prevent migraine is to find out what triggers your attacks and avoid or limit these triggers. Since migraine headaches are more common during times of stress, finding healthy ways to cut down on and cope with stress might help. Talk with your doctor about starting a fitness program or taking a class to learn relaxation skills.

Talk with your doctor if you need to take your pain-relief medicine more than twice a week. Doing so can lead to rebound headaches. If your doctor has prescribed medicine for you to help prevent migraine, take them exactly as prescribed. Ask what you should do if you miss a dose and how long you should take the medicine. Talk with your doctor if the amount of medicine you are prescribed is not helping your headaches.