This topic is about migraine headaches. If you are looking for information about tension headaches, see Tension Headaches.
If you are looking for information about headaches in children, see Headaches in Children.
Migraines are painful, throbbing headaches that last from 4 to 72 hours. When you have a migraine, it may be so painful that you are not able to do your usual activities. But even though migraines make you feel bad, they don't cause long-term damage.
Migraines are a health problem that can be treated. Talk to your doctor about your migraines.
Experts are not sure what causes migraines.
Migraines run in families, but it isn't clear why some people get migraines and others don't.
Some things can cause a migraine to start. These are called triggers. Your triggers may be different from someone else's. Some common triggers include:
The main symptom of a migraine is a throbbing headache on one side of your head. You also may feel sick to your stomach and vomit. Activity, light, noise, or odors may make the migraine worse. The pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Different people have different symptoms.
Some people have an aura before the migraine begins. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before the headache. But most people don't have auras.
A doctor can usually tell if you have a migraine by asking about your symptoms and examining you. You probably will not need lab tests, but your doctor may order some if he or she thinks your symptoms are caused by another disease.
You can't cure migraines. But medicines and other treatments may help you feel better and limit how often you get migraines.
At first, your doctor may want you to try an over-the-counter pain medicine, such as acetaminophen, aspirin, ibuprofen, or naproxen. Brand names include Advil, Aleve, Bayer, and Tylenol. Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine. Be safe with medicines. Read and follow all instructions on the label.
If these medicines don't work, your doctor can prescribe stronger medicine to stop the migraine. Your doctor also may prescribe medicine to prevent migraines.
You may not be able to use some medicines if you are pregnant or have other health problems, such as heart problems.
If the first medicine doesn't work, ask your doctor if you can try something else. It may take time to find what works best for you.
Some people also use other kinds of treatments, such as acupuncture. These may help reduce the pain or the number of migraines you have.
When you feel a migraine coming on:
Be careful when you use your migraine medicines. Taking them too often can cause you to get another headache when you stop taking the medicine. This is called a rebound headache. If you are taking headache medicine more than 2 days a week, or if you get more than 3 headaches a month, talk to your doctor.
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Experts aren't sure what causes migraines.
They run in families, and experts have found a genetic link. But it isn't clear why some people get migraines and others don't.
Certain things can bring on a migraine. These are called triggers. Your triggers may be different from someone else's. Having several triggers increases the chance you will get migraines.
Some common triggers include:
The most common symptom of a migraine headache is a throbbing pain on one side of your head. You also may have other symptoms before, during, and after a migraine. Different people have different symptoms.
A day or two before a migraine starts, you may feel:
About 1 out of 5 people has a warning sign of a migraine called an aura. It usually starts about 30 minutes before the headache starts. During an aura, you may:
Symptoms can include:
Less common symptoms include:
If you have these less-common symptoms and have not had them before, call your doctor right away so that he or she can make sure you aren't having a transient ischemic attack (TIA), stroke, or other serious problem.
Without treatment, a migraine headache can last from 4 to 72 hours.
After the headache stops, you may have muscle aches or feel very tired. These symptoms may last up to a day after your migraine ends.
You may have one or more types of migraine headache. Each type has its own features. For example, some people get migraines with an aura. Some get them without an aura. Some women get menstrual migraines, which happen before, during, or shortly after their menstrual period.
It can be hard to tell the difference between a migraine and another type of headache, such as a tension or sinus headache. You may think that you have sinus headaches. But it's more likely that they are migraine headaches if they happen often and interfere with your daily life.
Migraines can occur along with many other health problems, such as asthma or depression. More serious conditions, such as tumors or infections, can also cause migraine symptoms. But most headaches are not caused by serious health problems.
Call 911 or other emergency services if:
Call your doctor now or go to the emergency room if:
Watch closely for changes in your health, and be sure to contact your doctor if:
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.
Your doctor will diagnose a migraine by examining you and asking questions about your health and lifestyle. There are no tests that can prove that you have migraines.
Migraines can be hard to diagnose, because their symptoms are like those of other types of headaches. For example, many people have been diagnosed with sinus headaches when they actually have migraines.
It's likely that you are having migraine headaches if they happen often and interfere with your daily life.
Your doctor may use the International Headache Society's guidelines to diagnose migraines. You may be diagnosed if ALL of these are true:footnote 1
Your doctor will check your symptoms and decide if you need to have tests to find out if your headaches are caused by another health problem. Tests may include:
You can't cure migraines, but you can use medicines and other treatments to feel better.
The goal of treatment is to reduce how often you get migraines and to stop the headaches with the fewest drug side effects. Your doctor may have you try several types of medicines and may adjust the doses to manage your migraines.
Keeping a headache diary is a good way to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. You look for patterns to your headaches. This information can help you know what to avoid to prevent a migraine.
You may take:
For mild to moderate migraines, you may first want to try over-the-counter pain relievers that have fewer side effects and cost less than other medicines. But if they don't help, you may need prescription medicines. Be safe with medicines. Read and follow all instructions on the label.
If medicines to stop a migraine don't give you enough relief, or if you're taking them more than 2 times a week, talk to your doctor about whether you should take medicines to prevent a migraine.
You may want to try complementary treatments along with medicines. These may include:
For more information, see Other Treatment.
If you decide to try one or more of these treatments, make sure your doctor knows. He or she may have advice on how to use other treatments safely.
How you think can affect how you feel. So finding ways to relax and change your negative or worrisome thoughts may help prevent headaches.
You may want to try:
For more information, see Living With Migraine Headaches.
If treatment doesn't stop your migraines, you and your doctor may make changes. You may try different medicines, a new mix of medicines, or different doses.
If you have already tried several types of medicine, your doctor may want you to have tests (such as an MRI or CT scan) to look for any other cause for your headaches.
It is possible to be diagnosed with migraines when you really have another type of headache. (But it's more common for a person to be diagnosed with another type of headache when he or she really has migraines.)
It can be hard to tell the difference between migraines and other types of headaches such as sinus, tension, or cluster headaches. The symptoms can be the same. And you may have more than one kind of headache. Different types of headaches need different treatment.
You may be able to have fewer migraines by finding out what brings on (or triggers) your headaches and then avoiding those triggers.
Migraine triggers include certain foods and stress. Some common triggers are:
Keeping a headache diary can help you find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. This information can help you find and avoid your triggers.
Having a daily routine is one of the best ways to avoid migraines. For example, try to eat at the same times every day, and go to sleep at a regular time. Changes from your routine, such as skipping meals or staying up really late, could lead to a migraine.
Triggers add up, so the fewer triggers you have at one time, the better your chance of preventing a migraine. That doesn't mean that you can't go outside if hot weather often triggers your migraines. But on a hot day, you might avoid red wine or chocolate if those also are triggers for your headaches.
Your doctor may also prescribe drugs to help prevent migraine headaches.
You may have fewer migraines—and less pain when you do get them—by trying to:
You can reduce how many migraines you have by finding out what triggers your migraines and avoiding those things. Triggers may include food, alcohol, hot weather, and changes to your routine.
Keep a headache diary to find your triggers. You write down when you have a headache and how bad it is, along with details such as what you ate and what you did before the headache started. This information can help you find and avoid the things that bring on your headaches.
The information you put in your headache diary can also help your doctor find the best treatment for you. Finding the right treatment can help you have fewer headaches. And the headaches you do get may not be as bad.
One Woman's Story:
"I always used to wait too long to take my medicine. Now I take it as soon as I start to feel the twinges of pain."— Carole
Read more about how Carole changed the way she treated her migraines.
The best way to stop a migraine is to take your medicine at the first sign of a headache. You might think you can stop the migraine by lying down and being quiet or doing relaxation exercises. But if a migraine has started, it's probably too late for those other methods to work by themselves.
You may be able to have fewer headaches by taking prescription medicine to prevent migraines. But taking this medicine doesn't mean that you'll never get a migraine.
Migraine headaches are more common during stressful times or right after a stressful time ends.
You can lower your stress with positive thinking and relaxation methods. Research shows that you can change how you think. And how you think affects how you feel. Try these techniques on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy.
You also can learn to stop thinking all the time about things that bother you.
Two kinds of medicines are used to treat 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 drug that causes the fewest side effects. Drugs 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. Read and follow all instructions on the label.
Medicines to stop a migraine
If your migraines are mild to moderate, you may need only an over-the-counter drug to stop the pain. Most doctors recommend that you try these drugs first, because they may have fewer side effects than prescription drugs. If over-the-counter drugs don't stop your headaches, your doctor may prescribe other medicine.
Your doctor may suggest that you take a mix of medicines to stop a headache. For example, you may take acetaminophen or naproxen along with a prescription medicine, such as a triptan.
Drugs used to stop a migraine include:
Medicines to prevent a migraine
Drugs used to prevent migraines include:
You may want to try medicine to prevent a headache if:
Taking medicine too often to stop a migraine can cause more headaches. These rebound headaches are different from migraine headaches. They usually start after pain medicine wears off, which leads you to take another dose. After a while, you get a headache whenever you stop taking the drug.
Talk to your doctor if you are taking headache medicine more than 2 days a week. Take your medicine as prescribed by your doctor.
Some people find that complementary treatments reduce how many migraines they have or how bad the migraines are.
If you are thinking about trying a complementary treatment, get the facts first. Discuss these questions with your doctor:
Talk to your doctor if you decide to try:
For people who haven't been able to reduce the number of or control their headaches with medicine, stimulation of certain nerves in the head with mild electric current may help. If you have severe and frequent migraines and have not been able to control them with medicine, you may want to ask your doctor if this kind of treatment is available in your area.
- Headache Classification Committee of the International Headache Society (2013). The international classification of headache disorders, 3rd ed. (beta version). Cephalalgia, 33(9): 629–808. DOI: 10.1177/0333102413485658. Accessed February 1, 2016.
- Linde K, et al. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews, (3). DOI: 10.1002/14651858.CD001218.pub3. Accessed July 22, 2016.
- Holland S, et al. (2012). Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology, 78(17): 1346–1353.
- Haghighi AB, et al. (2010). Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: A randomised, double-blind, placebo-controlled, crossed-over study. International Journal of Clinical Practice, 64(4): 451–456.
Other Works Consulted
- Drugs for migraine (2013). Treatment Guidelines From The Medical Letter, 11(136): 107–112.
- Goadsby PJ, Sprenger T (2010). Current practice and future directions in the prevention and acute management of migraine. Lancet Neurology, 9(3): 285–298.
- Law S, et al. (2013). Sumatriptan plus naproxen for acute migraine attacks in adults. Cochrane Database of Systematic Reviews (10).
- Pittler MH, Ernst E (2004). Feverfew for preventing migraine. Cochrane Database of Systematic Reviews (1).
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