Migraines: types, causes, triggers, and medications

There’s a common misconception that migraines are simply a really bad headache, but anyone who has experienced one can tell you they are much worse than that. Around 30 million Americans have migraines, a debilitating type of headache that can include symptoms like nausea and sensitivity to light and sound (Maasumi, 2016; Pescador Ruschel, 2021). Let’s explore different migraines, common symptoms, what could trigger one, and what you can do to get relief.  

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Migraines are a recurring type of headache that comes with severe head pain, usually on one side of the head. The head pain associated with a migraine can feel pulsating, throbbing, pounding, severe, or dull. Additionally, a person experiencing a migraine headache will usually also feel nauseous and sensitive to light and sound. 

The symptoms can be so intense that people call in sick to work or miss social events. Migraines can last anywhere from four to 72 hours. Without acute treatment, symptoms may continue for days to a week.

Risk factors for migraines include a family history of migraines and being assigned female at birth. Women are three times more likely to have migraines than men (Pescador Ruschel, 2021). Mood disorders like anxiety and depression, sleep disorders, and epilepsy are also associated with migraines (Kim, 2018; Zarcone, 2017).

Fortunately, migraines tend to become less common after age 40 or once a woman reaches menopause (Pescador Ruschel, 2021).

Migraine vs. headache: what’s the difference?

Migraines are much more than just a bad headache. Headaches are mild to severe head pain, while migraines are severe headaches accompanied by debilitating symptoms like nausea or vomiting, increased sensitivity to light and sound, trouble speaking, and numbness or tingling (Robbins, 2021).

Migraine attacks have four distinct phases (Pescador Ruschel, 2021):

1. The prodrome phase begins up to two days before the migraine headache. Yawning is a common symptom, along with increased food cravings, changes in mood or energy levels, sensitivity to bright lights or loud noises, feeling cold or sweaty, neck stiffness, restlessness, or lethargy. 

2. Migraine aura sets in just before the headache or can occur simultaneously. Aura only occurs in about one in four migraines and lasts for around 60 minutes or less. Aura includes additional sensory symptoms like seeing zigzag lines or blind spots, tinnitus (ringing in the ears), or tingling in the face or on one side of the body.

3. The attack phase is when the person experiences changes in their blood pressure and circulation. These changes create migraine pain and additional symptoms like nausea, vomiting, and increased sensitivity to light, sound, touch, and smells. The throbbing pain gets worse over a period of hours.

4. After the attack stage, the postdrome phase begins. As blood changes continue, a person may feel fatigued or weak, have trouble focusing, or feel a sense of euphoria as symptoms relieve.

There are several different types of migraines. Let’s take a look at some of the more common ones.

Migraine with aura

One in four people with migraines experiences migraine with aura, which describes additional sensory symptoms that affect your ability to see, move, speak, or feel (Shankar Kikkeri, 2021). Visual aura is most common and may include seeing bright spots or flashing lights or temporarily losing your vision. People may feel tingling or numbness in the face or limbs or have trouble speaking clearly. 

Hemiplegic migraine is a rare migraine with aura that creates muscle weakness on one side of the body or face. Aura occurs when brain activity affects the neurons involved in your central nervous system.  

Silent migraines, or acephalgic migraines, have aura symptoms but no headache. Up to 38% of people who experience migraine with aura may experience the aura on its own, without the migraine pain (Shah, 2018).

Menstrual migraine 

Over half of women who have migraines experience menstrual migraines, which can happen at any point during their menstrual cycle (Allais, 2018). Menstrual migraine usually does not include aura, but the migraine pain is more severe and lasts longer. Also, since it’s closely tied to hormone levels, particularly estrogen, it can be less resistant to treatment. 

Chronic vs. acute migraine

People with chronic migraines experience severe head pain or migraine attacks at least 15 days a month for 3+ months. On the other hand, acute or episodic migraines refer to migraines that occur fewer than 15 days per month. 

Chronic migraines affect 2% of people overall and 8% of people with migraines. Risk factors include overuse of migraine medication, depression, stress, and obesity (May, 2016).

Vestibular migraine

Vestibular migraine affects 1–3% of people (Baloh, 2020). People with vestibular migraine experience vertigo and the typical migraine symptoms, like head pain, nausea, vomiting, and sensitivity to light and sound. Vestibular migraines can last from minutes to hours.  

Scientists still don’t know for sure what causes migraines to happen. Previously, they thought it might have had something to do with the expansion or narrowing of your blood vessels, but that theory has since been debunked. Today, scientists believe activity in the brainstem and cortex creates a ripple effect that leads to migraine symptoms. Migraines may also have a genetic basis; people with a family history of migraine are three times more likely to have migraines themselves (Pescador Ruschel, 2021). 

Migraine triggers

Migraine triggers can vary from person to person. Stress, changing hormone levels, and skipping meals are some of the most common migraine triggers. Additional triggers include (Pescador Ruschel, 2021; Shankar Kikkeri, 2021):

• Changes in weather

• Getting too much or too little sleep

• Exposure to strong lights or smells

• Medication overuse

• Drinking alcohol, particularly wine

• Eating certain foods that contain the artificial sweetener aspartame, aged cheese, or additives like monosodium glutamate (MSG) or nitrates

• Exposure to heat

• Smoking

• Caffeine

• Too much exercise or physical activity

Over-the-counter pain medications may help relieve migraines once they start. Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or acetaminophen, triptans, and anti-nausea medication can all be effective.

Your provider may prescribe prescription migraine medications for severe migraines. These can help prevent migraines or provide relief once a migraine attack starts.

Preventative migraine medications may be taken daily or via injection every few months. These include beta-blockers, anti-seizure medications, antidepressants, calcium channel blockers, and calcitonin gene-related peptide (CGRP) treatments. 

Your provider may also prescribe prescription medications to manage specific migraine symptoms, like nausea. For people with menstrual migraines, your provider may recommend hormone therapy.

When a migraine comes on, lie down in a quiet, dark place and place a cold compress on your forehead or the back of your neck. The migraine will usually go away or lessen if you can get some sleep. 

The following lifestyle changes can also help prevent migraines and make symptoms more manageable (Pescador Ruschel, 2021):

• Keep track of your triggers so you can try to avoid them. 

• Practice biofeedback or relaxation techniques to reduce your stress.

• Avoid skipping meals.

• Follow a regular sleep schedule that allows for plenty of sleep each night.

• Get regular exercise, such as yoga, to relieve stress and improve sleep.

• Quit smoking or drinking alcohol.

• Stay hydrated throughout the day.

Migraines are not curable, but they are treatable. Treatment can depend on the severity and frequency of your migraines, additional symptoms, and any other medical conditions you may have. Talk to a healthcare provider for a treatment plan tailored to you.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

February 10, 2022

Written by

Amelia Willson

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.