Migraine causes, symptoms and treatments
A migraine can ruin your day, make you miss work or social events and even affect your eyes.
Migraine is a condition that can cause recurring attacks with moderate to severe headaches, nausea, sensitivity to light or sound, and vision issues like seeing zigzags, wavy lines or flashing lights. Migraine pain may throb or pulsate and often occurs on just one side of the head.
Learn about the causes, triggers and treatment of migraines as well as the eye symptoms migraines can cause and how your eye doctor may be involved in your treatment.
What is a migraine?
Migraine is a neurological condition with "attacks" that usually include a headache and may last for as long as three days.
Migraines are classified based on how often attacks happen and how long they last, according to the American Migraine Foundation (AMF):
Chronic migraine – having migraine 15 or more "headache days" per month, with at least eight that include migraine features, for three or more months
Episodic migraine – having 14 or fewer "headache days" per month
About 12 percent of the U.S. population has migraine, and about 90 percent of people with migraine have a family history of the disease.
What does a migraine feel like?
A migraine attack typically has four phases, but some people don't always go through all the phases. The four phases of a migraine are:
Prodrome – In the day or days before a migraine, you may experience symptoms such as moodiness, fluid retention, yawning often and urinating more than usual.
Aura – Right before or during a headache, you may see zig zags, wavy lines of light, dots, spots or stars. These vision symptoms typically last up to 30 minutes.
Headache – A migraine often, but not always, includes a headache. The head pain may start slowly and build up over time. The pain may throb or pulsate. You may also have other symptoms such as nausea or sensitivity to light. This phase may last from a few hours to three days.
Postdrome – This is the period of recovery from a headache known as a "migraine hangover." You may feel achy, tired or weak.
Most people with migraine go through the prodrome, headache and postdrome, though they may not always recognize each phase. Only about one in five people with migraine go through the aura phase.
Learning how to recognize the prodrome phase can alert you that you need to take migraine medication to head off a headache or lessen symptoms.
Doctors do not know exactly what causes migraine. But it is clear some people have a higher risk due to genetics.
A migraine attack can be triggered by a variety of factors from certain foods to stress to strong smells to weather. (See below for a migraine triggers list.)
These factors may put people at higher risk for migraine:
Sex – About three times more women than men have migraine, and children also can get migraines.
Genetics – About nine in 10 people with migraine have a family history of the disease.
Other conditions – Having anxiety, bipolar disorder, depression, epilepsy or sleep disorders may increase your chance of having migraine.
Migraine causes can be hard to pin down. But you may be able to prevent some attacks if you identify and avoid your own migraine triggers.
Migraine headache symptoms
A migraine often includes a severe headache with pulsing or throbbing pain. You may get migraine pain behind your eyes, and/or on the left or right side of your head or the back of your head. Some people have a headache for a few hours, while others have a migraine lasting days.
Migraine symptoms may include:
Dizziness or vertigo
Head pain (may be on left and/or right side, or back of the head)
Numbness or tingling
Increased sensitivity to light and/or sound
Severe pain in the head, often on one side
Nausea and/or vomiting
Migraine symptoms may vary based on the person and the stage of the migraine. If you have any of these symptoms, see a doctor for diagnosis and treatment.
Migraine or sinus headache?
Many people mistake a migraine for a sinus headache. If you think you get regular "sinus headaches" the chances are good that you might really have migraines.
Here's the difference between a migraine and a sinus headache:
A sinus headache happens when you have a sinus infection caused by bacteria or viruses.
A person with a sinus headache likely will have symptoms such as a fever and a runny nose with yellowish mucus and lost or lessened sense of smell.
People who lack these symptoms probably have migraine, but it's important to see a health care provider to get the right diagnosis.
Migraine and the eyes
A migraine is one of the most common causes of a headache behind the eyes, and there are two types of migraine that can cause temporary problems with vision. These two types of migraines are:
Visual migraine – A visual migraine, or migraine aura, is a migraine that causes visual symptoms in both eyes such as: a blind spot in the center of your vision, zigzag lines or squiggles that may shimmer in different colors, dots, stars or a light that looks like a camera flash. These visual migraine symptoms usually last 10 to 30 minutes and may or may not be followed by a headache.
Ocular migraine – An ocular migraine, or retinal migraine, involves a blind spot (scotoma) in the center of your field of vision, usually in one eye. The blind spot grows in size, and the episode may last about an hour. An ocular migraine is caused by blood flow issues or blood vessel spasms in the retina, a membrane that covers the inside of the back of the eyeball.
Visual migraines are much more common than ocular migraines. As many as one in three people with migraine may have visual migraine symptoms.
How are migraines diagnosed?
There is no test that will tell your doctor that your symptoms are being caused by migraines. Your doctor will ask you questions about your symptoms, take a family history and do a physical exam.
Your doctor may ask you:
How often you get headaches or have other symptoms.
What level of severity of head pain you experience.
How long your headaches usually last.
How the headaches affect your daily life (making you miss work, events, etc.).
If you have other symptoms (nausea, sensitivity to light, etc.).
If you have a family history of headaches/migraines.
Your doctor may make a diagnosis based on your answers, exam, symptoms and family history. They may also ask you to keep a headache diary to help with diagnosis and identifying patterns or triggers.
Most people who go to a doctor for headaches do not have an MRI or CT scan. But in some cases, your doctor may order imaging to check for less common headache causes such as aneurysm, blood clots or a brain tumor.
There is migraine help available. Migraine treatment usually takes a two-sided approach: preventing migraines if possible and treating migraine symptoms when you do have an attack.
The goal of migraine prevention is to get fewer migraines that last a shorter time and cause less severe symptoms.
A good place to start: keep a migraine diary or log to ID patterns, symptoms and triggers. The Migraine Trust offers a migraine diary you can use to record the date, day, time, triggers, severity, symptoms and how long the migraine lasts.
Once you ID your migraine triggers and patterns, you can make a personal migraine prevention plan. This might include: avoiding migraine food triggers, starting an exercise regimen, practicing meditation, staying hydrated and getting on a regular sleep schedule. Because light can trigger migraines, it's also a good idea to wear sunglasses outside on bright days.
Medications for migraines include over-the-counter (OTC) drugs like Tylenol or Advil as well as prescription migraine medications.
Migraine medicine falls into two groups: medicine you take to prevent migraines and medicine you take to treat migraines.
Medicines used to prevent migraines typically are taken every day and may take months to start working. Migraine prevention medicines include: anticonvulsants, ACE inhibitors, beta blockers and calcium channel blockers.
Medicines used to treat migraines include:
Analgesics – These are pain relievers that include over-the-counter and prescription medications. Analgesics used for migraines include: acetaminophen, aspirin, ibuprofen and naproxen.
Antiemetics – These are drugs that are used to treat nausea. Antiemetics used for migraines include: domperidone, prochlorperazine and metoclopramide.
Triptans – These are drugs that relieve migraine pain by shrinking the blood vessels in the head and blocking pain signals in nerves in the face. Triptans used for migraines include almotriptan, eletriptan, rizatriptan, sumatriptan and zolmitriptan. Zolmitriptan nasal spray is a migraine relief nasal spray taken at the first sign of a headache.
Gepants and ditans – These newer migraine drugs can treat headache, nausea and sensitivity to light and sound. They work by targeting receptors on sensory nerves to stop symptoms.
If you have chronic migraine, Botox injections may be a treatment option. This treatment is FDA-approved only for those with 15 or more headache days a month for three or more months in a row.
Your doctor will help you find a migraine medication or combination of medications that work for you to prevent and treat your migraines.
If a migraine won't go away or you can't tolerate the pain, you may need to go to the emergency department (ED) or emergency room (ER) at a hospital. Headaches are the reason for more than two of every 100 ER visits.
In the ER, you may get migraine medication by injection, by IV or by mouth. In some cases, you may be asked to inhale a migraine medication. Healthcare providers in the ER often give a combination of two or more drugs — known informally as a "migraine cocktail."
Migraine triggers list
Migraine triggers may be different for each person, but it can be helpful to know about common triggers so you can see if they affect you.
Here is a list of migraine triggers:
Anxiety or stress
Certain foods (see: migraine food triggers list below)
Changes in barometric pressure
Changes or disturbances in sleep
Cigarette smoke and/or tobacco products
Hormone changes during period known as a "menstrual migraine"
Lights (sunlight, fluorescent lights or flickering lights)
Overuse of migraine medication
Strong smells (perfumes, chemicals, gasoline)
Weather (extreme heat, storms)
If you think certain foods trigger migraines, you might want to try a migraine elimination diet. Here is a list of common foods that may trigger migraines:
Aged cheeses and other dairy products
Cured, smoked or processed meats
Foods with MSG (monosodium glutamate)
Pickles or pickled products
Triggers are very individual. People with migraines have reported a variety of triggers, from bananas to ear piercing. Just because an item isn't on this migraine triggers list, it doesn't mean that it isn't a trigger for you.
See your eye doctor for vision symptoms
It's important to have regular eye exams and also to see your doctor if you have any eye pain or visual symptoms. These symptoms may be related to migraine or could be a sign of a more serious condition like retinal detachment. See your eye doctor right away if you have:
If you have symptoms of a visual migraine, your eye doctor may ask questions, take a family history, examine you and do any tests necessary to find out whether your symptoms are related to migraine with aura or another issue with your eyes.
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Migraine facts. Migraine Research Foundation. Accessed May 2021.
Migraine. MedlinePlus, National Library of Medicine. Accessed May 2021.
Sinus headaches. American Migraine Foundation. May 2016.
Visual disturbances: Related to migraine or not? American Migraine Foundation. February 2016.
Do I need an imaging study for my headache? American Migraine Foundation. July 2015.
Keeping a migraine diary. The Migraine Trust. Accessed May 2021.
Top 10 migraine triggers and how to deal with them. American Migraine Foundation. July 2017.
Preventive medicines. The Migraine Trust. Accessed May 2021.
Acute medicines. The Migraine Trust. Accessed May 2021.
Zolmitriptan nasal spray. MedlinePlus, National Library of Medicine. February 2018.
How gepants and ditans complement existing therapies. American Migraine Foundation. April 2020.
Botox for migraine. American Migraine Foundation. June 2017.
Migraine in the emergency department. American Migraine Foundation. April 2016.
Page published in June 2021
Page updated in June 2021