Symptoms & causes
Diagnosis & treatment
Doctors & departments
Diagnosis
If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.
If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:
MRI. An MRI scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help doctors diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) conditions.
CT scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.
CT scan
Lumbar puncture (spinal tap)
Treatment
Migraine treatment is aimed at stopping symptoms and preventing future attacks.
Many medications have been designed to treat migraines.
Medications used to combat migraines fall into two broad categories:
Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.
Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
Medications for relief
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:
Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.
Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.
Dihydroergotamines (D.H.E. 45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.
People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydrogergotamines.
Lasmiditan (Reyvow). This new oral tablet is approved for the treatment of migraine with or without aura. In drug trials, lasmiditan significantly improved pain as well as nausea and sensitivity to light and sound. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours. Lasmiditan also shouldn't be taken with alcohol or other drugs that depress the central nervous system.
Ubrogepant (Ubrelvy). This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without aura in adults. It's the first drug of this type approved for migraine treatment. In drug trials, ubrogepant was more effective than placebo in relieving pain and other migraine symptoms such as nausea and sensitivity to light and sound two hours after taking it. Common side effects include dry mouth, nausea and excessive sleepiness. Ubrogepant should not be taken with strong CYP3A4 inhibitor drugs.
Opioid medications. People who have migraines who can't take other migraine medications, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.
Preventive medications
Medications can help prevent frequent migraines. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don't respond well to treatment.
Preventive medication is aimed at reducing how often you get a migraine how severe the attacks are and how long they last. Options include:
Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, Innopran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Tarka, Verelan) can be helpful in preventing migraines with aura.
Antidepressants. A tricyclic antidepressant (amitriptyline) can prevent migraines. Because of the side effects of amitriptyline, such as sleepiness and weight gain, other antidepressants might be prescribed instead.
Anti-seizure drugs. Valproate and topiramate (Topamax) might help you have less frequent migraines, but can cause side effects such as dizziness, weight changes, nausea and more.
Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.
Calcitonin gene-related peptide (CGRP) monoclonal antibodies.
Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality) are newer drugs approved by the Food and Drug Administration to treat migraines. They're given monthly by injection. The most common side effect is a reaction at the injection site.
Migraine medications and antidepressants
Migraine treatment: Can antidepressants help?
Lifestyle and home remedies
When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead or at the back of your neck.
Other practices that might soothe migraine with aura pain include:
Try relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.
Develop a sleeping and eating routine. Don't sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day.
Drink plenty of fluids. Staying hydrated, particularly with water, might help.
Keep a headache diary. Continue recording in your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.
Exercise regularly. Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose aerobic activity you enjoy, such as walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.
Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.
Alleviating migraine pain
Alternative medicine
Nontraditional therapies might help with chronic migraine pain.
Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points.
Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
Cognitive behavioral therapy. Cognitive behavioral therapy may benefit some people with migraines. This type of psychotherapy teaches you how behaviors and thoughts affect how you perceive pain.
Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur might prevent migraines or reduce their severity, though study results are mixed. Butterbur isn't recommended because of safety concerns.
A high dose of riboflavin (vitamin B-2) may also prevent migraines or reduce the frequency of headaches. Coenzyme Q10 supplements might decrease the frequency of migraines, but larger studies are needed.
Due to low magnesium levels in some people with migraines, magnesium supplements have been used to treat migraines, but with mixed results.
Ask your doctor if these treatments are right for you. Don't use feverfew, riboflavin or butterbur if you're pregnant or without first talking with your doctor.
Chiropractic adjustment
Preparing for your appointment
You'll probably first see a primary care provider, who might then refer you to a doctor trained in evaluating and treating headaches (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
Keep track of your symptoms. Keep a headache diary by writing a description of each incident of visual disturbances or unusual sensations, including when they occurred, how long they lasted and what triggered them. A headache diary can help your doctor diagnose your condition.
Write down key personal information, including major stresses or recent life changes.
Make a list of all medications, vitamins or supplements you take, including doses. It's particularly important to list all medications you've used to treat your headaches.
Write down questions to ask your doctor.
Take a family member or friend along, if possible, to help you remember the information you receive.
For migraines, questions to ask your doctor include:
What is likely triggering my migraines?
Are there other possible causes for my migraine symptoms?
What tests do I need?
Are my migraines likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach that you're suggesting?
What changes to my lifestyle or diet do you suggest I make?
I have these other health conditions. How can I best manage them together?
Are there printed materials you can give me? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, including:
How often do your headaches occur?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Does anyone else in your family have migraines?
And Also:
Migraines: Simple steps to head off the pain
Migraines cause pain as real as the pain of injuries — with one difference: Healthy habits and simple nonmedical remedies sometimes stop migraines before they start.
Medication is a proven way to both treat and prevent migraines. But medication is only part of the story. It's also important to take good care of yourself and understand how to cope with migraine pain when it strikes.
The same lifestyle choices that promote overall good health can also reduce the frequency and severity of your migraines.
Combining medication with behavioral measures and lifestyle can often be the most effective way to handle migraines.
Find a calm environment
At the first sign of a migraine, take a break and step away from whatever you're doing if possible.
Turn off the lights. Migraines often increase sensitivity to light and sound. Relax in a dark, quiet room. Sleep if you can.
Try temperature therapy. Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the sensation of pain. Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect.
Drink a caffeinated beverage. In small amounts, caffeine alone can relieve migraine pain in the early stages or enhance the pain-reducing effects of acetaminophen (Tylenol, others) and aspirin.
Be careful, however. Drinking too much caffeine too often can lead to withdrawal headaches later on. And having caffeine too late in the day may interfere with your sleep, which can also affect migraines.
Sleep well
Migraines may keep you from falling asleep or wake you up at night. Likewise, migraines are often triggered by a poor night's sleep.
Here are some tips to encourage sound sleep.
Establish regular sleep hours. Wake up and go to bed at the same time every day — even on weekends. If you nap during the day, keep it short. Naps longer than 20 to 30 minutes may interfere with nighttime sleep.
Unwind at the end of the day. Anything that helps you relax can promote better sleep: listen to soothing music, soak in a warm bath or read a favorite book.
But watch what you eat and drink before bedtime. Intense exercise, heavy meals, caffeine, nicotine and alcohol can interfere with sleep.
Minimize distractions. Save your bedroom for sleep and intimacy. Don't watch television or take work materials to bed. Close your bedroom door. Use a fan to muffle distracting noises.
Don't try so hard to sleep. The harder you try to sleep, the more awake you'll feel. If you can't fall asleep, read or do another quiet activity until you become drowsy.
Check your medications. Medications that contain caffeine or other stimulants — including some medications to treat migraines — may interfere with sleep.
Eat wisely
Your eating habits can influence your migraines. Consider the basics:
Be consistent. Eat at about the same time every day.
Don't skip meals. Fasting increases the risk of migraines.
Keep a food journal. Keeping track of the foods you eat and when you experience migraines can help identify potential food triggers.
Avoid foods that trigger migraines. If you suspect that a certain food — such as aged cheese, chocolate, caffeine or alcohol — is triggering your migraines, eliminate it from your diet to see what happens.
Exercise regularly
During physical activity, your body releases certain chemicals that block pain signals to your brain. These chemicals also help alleviate anxiety and depression — and these two conditions can make migraines worse.
Obesity also increases the risk of chronic headaches. Maintaining a healthy weight through exercise and diet can provide additional benefits in managing migraines.
If your doctor agrees, choose any exercise you enjoy. Walking, swimming and cycling are often good choices. Just remember to ease into exercise gradually, as very vigorous exercise may trigger migraines.
Manage stress
Stress and migraines often go hand in hand. You can't avoid daily stress, but you can keep it under control to help manage your migraines:
Simplify your life. Don't look for ways to squeeze more activities or chores into the day. Instead, find a way to leave some things out.
Manage your time wisely. Update your to-do list every day — both at work and at home. Delegate what you can, and divide large projects into manageable chunks.
Take a break. If you feel overwhelmed, a few slow stretches or a quick walk may renew your energy for the task at hand.
Adjust your attitude. Stay positive. If you find yourself thinking, "This can't be done," switch gears. Think instead, "This will be tough. But I can make it work."
Enjoy yourself. Find time to do something you enjoy for at least 15 minutes every day. It could be playing a game, having coffee with a friend or pursuing a hobby. Doing something you enjoy is a natural way to combat stress.
Relax. Deep breathing from your diaphragm can help you relax. Focus on inhaling and exhaling slowly and deeply for at least 10 minutes every day. It may also help to consciously relax your muscles, one group at a time. When you're done, sit quietly for a minute or two.
Keep a migraine diary
A diary may help you determine what triggers your migraines. Note when your migraines start, what you were doing at the time, how long they last and what, if anything, provides relief.
Until recently, avoiding migraine triggers was considered the best advice. But new research suggests this may actually increase sensitivity to potential triggers.
A more useful approach may be to gradually expose yourself to triggers, and learn to cope with these headache triggers by using behavioral management techniques. These may include identifying and challenging negative thoughts, relaxation training, and stress reduction. More research is needed to understand if and how this approach is more effective in managing migraines.
Strive for balance
Living with migraines is a daily challenge. But making healthy lifestyle choices can help. Ask your friends and loved ones for support.
If you're feeling anxious or depressed, consider joining a support group or seeking counseling. Believe in your ability to take control of the pain.