Condition
Migraine
This condition has the following symptoms:
Head painLight sensitivitySound sensitivityNausea/vomitingNeck painVision changesDizzinessMigraine is a common neurological condition that causes repeated attacks of head pain and sensitivity to light or sound. Attacks can last hours to days and tend to come and go over years. Many people with migraine notice nausea, vision changes called aura, and trouble thinking clearly during an attack. It affects children and adults, more often women, and it is not life-threatening but can disrupt school, work, and daily life. Treatment includes fast-acting pain or anti-nausea medicines, preventive medicines, and lifestyle strategies, and recognizing early symptoms of migraine can help start treatment sooner.
Short Overview
Symptoms
Migraine often brings a throbbing, one-sided headache that worsens with activity, plus nausea and sensitivity to light and sound. Some notice early symptoms of migraine—fatigue, neck stiffness, yawning, or food cravings—hours before. Some have visual aura, tingling, or speech trouble.
Outlook and Prognosis
Most people with migraine find symptoms improve over time, especially with a tailored plan and trigger management. Attacks may come in cycles; frequency can rise during hormone shifts, then settle. Early treatment and lifestyle steps often reduce days lost to migraine.
Causes and Risk Factors
Migraine stems from a sensitive brain with strong genetic influence. Triggers and risks include hormones, stress, poor sleep, dehydration, skipped meals, certain foods, alcohol, bright light, family history, female sex, adolescence, obesity, anxiety/depression, head injury, and medication overuse.
Genetic influences
Genetics plays a major role in migraine; having an affected parent roughly doubles your risk. Many common gene variants affect brain excitability and pain pathways, shaping triggers, frequency, and response to medicines. Rare familial hemiplegic migraine involves single-gene mutations.
Diagnosis
Migraine is diagnosed clinically from your symptom pattern and history, with a neuro exam. A headache diary or response to treatment can help. Tests or brain imaging are to rule out other causes; diagnosis of migraine usually needs no scan.
Treatment and Drugs
Migraine treatment aims to ease attacks, shorten recovery, and reduce how often they happen. Many benefit from quick-relief medicines (like triptans, gepants, or anti-nausea drugs), plus rest and hydration. Preventive options include beta-blockers, topiramate, CGRP blockers, onabotulinumtoxinA, and lifestyle adjustments.
Symptoms
On a normal day, a pulsing headache, bright lights that feel too harsh, and a wave of nausea can derail plans. Migraine often brings intense head pain along with light and sound sensitivity and trouble thinking clearly. Symptoms vary from person to person and can change over time. Some people notice early symptoms of migraine—like yawning, food cravings, or neck tightness—hours before the head pain starts.
Throbbing head pain: Pulsing or pounding pain, often on one side of the head. It can be moderate to severe and worsens with movement or bending. Many describe the pain as a steady throb during a migraine attack.
Light and sound sensitivity: Bright lights and ordinary noises can feel harsh or painful. Many seek a dark, quiet room until the migraine eases.
Nausea and vomiting: An unsettled stomach is common, and some people vomit. Eating, smells, or motion may make nausea worse.
Aura symptoms: Flickering lights, zigzag lines, blind spots, or tingling can appear before or during the headache. Clinicians call this aura, which means short-lived visual or sensory changes that usually last 5 to 60 minutes. Speech trouble or one-sided numbness can occur, then typically fade.
Neck and shoulder tightness: Achy or tight muscles in the neck and shoulders can build before or during an attack. Turning the head may feel stiff or tender. The soreness can linger after the pain fades.
Dizziness or vertigo: You may feel lightheaded, off balance, or as if the room is spinning. Standing up or moving quickly can worsen it.
Smell sensitivity: Everyday scents like perfume, smoke, or cleaning products can feel overpowering. Strong smells can trigger or intensify an attack.
Brain fog: Concentration can slip, and finding words may take extra effort. Thinking may feel slow during and after a migraine.
Worsened by activity: Routine movement—walking, climbing stairs, or bending—can intensify head pain. Many people pause what they’re doing because activity makes symptoms surge.
Warning phase: Early symptoms of migraine can include yawning, food cravings, neck tightness, or mood changes. These signs may appear hours to a day before the headache. They can signal an attack is coming.
Post-attack fatigue: After-effects like tiredness, brain fog, and scalp tenderness can last up to a day. Some feel washed out or sore even once the head pain ends.
How people usually first notice
Many people first notice migraine as a throbbing headache on one side of the head that builds over hours, often with nausea, vomiting, or a strong sensitivity to light, sound, or smells. For some, the first signs of migraine are warning cues called aura—brief visual changes like shimmering zigzags or blind spots, or tingling in the face or arm—appearing 5–60 minutes before the head pain. It’s usually recognized when these attacks recur in patterns, such as headaches lasting 4–72 hours, worsening with routine activity, and improving in a dark, quiet room.
Dr. Wallerstorfer
Types of Migraine
Migraine affects daily life in different ways, from head pain that sidelines plans to sensitivity to light that makes screens tough to face. Symptoms don’t always look the same for everyone. Clinicians often describe them in these categories: headache-focused attacks, sensory “aura” migraines, shorter but frequent attacks, and hormonally linked patterns. Below are the main types of migraine and how their symptoms differ, which can help when you’re trying to understand the types of migraine you might be experiencing.
Migraine without aura
Throbbing head pain on one side is common, often with nausea and sensitivity to light or sound. Activity usually makes the pain worse. Attacks can last 4–72 hours.
Migraine with aura
Visual changes like flashing lights, zigzag lines, or blind spots may appear 5–60 minutes before the headache starts. Some also feel tingling, numbness, or trouble finding words. The head pain may be milder or even absent in a few attacks.
Menstrual migraine
Attacks cluster around the days just before or during a period due to hormone shifts. Pain and sensitivity can be stronger and longer-lasting than usual. They may respond differently to certain medicines timed around the cycle.
Chronic migraine
Headache occurs on 15 or more days each month for over 3 months, with at least 8 days having migraine features. Symptoms can blur together, mixing migraine pain with tension-type features. Fatigue, brain fog, and mood changes are common between attacks.
Vestibular migraine
Dizziness, spinning, or balance problems are prominent, sometimes with motion sensitivity. Headache can be mild or missing, but nausea and visual sensitivity are frequent. Lights, patterns, or busy spaces may trigger symptoms.
Hemiplegic migraine
Weakness or heaviness on one side of the body develops during the aura phase, sometimes with numbness and speech changes. Symptoms can mimic a stroke but resolve as the attack ends. Seek urgent care for any new or severe weakness or speech trouble.
Retinal migraine
Vision dims or goes blind in one eye for minutes to an hour, usually followed by head pain. These episodes are rare but can be alarming. An eye exam and medical evaluation help rule out other causes.
Brainstem aura migraine
Aura symptoms start in the brainstem, leading to vertigo, ringing in the ears, slurred speech, or double vision. Headache often follows the aura. Fainting is possible, so medical review is important.
Abdominal migraine
Belly pain, nausea, and vomiting occur mainly in children, often without head pain. Episodes can last 1–72 hours and may be followed by typical migraine later in life. Between episodes, children usually feel well.
Episodic migraine
Attacks occur on fewer than 15 days per month. Pain-free days between attacks are common. Keeping a diary can help spot triggers and patterns.
Did you know?
Certain genetic variations in ion channels and pain-sensing pathways make brain cells more excitable, raising the chance of throbbing head pain, nausea, and sensitivity to light or sound. In some families, rare CACNA1A or ATP1A2 changes trigger hemiplegic migraine with temporary weakness.
Dr. Wallerstorfer
Causes and Risk Factors
Migraine stems from sensitive brain pathways that overreact to everyday triggers.
Genes and family history raise risk, and early symptoms of migraine often start in the teen years.
Doctors distinguish between risk factors you can change and those you can’t.
Women have higher risk, and hormone shifts with periods can spark attacks.
Stress, poor sleep, alcohol, dehydration, and frequent use of pain medicines can increase attack frequency.
Environmental and Biological Risk Factors
Migraine often flares when your body’s inner sensitivities meet outside triggers. Two people with the same exposure can react very differently—biology shapes the response. Below are environmental and biological factors that can set off or intensify attacks.
Hormone fluctuations: Changes in estrogen around periods, pregnancy, or perimenopause can raise the chance of a migraine attack. The drop in estrogen just before bleeding is a common trigger.
Illness and infection: Colds, flu, or other infections can spark inflammation that lowers the threshold for an attack. Fever or immune reactions may set off pain pathways.
Head and neck injury: Concussion, whiplash, or other neck strain can sensitize nerves and blood vessels. For some, migraine begins or worsens after such injuries.
Sensory sensitivity: A highly responsive nervous system can overreact to light, sound, or smells. When several inputs add up, the brain reaches a tipping point more easily.
Bright or flicker: Glare, flickering lights, or long stretches under fluorescent or screen lighting can start early symptoms of migraine, like visual changes. Very bright light later in the day can add to the effect.
Loud environments: Persistent noise, sudden loud sounds, or echoing spaces can push the brain toward overload. This can intensify head pain and nausea during an attack.
Strong odors: Perfumes, cleaning sprays, solvents, smoke, or fuel fumes can provoke head pain and aura in sensitive people. Even brief exposure can be enough to set things off.
Weather changes: Rapid shifts in barometric pressure, storms, or dry winds can precipitate migraine. Many notice attacks cluster around seasonal transitions.
Air quality: Air pollution, wildfire smoke, and poor indoor ventilation can irritate nerves involved in head pain. Fine particles in the air are common culprits.
Certain medications: Medicines that widen blood vessels or alter hormones can trigger migraine attacks. Examples include some heart drugs and hormone therapies; ask your doctor before changing any prescription.
Altitude and travel: High altitude and cabin pressure changes during flights can strain oxygen delivery to sensitive brain tissue. Crossing time zones can also nudge the brain’s clock toward an attack.
Stress responses: Surges of stress hormones during intense pressure—or the letdown right after a stressful period—can open the door to an attack. Muscle tension in the neck and scalp can add to the load.
Genetic Risk Factors
Many people notice migraine runs in their family, which points to strong genetic influences. Most cases come from many small DNA changes acting together rather than a single faulty gene. Risk is not destiny—it varies widely between individuals.
Family history: Migraine often clusters in families due to shared genes. If a parent or sibling is affected, your own chance can be higher. In some families, early symptoms of migraine show up in childhood.
Polygenic risk: Dozens to hundreds of common DNA changes each add a small amount of risk. Together they can raise the likelihood of the condition. This is the most common genetic pattern.
Hemiplegic migraine genes: Rare single-gene changes can cause familial hemiplegic migraine. These affect how brain cells pass electrical signals, sometimes leading to temporary weakness on one side during attacks. Families often show a clear inheritance pattern.
Mitochondrial DNA: Some changes passed down through the maternal line can alter cellular energy. In a minority of families, this may contribute to susceptibility. A maternal-only pattern across generations can be a clue.
Aura-specific variants: Certain genetic changes appear more tied to migraine with aura than to migraine without aura. This may help explain visual flashes or other aura features in some families. Patterns can differ between subtypes.
Neurovascular genes: Variants affecting nerve signaling and blood-vessel control can increase susceptibility. They shape how the head’s pain pathways respond and how vessels tighten or relax. Small shifts can lower the threshold for an attack.
Ancestry differences: Which risk variants are common can vary by ancestry. Most genetic studies of migraine have focused on people of European descent, so findings may not capture all populations. Research is expanding to fill these gaps.
Rare vascular syndromes: A few inherited small-vessel conditions can feature migraine, often with aura. Clues include headaches alongside early strokes, memory changes, or numbness between attacks. Genetic evaluation may be considered when these red flags are present.
Dr. Wallerstorfer
Lifestyle Risk Factors
Certain daily habits can raise the likelihood of a migraine attack or make them occur more often. Understanding lifestyle risk factors for Migraine helps you identify patterns you can change. Small, consistent adjustments in routines like sleep, diet, and stress can meaningfully lower attack frequency. Use a diary to connect habits with symptoms and refine your plan.
Irregular sleep: Too little, too much, or shifting sleep times can trigger migraine attacks. A consistent sleep and wake schedule may reduce attack frequency and severity.
High stress: Ongoing stress and the “let-down” after stress are common triggers. Regular stress-management practices like relaxation or mindfulness can cut attack days.
Caffeine habits: Heavy caffeine or abrupt caffeine withdrawal can provoke migraines. Keep intake moderate and consistent, ideally earlier in the day.
Alcohol intake: Red wine and certain spirits often trigger migraines in sensitive people. Limiting alcohol or avoiding known triggers can reduce attacks.
Dehydration: Inadequate fluids can precipitate an attack, especially with heat or exercise. Steady hydration throughout the day may lower risk.
Skipping meals: Fasting or long gaps between meals can trigger migraines via blood sugar swings. Regular, balanced meals help stabilize energy and reduce attacks.
Trigger foods: Aged cheeses, processed meats, MSG, and some sweeteners can trigger attacks in some people. Tracking food-symptom links helps you personalize avoidance.
Intense exercise: Sudden, vigorous exertion can bring on an attack in some individuals. Gradual conditioning and regular moderate activity often reduce migraine frequency.
Screen and light: Prolonged screen time and bright or flickering lights can trigger symptoms. Frequent breaks and using dimming or blue-light filters can help.
Poor posture: Neck and shoulder strain from long sitting can precipitate migraines. Ergonomic setup and gentle neck-shoulder stretches may reduce attacks.
Smoking: Nicotine can trigger headaches and increase migraine frequency. Quitting smoking lowers attack risk and improves overall migraine control.
Painkiller overuse: Using acute pain medicines on many days per month can cause medication-overuse headaches. Work with your clinician on limits and preventive options.
Risk Prevention
Migraine prevention focuses on lowering how often attacks happen and how severe they feel. Different people need different prevention strategies—there’s no single formula. Small, steady habits plus the right medicines can reduce days lost to pain, light sensitivity, and nausea. Work with your clinician to tailor a plan that fits your triggers, schedule, and health history.
Symptom tracking: Keep a brief diary of early symptoms of migraine, triggers, and what helps. Patterns in sleep, stress, foods, or hormones often become clear within a few weeks.
Regular sleep: Keep a steady sleep and wake time, even on weekends. Big swings in schedule can set off migraine the next day.
Steady meals: Eat regular, balanced meals and avoid long gaps without food. Sudden drops in blood sugar can trigger migraine symptoms.
Hydration and caffeine: Drink water regularly and limit caffeine to a modest, consistent amount. Big caffeine swings or dehydration can invite a migraine attack.
Exercise routine: Aim for moderate activity most days, like brisk walking or cycling. Gradual, consistent exercise can lower migraine frequency over time.
Stress skills: Try relaxation training, deep breathing, or mindfulness for 10–15 minutes a day. Biofeedback or cognitive behavioral strategies can further reduce migraine days.
Acute meds plan: Use fast-acting pain relievers or migraine-specific medicines early in an attack. Limit them to no more than 2–3 days per week to avoid medication-overuse headache.
Preventive medicines: If attacks are frequent or disabling, ask about daily or monthly preventives. Options can include blood pressure medicines, anti-seizure medicines, CGRP blockers, or onabotulinum toxin for chronic migraine.
Hormone management: For menstrual migraine, discuss short-term prevention around your period or adjusting contraception. Tailoring hormones can reduce predictable, monthly attacks.
Trigger control: Manage light, sound, and screen glare with tinted lenses, noise control, and regular screen breaks. Keeping work and home spaces calm can lower migraine risk.
Alcohol and smoking: Limit alcohol and avoid tobacco smoke exposure. Both can trigger or worsen migraine for many people.
Supplements check: Ask about magnesium, riboflavin (B2), or coenzyme Q10, which have supportive evidence for some. Your doctor can recommend safe doses and check for interactions or pregnancy considerations.
Healthy weight: If you live with overweight, gradual weight loss can reduce migraine frequency and intensity. Small, sustainable changes are more protective than strict diets.
Neck and posture: Gentle stretching, ergonomics, and physical therapy can ease neck tension that feeds into migraine. Set reminders to move and adjust posture during long desk time.
Regular follow-ups: Schedule check-ins to adjust your plan as life changes. Fine-tuning treatment and habits keeps migraine prevention on track.
How effective is prevention?
Migraine is an acquired neurological condition, so “prevention” means lowering how often and how severe attacks are, not eliminating them. For many, daily preventive medicines can cut attacks by about one‑third to one‑half, and newer CGRP blockers sometimes do even better. Avoiding personal triggers, steady sleep, regular meals, hydration, and limiting alcohol can add meaningful extra reduction. Early treatment plans, stress-management skills, and tailored preventive choices work best when followed consistently and reviewed with your clinician.
Dr. Wallerstorfer
Transmission
Migraine is not contagious—you cannot catch it from someone or spread it through touch, shared air, kissing, or sex.
Migraine often runs in families, and having a parent or sibling with migraine raises your chances because many genes together can make the brain more sensitive to triggers. In most people, genetic transmission of migraine is complex, with no single gene in charge, but rarely a single‑gene form exists in some families and each child then has about a 50% chance of inheriting it. New gene changes can also arise for the first time, and even when the tendency is inherited, it does not guarantee you will develop attacks—lifestyle and environment still play a role.
When to test your genes
Consider genetic testing if migraines start very early, are severe or hemiplegic, cluster with neurologic symptoms (like weakness or seizures), or many close relatives are affected. Testing can guide preventive choices and medication safety. Discuss it sooner if attacks worsen despite tailored therapy or pregnancy is planned.
Dr. Wallerstorfer
Diagnosis
For most people, the diagnosis of migraine is based on a pattern of repeat headaches and how they affect daily life. Many people find reassurance in knowing what their tests can—and can’t—show. Doctors usually start with your story: what the pain feels like, how long it lasts, what brings it on, and what helps. From there, they decide if any exams or scans are needed to rule out other causes.
Symptom pattern: Clinicians look for repeated headaches that last hours to a couple of days with features like throbbing pain, nausea, and sensitivity to light or sound. Head pain often worsens with routine activity and may be one-sided. A history of aura (temporary visual or sensory changes) can further support migraine.
Medical history: A detailed family and health history can help connect your symptoms to migraine and exclude other conditions. Migraine often runs in families, so relatives with similar headaches are a helpful clue.
Neurologic exam: Doctors check reflexes, strength, vision, coordination, and sensation. In migraine, this exam is usually normal between attacks, which helps distinguish it from problems involving the brain or nerves.
Headache diary: Tracking when headaches start, how long they last, symptoms, medicines, menstrual cycles, sleep, and possible triggers helps clarify patterns. This record can show frequency and supports how migraine is diagnosed over time.
Trigger review: Your provider may suggest looking for common triggers like stress changes, skipped meals, alcohol, strong smells, or hormone shifts. Identifying patterns can reduce attacks and strengthens confidence in a migraine diagnosis.
Red flags check: Doctors ask about warning signs like sudden worst-ever headache, fever, stiff neck, new neurologic symptoms, or headaches that rapidly escalate. These features suggest other causes and point to urgent evaluation.
Imaging scans: Brain MRI or CT may be ordered if red flags are present, the pattern is new or unusual, or the exam is abnormal. Otherwise, routine imaging isn’t needed for typical migraine.
Blood tests: Basic labs may be used to rule out conditions like thyroid imbalance, infection, anemia, or electrolyte problems that can worsen headaches. Normal results support a primary headache like migraine.
Medication response: A good response to migraine-specific treatments, such as triptans or gepants, can support the diagnosis. Your provider may use a treatment trial alongside your history and exam.
Stages of Migraine
Migraine often unfolds in a few predictable phases, which can help you spot a pattern and act sooner. Knowing where you are in an attack can guide timing of medicines and rest. Many people feel relief once they understand what’s happening.
Prodrome (preheadache)
Subtle changes like yawning, food cravings, neck stiffness, mood shifts, or frequent urination can show up first. These early symptoms of migraine may start hours to 1–2 days before head pain. Tracking them can help you take treatment sooner.
Aura (if present)
Some people notice visual effects like flashing or zigzag lines, blind spots, tingling, or trouble finding words. Aura usually lasts 5–60 minutes and not everyone with migraine experiences it. New, sudden, or different aura symptoms should be checked by a clinician to rule out other causes.
Headache attack
Throbbing or pulsing pain—often on one side—builds and can be moderate to severe. It may worsen with routine movement and come with nausea, vomiting, and sensitivity to light, sound, or smells. Without treatment, this phase can last 4–72 hours.
Postdrome (recovery)
After the pain fades, many feel drained, foggy, or sensitive to light and sound, and the scalp may feel tender. This “migraine hangover” often improves within about 24–48 hours. Gentle routines, fluids, and sleep can help recovery.
Did you know about genetic testing?
Did you know genetic testing can sometimes shine a light on why migraines run in families and which triggers or pathways might be at play for you? While most migraines aren’t caused by a single gene, certain tests can confirm rare inherited migraine types and help your care team tailor prevention and treatment plans. Knowing your genetic clues won’t predict every attack, but it can guide smarter choices—from medications to lifestyle steps—so you spend more days feeling like yourself.
Dr. Wallerstorfer
Outlook and Prognosis
Looking at the long-term picture can be helpful. For most people with migraine, the condition is long-lasting but manageable, with symptom patterns that can shift over time. Some notice attacks become less frequent or milder with age, while others have cycles of active periods and quiet stretches. Severe complications are uncommon, and migraine itself is not considered life-threatening, but it can raise the risk of anxiety, depression, and sleep problems if pain and unpredictability disrupt daily life.
Many people ask, “What does this mean for my future?”, and the answer depends on attack frequency, triggers, and how early effective care starts. Early symptoms of migraine—like light sensitivity, nausea, or a warning “aura”—are often a chance to step in with fast-acting treatment and trigger management, which can reduce how long and how intense an attack becomes. Over months to years, consistent prevention strategies can cut monthly attack days by half or more for many living with migraine. When doctors talk about “remission,” they mean months or years with few or no attacks, which some people experience, especially later in life.
With ongoing care, many people maintain work, school, and family routines, even if they still need to plan around occasional bad days. Mortality directly from migraine is not increased, but a small subset of people with migraine with aura have a slightly higher stroke risk, especially if they smoke or use certain estrogen-containing contraceptives; addressing those risks helps keep the long-term outlook favorable. Talk with your doctor about what your personal outlook might look like.
Long Term Effects
Migraine can leave lasting footprints beyond the headache hours, shaping energy, focus, and how reliably people can plan their days. Some continue with occasional attacks for years, while others develop chronic migraine with headaches on many days each month. Long-term effects vary widely, and what lasts for one person may fade for another. A small group faces higher risks linked to aura, which doctors monitor over time.
Chronic progression: Over time, episodic migraine can shift to chronic migraine with headaches on 15 or more days a month. This change often follows years of frequent attacks and higher symptom burden.
Medication overuse: Regular, frequent use of quick-relief pain medicines can lead to more headache days over the long term. This pattern, sometimes called medication overuse headache, can keep migraine more active.
Mood disorders: Many living with migraine have higher rates of anxiety and depression over the years. These conditions can worsen attack frequency and recovery time.
Sleep disruption: Long-standing migraine is linked with insomnia, non-restorative sleep, and irregular sleep–wake patterns. Poor sleep can make migraine attacks more likely and more severe.
Cognitive fog: People often report slower thinking, word-finding trouble, and memory lapses during and between attacks. This “brain fog” can linger for hours or days after a migraine.
Sensory sensitivity: Light, sound, and smell sensitivity can persist between attacks in some people. Ongoing skin tenderness or allodynia may make routine touch or wearing glasses uncomfortable.
Stroke risk with aura: Migraine with aura is linked to a small but increased lifetime risk of ischemic stroke. The risk is most noted in women under 45, and rises with smoking or estrogen-containing contraceptives.
Work and school impact: Missed days, reduced productivity, and unpredictable flares can affect long-term earnings and education. Career choices and schedules may shift to accommodate migraine patterns.
Vestibular symptoms: Some develop long-term vertigo or balance problems, sometimes called vestibular migraine. These episodes can make driving, screens, or crowded spaces difficult.
Neck and body pain: Chronic neck pain and widespread muscle tenderness are common companions of long-standing migraine. These pains can amplify headache intensity and recovery time.
Hormonal patterns: Across life stages, hormone shifts can shape migraine frequency and severity. Many notice changes around menstruation, pregnancy, perimenopause, and menopause.
Brain MRI changes: Small white-matter spots can appear on MRI scans in people with long-term migraine, especially with aura. These findings are generally considered benign and not linked to cognitive decline.
Prodrome and early signs: Some remember early symptoms of migraine like light sensitivity, yawning, or nausea hours before head pain, and these patterns can persist for years. Recognizing these early cues may help explain why attacks feel predictable even when timing varies.
How is it to live with Migraine?
Living with migraine often means planning your day around uncertainty: a normal morning can tilt into throbbing head pain, light and sound sensitivity, nausea, and brain fog that make work, school, or driving feel unsafe. Many learn to manage triggers—like irregular sleep, certain foods, skipped meals, dehydration, bright lights, or stress—and keep rescue medications close, but attacks can still break through and force quiet, dark rest. For family, friends, and coworkers, it helps to know that migraine is a neurologic condition, not “just a headache,” and that flexibility—dimming lights, lowering noise, adjusting schedules—can make a real difference. With a plan, preventive care, and support, many living with migraine find a workable rhythm, even if they need to cancel or slow down on flare days.
Dr. Wallerstorfer
Treatment and Drugs
Migraine treatment focuses on easing pain during attacks and preventing future ones, so you have fewer lost days to headaches, light sensitivity, or nausea. Doctors often use a two-part plan: quick-relief medicines taken at the first sign of pain (like NSAIDs, triptans, or gepants), and preventive options taken daily or monthly (such as beta blockers, certain anti-seizure or antidepressant medicines, CGRP blockers, or onabotulinumtoxinA injections for chronic migraine). Beyond medication, other therapies like regular sleep, hydration, exercise, stress reduction, and limiting known triggers can reduce attack frequency, and some people benefit from neuromodulation devices or cognitive behavioral therapy. Not every treatment works the same way for every person, so your doctor may adjust your plan over time to balance benefits and side effects. If first-line treatments don’t help, specialists may try second-line options, and keeping a simple headache diary can guide what to try next.
Non-Drug Treatment
Many living with migraine want options that reduce attacks without relying only on medicine. Non-drug treatments often lay the foundation for fewer and milder attacks. A mix of routines, therapies, and devices can help you spot early symptoms of migraine and respond quickly. Plans usually work best when they’re tailored to your triggers, schedule, and other health needs.
Sleep routine: Keep a steady sleep and wake time, even on weekends. Aim for 7–9 hours in a dark, cool, quiet room.
Hydration and meals: Drink water regularly across the day and don’t skip meals. Gentle caffeine moderation can help some but too much or sudden cutbacks may trigger symptoms.
Trigger tracking: Use a simple diary to link attacks with stress, sleep loss, bright light, or certain foods. When patterns are clearer, you can plan around high‑risk times and reduce exposure.
Stress skills: Relaxation training, biofeedback, or cognitive behavioral therapy can lower attack frequency. These skills help your nervous system settle during early warning signs.
Mindfulness and breathing: Short daily sessions of mindful attention or paced breathing can reduce reactivity to pain. Many people find these tools make flares shorter and less intense.
Regular exercise: Moderate aerobic activity, like brisk walking or cycling, 150 minutes per week (about 2½ hours) can lower attack rates. Start slowly and warm up to avoid overexertion triggers.
Physical therapy: Targeted neck and shoulder work can ease muscle tension that feeds head pain. A therapist can also coach posture and gentle mobility exercises.
Ergonomics and light: Adjust screens, seating, and lighting to cut glare and neck strain. Consider frequent breaks, larger fonts, and tinted lenses that reduce harsh light.
Heat or cold: A cold pack on the forehead or neck can numb throbbing pain. Warmth on tight shoulder or jaw muscles can release tension that keeps pain going.
Neuromodulation devices: At‑home devices that stimulate the trigeminal or vagus nerve, or single‑pulse magnetic stimulation, can reduce pain or prevent attacks. These usually require a prescription and brief, guided sessions.
Pacing and routine: Plan demanding tasks for your best hours and build in short rests. Consistent daily rhythms around sleep, meals, activity, and hydration can buffer your brain from swings.
Social support: Share your plan with family, friends, or a support group so routines are easier to keep. Having backup for childcare, meals, or rides can lower stress during a flare.
Did you know that drugs are influenced by genes?
For many with migraine, genes shape how fast medicines are absorbed, broken down, and cleared, which changes how well they work and whether side effects show up. This is why doses, drug choices, or timing often need to be personalized.
Dr. Wallerstorfer
Pharmacological Treatments
Living with migraine often means planning your day around the possibility of an attack. Treating early symptoms of migraine quickly can shorten or soften an episode. Sometimes medicines are taken short-term (acute treatment), while others are used long-term (maintenance therapy). The options below include fast-acting drugs for an attack and preventives to reduce how often migraines happen.
NSAIDs: Ibuprofen or naproxen can ease mild to moderate migraine pain and light or sound sensitivity. They work best when taken as soon as symptoms begin. Limit use to avoid rebound headaches and stomach irritation.
Acetaminophen/paracetamol: Eases pain and is gentler on the stomach than some other pain relievers. Works best for early symptoms of migraine or milder attacks. Keep within the daily dose limit to protect the liver.
Triptans: Sumatriptan, rizatriptan, or eletriptan can stop an attack by targeting migraine pathways. They work best at the first sign of pain or aura. Not suitable for some people with heart or stroke risks.
Gepants: Ubrogepant or rimegepant treat acute attacks by blocking CGRP without tightening blood vessels. Helpful if triptans don’t work or aren’t tolerated. Rimegepant can also be used on a preventive schedule.
Ditans: Lasmiditan treats an attack without constricting arteries. It may cause sleepiness or dizziness. Avoid driving or operating machinery for at least 8 hours after a dose.
Antiemetics: Metoclopramide or prochlorperazine reduce nausea and can help pain medicine absorb better. Often combined with other acute drugs at home or in clinic. Possible side effects include drowsiness or restlessness.
Dihydroergotamine: A nasal spray, injection, or IV option for severe or prolonged attacks. Can help when other acute medicines fail. Not recommended in pregnancy or vascular disease.
Beta-blockers: Propranolol or metoprolol taken daily can reduce how often and how intense migraines are. Benefits build over several weeks. Side effects can include fatigue or low blood pressure.
Antiseizure preventives: Topiramate or valproate can cut monthly migraine days. Topiramate may cause tingling or word-finding issues, while valproate is not recommended in pregnancy. Doses are adjusted slowly to balance benefit and side effects.
Antidepressants: Amitriptyline or venlafaxine can prevent attacks, especially when poor sleep or anxiety are also present. Dry mouth and sleepiness are common with amitriptyline. Taking it at night can improve tolerance.
CGRP antibodies: Erenumab, fremanezumab, galcanezumab, or eptinezumab prevent migraines by blocking CGRP signals. Given monthly or every 3 months by injection or IV. Common issues include constipation or injection-site reactions.
OnabotulinumtoxinA: For chronic migraine with 15 or more headache days per month. Injections every 12 weeks can reduce frequency and severity. Given by trained clinicians across specific head and neck sites.
Hormonal options: For menstrual migraine, continuous or extended-cycle hormonal contraception may help some. NSAIDs or triptans can be timed before predictable periods. Suitability depends on clotting or stroke risk.
Rescue medicines: Short courses of steroids or clinic-based nerve blocks may be used for status migrainosus. Reserved for severe flares that don’t respond to usual therapy. Not intended for long-term prevention.
Genetic Influences
Migraine often runs in families, suggesting a genetic influence on who is more likely to develop it. Many people ask, is migraine hereditary? Family history is one of the strongest clues to a genetic influence. For most people, the risk comes from many small gene differences working together like dimmer switches on brain pathways that handle pain and sensory signals, rather than a single “migraine gene.” If a parent or sibling has migraine, your chance is higher—roughly two to three times—although not everyone with that family history will develop attacks. Genes also interact with triggers such as hormonal shifts, stress, missed sleep, or certain foods, which is why episodes can vary widely even within the same family. A rare, inherited form called familial hemiplegic migraine is linked to single-gene changes and causes temporary weakness on one side; in those families, doctors may discuss genetic testing and counseling. For typical migraine, routine genetic testing isn’t needed, but knowing your family history can guide prevention and treatment choices.
How genes can cause diseases
Humans have more than 20 000 genes, each carrying out one or a few specific functiosn in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the bodies cells to begin lultiplying uncontrollably and develop into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified, that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call this hotspots “Genetic Variations” or “Variants” in short. In many cases, studies have been able to show, that having the genetic Letter “G” in the position makes you healthy, but heaving the Letter “A” in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
Pharmacogenetics — how genetics influence drug effects
For many living with migraine, finding a medicine that both works and feels tolerable can take trial and error. Your genes can affect how your body handles certain migraine medicines, which can change how well they work and whether side effects show up. A “slow metabolizer” may process medicine more slowly, which can make a standard dose feel too strong. Others break medicines down very quickly, so the effect can wear off sooner or not be noticeable. Variants in genes that guide liver enzymes such as CYP2D6 and CYP2C19 can influence response to tricyclics (like amitriptyline) and some beta blockers used for prevention, and doctors sometimes use this information to adjust the starting dose to reduce problems like sleepiness, dizziness, or a very low heart rate. For triptans and newer CGRP‑targeting medicines, the evidence for routine pharmacogenetic testing is limited right now, so drug interactions and overall health history often matter more; pharmacogenetic testing for migraine treatment is currently most helpful when choosing certain preventive medicines rather than acute therapies. Other factors such as other medications, age, and liver or kidney health still play a big role.
Interactions with other diseases
Migraine often travels alongside other health issues, and the mix can shape how often attacks happen and how they feel. Someone might notice their symptoms flare when another condition is active. Anxiety, depression, and poor sleep—especially insomnia or sleep apnea—can lower your pain threshold and make attacks more frequent. For people with migraine with aura, there’s a small but real increase in ischemic stroke risk, particularly in women under 45 who smoke or use estrogen-containing birth control; managing blood pressure, cholesterol, and smoking status matters. Asthma, allergies, irritable bowel syndrome, and fibromyalgia often cluster with this condition, likely due to shared sensitive nerves and immune pathways. If you live with other long-term conditions, tell your care team about all diagnoses and early symptoms of migraine so treatment plans align and one therapy doesn’t worsen another.
Special life conditions
You may notice new challenges in everyday routines. During pregnancy, migraine can shift: for many, attacks ease after the first trimester, but some continue to have nausea, light sensitivity, or disabling head pain. Medication choices often change in pregnancy and while breastfeeding, so talk with your doctor before starting or stopping any treatment.
Children with migraine may look pale, feel sick to their stomach, or become very quiet rather than describing classic head pain. Teens can have school absences and sensitivity to screens, while older adults may have fewer headaches but more visual auras or dizziness, and doctors will also check for other causes of new headaches at that age.
Active athletes with migraine can usually stay active; hydration, steady meals, warm-ups, and sleep routines help reduce exertion‑triggered attacks. With the right care, many people continue to manage migraine well through life changes like pregnancy, aging, and shifts in activity.
History
Throughout history, people have described sudden, pounding head pain that came in waves and sometimes stole the senses—light felt sharp, sounds too loud, and the world tilted. In a busy marketplace or a quiet classroom, people with migraine might have had to step away, lie down, or find a dark corner until the storm eased. Community stories often described the condition as “sick headaches” that ran in certain families, turning ordinary days into careful planning around triggers like missed meals or lack of sleep.
Ancient descriptions show that physicians in Greece and Rome recognized one‑sided head pain with nausea and sensitivity to light. Remedies were simple and sometimes harsh, but the pattern was noted: attacks arrived, then cleared. From early theories to modern research, the story of migraine has shifted from viewing it as a blood vessel problem to understanding it as a nerve network condition that can affect the whole body. Over time, descriptions became more precise, separating migraine from other headaches and noticing early symptoms of migraine such as yawning, food cravings, or neck stiffness hours before the pain.
In the 19th and early 20th centuries, journals described visual “auras”—flashing zigzags, blind spots, or shimmering arcs—that some people experienced before the headache. Initially understood only through symptoms, later tools like the electroencephalogram and brain imaging helped rule out other causes but also showed that migraine doesn’t leave a scar on the brain between attacks. With each decade, researchers charted patterns: migraine was common, tended to run in families, and affected more women than men after puberty.
In recent decades, awareness has grown that migraine is a neurologic disorder involving sensitive brain pathways, not a sign of weakness or poor coping. Scientists mapped “trigeminovascular” pain circuits, described spreading waves of brain activity that may explain aura, and identified chemicals like calcitonin gene–related peptide (CGRP) that rise during attacks. These findings led to targeted treatments and preventive options, a turning point for many living with frequent migraine.
Medical classifications changed as expert groups set clear criteria, improving diagnosis and research. This helped distinguish migraine with aura, migraine without aura, and chronic migraine, while also recognizing that symptoms vary across life stages and between individuals. Not every early description was complete, yet together they built the foundation of today’s knowledge.
Today, the history of migraine is still being written through genetics and population studies. Inheritance patterns were noticed long before DNA research now explains some of the risk, showing multiple genes act like dimmer switches on nerve sensitivity. Looking back helps explain why understanding and care have steadily improved—and why people with migraine deserve the same respect and support given to any long-term health condition.