Migraines are extremely painful, recurring headaches that are sometimes accompanied by other symptoms, such as visual disturbances, for example, seeing an aura or nausea. There are 2 types of migraine:
If you have a migraine with aura, you may see things, such as stars, or zigzag lines, or have a temporary blind spot about 30 minutes before the headache starts. Even if you do not experience an aura, you may have other warning signs in the period before the headaches starts, such as a craving for sweets, thirst, sleepiness, or depression.
Although there is no cure for migraines, you can manage the condition by reducing the frequency of attacks and reducing pain once an attack starts.
Signs and Symptoms
The headache from a migraine, with or without aura, has the following characteristics:
These symptoms may happen at the same time or before the headache:
Symptoms that may linger even after the headache is gone:
Researchers are not sure what causes a migraine, but they know it involves changes in the blood flow to the brain. At first, blood vessels narrow or constrict, reducing blood flow and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. Later, the blood vessels dilate or enlarge, leading to increased blood flow and a severe headache.
There also seems to be a genetic link to migraine headaches. More than half of people with migraines have an affected family member. Migraine triggers can include the following:
Your doctor will take a detailed medical history so he or she can determine whether you have a migraine or another kind of headache, such as a tension or sinus headache. Your doctor will ask questions about when your headaches occur, how long they last, how often they come on, the location of the pain, and any symptoms that accompany or precede the headaches. Sometimes it helps to keep a diary about your headaches before seeing the doctor, so you'll have an accurate recording of how often they happen. (See Lifestyle section for what information to include in a diary.)
Tests your doctor may order, depending on your symptoms and exam, include:
Call 911 or go to the emergency room if you have the following symptoms:
These may indicate a stroke, a bleed in the brain, or other serious condition.
Treatment for migraines is aimed at preventing them from happening and reducing pain once an attack starts.
You can control your migraines with a combination of medications, lifestyle changes, and complementary therapies. Biofeedback (see also: Mind-body medicine) may help control the initial contraction of blood vessels. Relaxation techniques may reduce both the frequency and intensity of attacks.
Keeping a migraine diary, particularly when you first begin to have migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine happens, write down the date and time it started. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.
Other lifestyle measures that may reduce the number of migraines include:
Once a headache or migraine symptoms begin, it helps to:
Medications for migraines can be classified in two major categories: those designed to prevent attacks, and those designed to relieve pain.
Drugs for Prevention
Your doctor may prescribe medications to prevent migraines if you have 2 or more migraines per month, use pain relievers more than twice a week, or if your symptoms are especially debilitating. Depending on your condition and medication, your doctor may recommend taking the medication daily or when a known trigger is about to happen.
Beta-blockers. Also used to treat heart disease; researchers are not sure why they work for migraines, although they may help keep blood vessels in the brain from constricting and dilating. Beta-blockers include:
Calcium-channel blockers. Another heart disease drug that can help prevent migraines, including:
Antidepressants. Tricyclic antidepressants are helpful in preventing all kinds of headaches, including migraines. Tricyclic antidepressants include:
Anticonvulsants. Some antiseizure drugs help prevent migraines, although researchers are not sure why:
Botox. Botox, a medication made from a purified form of botulinum toxin, has been approved to treat migraines. Researchers are not sure why it helps some people. To treat migraines, Botox is given as a series of injections in the forehead, temples, back of the neck, and shoulders. Injections are given about every 3 months.
Drugs for Treatment
To work, these medications should be taken as soon as you feel a migraine coming on.
Triptans. These medications are often the first ones prescribed to relieve pain, nausea, and sensitivity to light and sound. They work by constricting the blood vessels in the brain. Triptans include:
Ergots. Ergots also work by constricting blood vessels, but tend to have more side effects than triptans. Ergots include:
Isometheptene, dichloralphenazone, and acetaminophen (Midrin). Midrin combines a pain reliever (acetaminophen) and sedative (dichloralphenazone) with a medication that constricts blood vessels (isometheptene) to prevent migraines.
Other medications used to treat the headache pain or associated symptoms:
Nutrition and Dietary Supplements
The following foods may trigger migraine headaches:
If you think that any of these foods cause your migraines, try eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to when the number of headaches increases after eating certain foods. Then you know which trigger foods to avoid. You may also want to consider food allergy testing to determine your specific sensitivities or triggers.
Preliminary research indicates that these supplements may also help prevent migraines, although more research is needed to say for sure:
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Although there are no scientific studies showing these herbs work, they are sometimes suggested to treat migraines and other types of headaches. People who take blood-thinning medications, or who have bleeding disorders, should not take these herbs and check with your doctor regarding any medications that you may be taking:
Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown it helps, researchers agree that acupuncture appears safe, and may work for some people. A study published in 2003 suggest that getting an acupuncture treatment when migraine symptoms first start works as well as taking the drug Imitrex. As symptoms continue, however, the medication works better than acupuncture.
In addition to needling treatment, acupuncturists may recommend lifestyle changes, such as suggestions for specific breathing techniques, qi gong exercise, and dietary changes.
Several clinical trials indicate that spinal manipulation therapy may help treat migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks. Also, 49% reported a significant reduction of the intensity of each migraine.
In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining therapies didn't work any better.
In addition, researchers reviewed 9 studies that tested chiropractic for tension or migraine headaches and found that it worked as well as medications in preventing these headaches. More research is needed to say for sure whether chiropractic care can prevent migraines.
Massage and Physical Therapy
Reflexology is a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body. Preliminary studies suggest it may relieve pain and allow people with migraines to take less pain medication. More research is needed. Practitioners believe reflexology helps you become more aware of your own body signals, which might help you sense an oncoming migraine, before pain starts. They also believe reflexology helps improve general well-being and energy level.
One of the most common reasons people seek homeopathic care is to treat chronic headaches. However, only 1 out of 4 studies included in a scientific review found that individually prescribed homeopathic remedies significantly reduced the frequency, severity, and duration of migraines. Some of these effective remedies are listed below.
Professional homeopaths may also recommend treatments based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account the individual's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
The following are some of the remedies found to be effective:
Homeopaths may also prescribe the following remedies based on their knowledge and clinical experience:
Reducing and learning to cope with stress may help reduce the number and intensity of your headaches. Techniques that can help include:
Many of the medications, herbs, and supplements used to prevent or treat migraines should not be used during pregnancy. Talk to your doctor before using any medication, over-the-counter or prescription, or any complementary therapy before or during your pregnancy. Some doctors may recommend treating mild-to-moderate attacks during pregnancy with acetaminophen (Tylenol).
Warnings and Precautions
Use medications only as directed. Using some medications on a regular basis can cause rebound headaches.
Call your doctor if you experience a new headache, a change in quality of a previous headache or headache pattern, or if a medication that usually takes away the pain no longer works.
Prognosis and Complications
Migraine headaches generally do not pose a threat to your overall health, although they can be chronic, recurrent, frustrating, and interfere with your daily life. Stroke is an extremely rare complication from severe migraines. Other studies show that migraine headaches are associated with heart disease. People who have migraines are up to 4 times more likely to suffer from depression. Migraine patients also have an increased rate of anxiety and panic disorders.
Adolescent migraine is associated with inflammatory conditions, such as asthma and seasonal allergies, as well as with epilepsy, persistent nightmares, and motion sickness. Many people find that migraines go into remission, meaning they stop for a long time and happen only very infrequently, or even disappear altogether, especially as you get older. For women, this may be related to lower levels of estrogen after menopause.
Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-31.
Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(8):617-23.
Barrows KA, Jacobs BP. Mind-body medicine: an introduction and review of the literature. Med Clin North Am. 2002;86(1):11-31.
Bauman RJ. Behavioral treatment of migraine in children and adolescents. Paediatr Drugs. 2002;499):555-61.
Boehnke C, Reuter U, Flach U, et al. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 2004;11:475-7.
Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-66.
Buse DC, Loder EW, Gorman JA, et al. Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine, and other severe headache: results of the American Migraine Prevalence and Prevention (AMPP) study. Headache. 2013; 53(8):1278-99.
Cady RK, Schreiber CP. Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology. 2002;58(9 Suppl 6):S10-4.
D'Andrea G, Ceboli S, Cologno D. Herbal therapy in migraine. Neurol Sci. 2014;35 Suppl 1:135-40.
Dagenais S. Haldeman S. Chiropractic. Prim Care. 2002;29(2):419-37.
Dalla Libera D, Colombo B, Pavan G, Comi G. Complementary and alternative medicine (CAM) use in an Italian cohort of pediatric headache patients: the tip of the iceberg. Neurol Sci. 2014;35 Suppl 1:145-8.
Diener HC, Pfaffenrath V, Schnitker J, et al. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention - a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005;25:1031-41.
Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol. 2004;51:89-97.
Demirkaya S, Vural O, Dora B, Topcuoglu MA. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001;41(2):171-7.
Digre KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:2246-52.
Endres HG, Diener HC, Molsberger A. Role of acupuncture in the treatment of migraine. Expert Rev Neurother. 2007;7(9):1121-34.
Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr. 2000;3(4A):509-14.
Evans R. Migraine: A Question and Answer Review. Medical Clinics of North America. 2009;93(2):245-62.
Ferri FF. Headache, migraine. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier Mosby; 2016:514-5.e1.
Grossmann WM, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther. 2000;38:430-5.
Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307(16):1736-45.
Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR. Physical comorbidity of migraine and other headaches in US adolescents. J Pediatr. 2012;161(2):308-13.e1.
Lieba-Samal D, Wober C, Frantal S, et al. Headache, menstruation and combined oral contraceptives: a diary study in 184 women with migraine. Eur J Pain. 2011;15(8):852-7.
Linde K, Melchart D, Fisher P et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev. 2001;(1):CD001218.
Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A.. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;28;63(12):2240-4.
Manias P, Tagaris G, Karageorgiou K. Acupuncture in headache: a critical review. Clin J Pain. 2000;16(4):334-9.
Mauskop A. Alternative therapies in headache. Is there a role? Med Clin North Am. 2001;85(4):1077-84.
Mauskop A, Altura BT, Altura BM. Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with menstrual migraine. Headache. 2002;42(4):242-8.
Melchart D, Thormaehlen J, Hager S, Liao J, Linde K, Weidenhammer W. Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial. J Intern Med. 2003;253(2):181-8.
Mueller L. Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Postgrad Med. 2002;111(4):25-26, 31-32, 37-38.
Negro A, Martelletti P. Chronic migraine plus medication overuse headache: two entities or not? J Headache Pain. 2011;12(6):593-601.
Oelkers-Ax R, Leins A, Parzer P, et al. Butterbur root extract and music therapy in the prevention of childhood migraine: An explorative study. Eur J Pain. 2008;12(3):301-13
Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback. 2002;27(20):163-81.
Pfaffenrath V, Diener HC, Fischer M, Friede M, Henneicke-von Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis - a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalagia. 2002;22(7):523-32.
Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev. 2004;(1):CD002286.
Rist PM, Schurks M, Buring JE, Kurth T. Migraine, headache, and the risk of depression: Prospective cohort sutdy. Cephalalgia. 2013;33(12):1017-25.
Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia. 2002;22:137-41.
Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology. 2005;64:713-5.
Savi L, Rainero I, Valfre W, Gentile S, Lo Giudice R, Pinessi L. A comparison of patients with migraine and tension-type headache. Panminerva Med. 2002;44(1):27-31.
Silberstein SD, Goadsby PJ, Lipton RB. Management of migraine: an algorithmic approach. Neurology. 2000;55(9 Suppl 2):S46-S52
Streng A, Linde K, Hoppe A, et al. Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache. 2006;46(10):1492-1502.
Trauninger A, Pfund Z, Koszegi T, Czopf J. Oral magnesium load test in patients with migraine. Headache. 2002;42(2):114-9.
Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000;23(2):91-5.
Walach H, Lowes T, Mussbach D, et al. The long-term effects of homeopathic treatment of chronic headaches: 1 year follow up. Cephalalgia. 2000;20:835-7.
Walach H, Lowes T, Mussbach D, et al. The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis. Br Homeopath J. 2001;90(2):63-72.
White AR, Resch KL, Chan JC, et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalagia. 2000;20(7):632-7.
Review Date: 9/29/2015
Reviewed By: Reviewed by Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.