What is Migraine?
Migraine is a neurological condition causing recurrent attacks of moderate to severe headache, often one-sided and throbbing, with nausea and sensitivity to light and sound. Attacks typically last 4 to 72 hours and worsen with routine activity. About a third of people experience aura — reversible visual or sensory symptoms before or during the headache.
Key takeaways
- Migraine is a brain disorder involving nerve and vascular pathways, not simply a severe tension headache.
- Attacks have phases: prodrome, aura in some people, headache, and postdrome — recognising the earliest phase helps timing of treatment.
- Treating an attack early, at mild pain, works substantially better than waiting.
- Using acute medication more than about 10-15 days a month can cause medication-overuse headache.
- CGRP-targeted treatments have significantly expanded both acute and preventive options in recent years.
Overview
Migraine affects roughly one in seven people worldwide and is a leading cause of years lived with disability, particularly in women aged 15 to 49. Describing it as a headache understates it considerably. An attack is a whole-brain event involving abnormal excitability of neurons, activation of the trigeminal nerve pathway, and release of signalling molecules — most notably calcitonin gene-related peptide, or CGRP — that produce inflammation around blood vessels in the meninges and transmit pain.
Attacks unfold in phases. A prodrome hours to a day beforehand may bring yawning, food cravings, neck stiffness, mood change, or fatigue. Around a third of people then experience aura: reversible neurological symptoms, usually visual, developing over minutes and lasting under an hour. The headache phase follows, often one-sided and throbbing with nausea and light and sound sensitivity, and a postdrome leaves many people drained and foggy for a day afterward. Recognising these phases is practically useful, because treating early makes a substantial difference.
What Migraine is
Migraine without aura requires at least five attacks lasting 4-72 hours untreated, with at least two of: one-sided location, pulsating quality, moderate or severe intensity, or aggravation by routine physical activity — plus either nausea or vomiting, or sensitivity to both light and sound. Migraine with aura requires at least two attacks with reversible aura symptoms developing gradually over five minutes or more and lasting under 60 minutes.
Chronic migraine means headache on 15 or more days a month for more than three months, with migraine features on at least eight of those days. Distinguishing episodic from chronic matters because chronic migraine warrants preventive treatment and specific therapies. Medication-overuse headache is a common and reversible contributor to chronification.
Common symptoms
Migraine symptoms extend well beyond head pain and vary between attacks and between people.
- Moderate to severe headache, often one-sided and throbbing or pulsating
- Worsening with routine physical activity such as climbing stairs
- Nausea, sometimes with vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
- Attacks lasting 4-72 hours when untreated
- A need to lie down in a dark, quiet room
- Neck pain or stiffness, often before or during the attack
Less common symptoms
- Visual aura — zigzag lines, flickering lights, or a blind spot expanding over minutes
- Sensory aura — tingling spreading up an arm and into the face
- Speech difficulty during aura
- Sensitivity to smells, or skin tenderness on the scalp (allodynia)
- Vertigo or dizziness (vestibular migraine)
- Postdrome exhaustion, difficulty concentrating, and mood change for up to a day afterward
Risk factors
- Female sex — migraine is roughly three times more common in women, linked to hormonal fluctuation
- Family history — a strong genetic component, with most people having an affected relative
- Age between 20 and 50, when prevalence peaks
- Hormonal changes — menstruation, oral contraceptives, pregnancy, and perimenopause commonly alter patterns
- Sleep disruption — both too little and too much sleep are common triggers
- Stress, and notably the let-down period after stress rather than the stress itself
- Skipped meals and dehydration
- Depression, anxiety, and other chronic pain conditions — frequently coexist
- Overuse of acute headache medication — a leading cause of episodic migraine becoming chronic
Causes
Migraine is a genetically influenced disorder of brain excitability. Between attacks the brain of someone with migraine processes sensory input differently, with reduced habituation to repeated stimuli. An attack begins with activation of the hypothalamus and brainstem, which explains prodromal symptoms such as yawning and food craving. Aura corresponds to cortical spreading depression — a slow wave of neuronal activity followed by suppression moving across the cortex.
The headache phase involves the trigeminovascular system: activation of trigeminal nerve fibres supplying the meninges, release of CGRP and other peptides, dilation of vessels, and sensitisation of pain pathways. That last mechanism is why CGRP-targeted drugs work and why treating early — before central sensitisation is established — is more effective than treating late.
How it is diagnosed
Migraine is a clinical diagnosis based on the pattern of attacks; imaging is used to exclude other causes when red flags are present.
| Test or assessment | What it looks at |
|---|---|
| Clinical history against diagnostic criteria | Attack frequency, duration, features, and associated symptoms assessed against the International Classification of Headache Disorders criteria. This is the diagnosis. |
| Headache diary | Recording dates, duration, severity, triggers, and medication use. Essential for identifying medication overuse and measuring whether preventive treatment is working. |
| Neurological examination | Should be normal between attacks. Abnormal findings prompt further investigation rather than a migraine diagnosis. |
| Brain MRI or CT | Not routine. Indicated for red flags such as sudden severe onset, new headache after 50, progressive worsening, abnormal examination, or headache with fever and neck stiffness. |
| Blood tests | Selected tests such as inflammatory markers when giant cell arteritis is a consideration in people over 50, or thyroid function where relevant. |
| Assessment for coexisting conditions | Sleep disorders, depression, anxiety, and neck problems commonly accompany migraine and influence treatment. |
Treatment overview
Treatment has two arms: stopping individual attacks and reducing how often they happen. The categories below describe available classes; specific choices and all dosing decisions belong with your clinician.
Acute treatment — simple analgesics
NSAIDs and acetaminophen, sometimes with an antiemetic, work best when taken early in an attack. Frequency of use must be monitored to avoid medication-overuse headache.
Acute treatment — triptans
Migraine-specific serotonin receptor agonists that are effective for many people. They have cardiovascular contraindications that a prescriber assesses.
Acute treatment — gepants and ditans
Newer CGRP receptor antagonists and a selective serotonin 1F agonist, useful for people who cannot take triptans or do not respond to them.
Preventive medication classes
Beta blockers, certain antidepressants, antiseizure medicines such as topiramate, and candesartan. Choice is guided by other conditions and side-effect profile.
CGRP-targeted prevention
Monthly or quarterly monoclonal antibody injections and daily oral gepants, developed specifically for migraine prevention.
Procedural options
OnabotulinumtoxinA injections for chronic migraine, nerve blocks, and neuromodulation devices applied to the head or neck.
Behavioural and lifestyle treatment
Regular sleep and meals, aerobic exercise, cognitive behavioural therapy, biofeedback, and relaxation training all have supporting evidence for reducing frequency.
Lifestyle considerations
- Treat attacks early, at mild pain, rather than waiting to see whether it becomes severe.
- Keep a headache diary, including how many days a month you take acute medication.
- Limit acute medication to fewer than 10-15 days a month depending on the type, to avoid medication-overuse headache.
- Keep sleep and wake times consistent, including at weekends — irregular sleep is a leading trigger.
- Eat regularly and stay hydrated; skipped meals are a common and easily fixed trigger.
- Build in regular aerobic exercise, which reduces attack frequency in trials.
- Track triggers honestly rather than assuming — chocolate cravings, for instance, are often a prodrome symptom rather than a cause.
- Manage stress deliberately, and expect attacks during the let-down period after stress as well as during it.
Prevention
- Use preventive treatment if you have four or more migraine days a month, or fewer but disabling attacks.
- Maintain regular sleep, meals, hydration, and exercise — the fundamentals genuinely reduce frequency.
- Avoid medication overuse, which is one of the most common reversible causes of worsening migraine.
- Identify and manage your personal triggers rather than following generic avoidance lists.
- Treat coexisting depression, anxiety, and sleep disorders.
- Discuss hormonal patterns with your clinician if attacks cluster around menstruation.
- If you have migraine with aura, discuss estrogen-containing contraception and smoking with your clinician, since both affect stroke risk.
Warning signs and when to get help
Signs that need emergency care
If you believe you are experiencing a medical emergency, call emergency services immediately (911 in the United States).
- A sudden severe headache reaching maximum intensity within seconds to a minute — a thunderclap headache requires emergency assessment
- Headache with fever, neck stiffness, rash, or confusion — possible meningitis
- Sudden face droop, arm weakness, or speech difficulty — BE-FAST stroke signs, call emergency services
- Headache after a head injury, particularly with vomiting or drowsiness
- New weakness, numbness, or vision loss that does not resolve within an hour
- Headache with a seizure, or a first ever severe headache after age 50
Signs that warrant a prompt appointment
These are not emergencies, but they are worth a call to your clinician rather than a wait-and-see.
- A distinct change in your usual headache pattern, severity, or frequency
- Aura lasting longer than an hour, or aura occurring for the first time
- Headaches on 15 or more days a month
- Needing acute medication on more than 10 days a month
- Headache consistently worse when lying down, coughing, or straining
- Headache with new visual changes or persistent vomiting
Questions to ask a healthcare professional
Take these to your next appointment — or build an agenda with the Appointment Prep tool.
- Do my attacks meet the criteria for migraine, and is there aura?
- How many days a month am I taking acute medication, and is that too many?
- Should I be on preventive treatment?
- Which preventive option fits best with my other conditions?
- What should I do if my usual acute medicine does not work?
- Are my hormonal patterns relevant, and does that affect contraception choices?
- Do I need brain imaging, and why or why not?
- Would CBT, biofeedback, or a neuromodulation device be available to me?
Frequently asked questions
What is the difference between a migraine and a bad headache?
Migraine is a neurological condition with characteristic features: moderate to severe pain often one-sided and throbbing, worsening with routine activity, plus nausea or sensitivity to light and sound, lasting 4-72 hours. Tension-type headache is usually bilateral, pressing rather than throbbing, and not worsened by activity.
What is migraine aura?
Reversible neurological symptoms that develop gradually over five minutes or more and usually last under an hour — most often visual, such as zigzag lines or an expanding blind spot, sometimes tingling that spreads up the arm, or speech difficulty. Aura occurring for the first time should be evaluated.
Can painkillers make migraines worse?
Yes. Taking acute headache medication too frequently — generally more than 10 days a month for triptans and combination analgesics, or 15 days for simple analgesics — can cause medication-overuse headache, turning episodic migraine into a near-daily problem. It is reversible, but usually needs a structured plan with your clinician.
Does chocolate trigger migraines?
Less often than assumed. Craving sweet foods is a common prodrome symptom appearing hours before the headache, so chocolate is frequently a consequence of the attack starting rather than its cause. A headache diary is the way to test your own triggers rather than relying on general lists.
Is migraine linked to stroke risk?
Migraine with aura is associated with a modest increase in ischemic stroke risk, which is amplified by smoking and by estrogen-containing contraception. The absolute risk remains low for most people, but it is worth an explicit conversation with your clinician about contraception and smoking.
When should I consider preventive treatment?
Generally when you have four or more migraine days a month, when attacks are severely disabling even if less frequent, or when acute treatment is not working well or is being used too often. Preventives aim to reduce frequency and severity rather than eliminate attacks entirely.
Sources
- NINDS — Migraine — NIH neurological overview and research
- American Migraine Foundation — Patient resources on treatment, triggers, and diaries
- MedlinePlus — Migraine — Consumer summary and treatment links
- Mayo Clinic — Migraine — Symptom, phase, and treatment reference
Health Captain links to primary public-health and clinical sources so you can read the original material yourself. See our sources policy.