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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.
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.
are a health problem that can be treated. Talk to your
doctor about your migraines.
Experts are not sure what
Migraines run in families, but it isn't clear
why some people get migraines and others don't.
things can cause a migraine to start. These are called triggers. Your triggers
may be different from someone else's. Some common triggers
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
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.
your doctor may want you to try an
over-the-counter pain medicine, such as acetaminophen, aspirin, ibuprofen, or
naproxen. Brand names include Tylenol, Bayer, Advil, and Aleve. Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine. If these medicines don't work, your doctor can prescribe stronger medicine
to stop the migraine. Your doctor also may prescribe medicine to
You may not be able to use some
medicines if you are pregnant or have other health problems, such as heart
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
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.
Learning about migraine headaches:
Living with migraines:
Health Tools help you make wise health decisions or take action to improve your health.
Experts aren't sure what causes
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
Some common triggers
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
About 1 out of 5 people has a warning sign of a migraine
aura. It usually starts about 30 minutes
before the headache starts. During an aura, you
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
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.
occur along with many other health problems, such as
depression. More serious conditions, such as tumors or
infections, can also cause migraine symptoms. But most headaches are
not caused by serious health problems.
You may be more likely to
migraines if you:
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 period of time during
which you and your doctor watch your symptoms or condition
without using medical treatment. Watchful waiting may be fine if you have recently been diagnosed with migraines and over-the-counter medicines are controlling your pain.
Health professionals who may diagnose
and treat your migraines include the following:
If you think your headaches
might be linked to
anxiety, talk to your doctor.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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.
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
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.
You can reduce how many migraines you have by finding your
triggers and avoiding them. For more information on
headache diary(What is a PDF document?) 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
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
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
want to try
complementary treatments along with medicines. These
For more information, see
Before you try
these treatments, be sure to ask your doctor if they are safe for
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:
headache diary(What is a PDF document?) 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
Your doctor may also prescribe drugs to help prevent
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
headache diary(What is a PDF document?) 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.
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
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.
headaches are more common during stressful times or right
after a stressful time ends.
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
You also can learn to stop thinking all the
time about things that bother you.
A doctor or counselor, or both, can
help you if a problem like
anxiety makes your migraines worse. Treating these
health problems may reduce how many migraines you get.
Two kinds of medicines are used to
Finding the right mix of medicines for you may
take some time. So work closely with your doctor to try different medicines and
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.
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
Drugs used to stop a migraine include:
Drugs used to prevent migraines include:
You may want to try medicine to prevent a headache
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
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
Talk to your doctor about whether you
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The American College of Physicians (ACP) is
a national organization of internists. Doctors of internal medicine focus on
adult medicine and have had special study and training focusing on the
prevention and treatment of adult diseases. The ACP provides information for
patients and families on the organization's website, including information on
diseases and conditions, end-of-life care, women's issues, and immunizations.
The site also offers video news stories, health tips, special reports, and a
link to the ACP diabetes webpage.
The American Headache Society Committee for Headache
Education (ACHE) is a nonprofit partnership between health professionals and
headache sufferers. ACHE provides resources and tools to health care
professionals to help them help their headache patients. This website has many
educational resources for doctors, patients, families, schools, and
employers. Resources include newsletters, articles on headaches, tools for both
patients and doctors, and lists of certified headache doctors.
The National Headache Foundation is a nonprofit
organization dedicated to three major goals: educating the public that
headaches are serious disorders and that sufferers need understanding and
continuity of care; promoting research into potential headache causes and
treatments; and serving as an information resource for sufferers, their
families, and doctors who treat them. The NHF can provide lists of local
doctors specializing in headache treatment. It also has a monthly newsletter
and many pamphlets on a variety of topics related to the different headache
Linde K, et al. (2009). Acupuncture for migraine
prophylaxis. Cochrane Database of Systematic Reviews
Lipton RB, et al. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for
migraine. Neurology, 63(12): 2240–2244.
Pittler MH, Ernst E (2004). Feverfew for preventing
migraine. Cochrane Database of Systematic Reviews
Evans RW, Taylor FR (2006). "Natural" or alternative
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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,
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migraine prophylaxis: A randomized controlled trial. Neurology, 64(4): 713–715.
Other Works Consulted
Goadsby PJ, Sprenger T (2010). Current practice and future directions in the prevention and acute management of migraine. Lancet Neurology, 9(3): 285–298.
Landy S, et al. (2004). Efficacy and tolerability of
sumatriptan tablets administered during the mild-pain phase of menstrually
associated migraine. International Journal of Clinical Practice, 10: 913–919.
Loder E, et al. (2004). Efficacy and tolerability of
oral zolmitriptan in menstrually associated migraine: A randomized,
prospective, parallel-group, double-blind, placebo-controlled study.
Headache, 44: 120–130.
June 10, 2011
Anne C. Poinier, MD - Internal Medicine & Colin Chalk, MD, CM, FRCPC - Neurology
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