Migraine

What it is

Migraine is a neurologic disorder causing recurrent headache attacks, and about one-third of people with migraine have aura. It is not simply a “bad headache.” Migraine attacks often cause moderate to severe head pain, usually with nausea, vomiting, and sensitivity to light, sound, or movement. Attacks can last from hours to several days and may interfere with work, school, sleep, and daily activities. Migraine without aura is the most common form and accounts for about 75% of cases.

Migraine is common across the world and is a major cause of disability, especially in younger and middle-aged adults. Women are affected more often than men, likely in part because of hormonal influences. In India, migraine is also a frequent reason for outpatient visits and self-medication with painkillers, which matters because frequent use of acute pain medicines can itself worsen headache over time.

Common migraine types include:

Type	Key feature
Migraine without aura	Recurrent headache attacks without warning neurologic symptoms
Migraine with aura	Temporary visual, sensory, speech, or other neurologic symptoms before or during the headache
Chronic migraine	Headache on 15 or more days per month for more than 3 months, with migraine features on at least 8 days per month
Menstrual migraine	Attacks linked to the menstrual cycle

A migraine attack may have phases: prodrome, aura, headache, and postdrome. Not everyone has all phases.

How it works

Migraine is a complex brain disorder with genetic and environmental influences. Current evidence suggests abnormal activation of pain pathways involving the trigeminal nerve and release of signaling molecules such as calcitonin gene-related peptide, or CGRP. These changes can increase pain signaling and sensitivity to light, sound, and movement.

Migraine also involves altered brain excitability. In migraine with aura, a wave of altered electrical activity called cortical spreading depression is thought to help explain temporary neurologic symptoms such as flashing lights, zigzag lines, numbness, or trouble speaking.

Migraine triggers vary from person to person and do not mean the person “caused” the attack. Common triggers include:

1. Stress or let-down after stress
2. Sleep loss or oversleeping
3. Skipping meals or dehydration
4. Menstrual hormone changes
5. Alcohol, especially in some individuals
6. Bright light, strong smells, heat, or weather changes
7. Too much caffeine or caffeine withdrawal

Keeping a headache diary can help identify patterns, but many attacks occur without an obvious trigger.

Diagnosis / how it's measured

Migraine is diagnosed clinically, meaning mainly from the history and symptom pattern rather than a blood test or scan. A clinician asks about the headache’s location, severity, duration, associated symptoms, frequency, and any warning symptoms or neurologic changes.

Typical migraine features include:

• Headache lasting 4 to 72 hours if untreated
• Pulsating or throbbing quality
• Moderate to severe intensity
• Worse with routine physical activity
• Nausea and/or vomiting
• Sensitivity to light and sound

Aura symptoms are usually fully reversible and often develop gradually over several minutes, lasting up to 60 minutes. Visual aura is most common.

Brain imaging is not needed for every person with migraine. It is more likely to be considered when symptoms are unusual, the neurologic exam is abnormal, or there are red flags suggesting another cause.

Important red flags include:

Red flag	Why it matters
Sudden “worst headache”	Could suggest bleeding or another emergency
New headache after age 50	Needs evaluation for secondary causes
Fever, stiff neck, confusion	Could suggest infection or inflammation
Weakness, persistent numbness, seizure, fainting	Could suggest stroke or another neurologic disorder
New headache in pregnancy, cancer, or immune suppression	Higher risk of secondary causes
Progressive worsening pattern	Needs medical review

A related problem is medication-overuse headache, which can happen when acute headache medicines are used too often. This is one reason clinicians ask exactly how many days per month a person takes pain relievers, triptans, or combination headache tablets.

Evidence and uses

Treatment has two main goals: stop or reduce an attack when it happens, and prevent future attacks when migraines are frequent or disabling.

Acute treatment may include simple pain relievers such as paracetamol or nonsteroidal anti-inflammatory drugs, anti-nausea medicines, and migraine-specific drugs such as triptans. These work best when taken early in the attack. Newer options that target CGRP pathways or serotonin receptors are available in some settings, though access and cost vary.

Preventive treatment is considered when attacks are frequent, prolonged, hard to treat, or causing major disability. Options include certain blood pressure medicines, anti-seizure medicines, some antidepressants, onabotulinumtoxinA for chronic migraine, and CGRP-targeting therapies. Choice depends on headache pattern, other health conditions, pregnancy plans, cost, and side effects.

Lifestyle measures can help reduce attack frequency in some people:

1. Regular sleep and wake times
2. Consistent meals and hydration
3. Regular physical activity
4. Stress management
5. Limiting overuse of acute pain medicines

Evidence supports behavioral approaches such as cognitive behavioral therapy, relaxation training, and biofeedback for some patients. Supplements such as magnesium or riboflavin are sometimes used in prevention, but evidence varies by product and dose, and they should still be discussed with a clinician.

When to see a clinician

See a clinician if headaches are new, changing, frequent, severe, or interfering with daily life. Medical review is also important if you need acute headache medicine often, because this can point to medication overuse or a need for preventive treatment.

Seek urgent care right away for a sudden explosive headache, headache with fever or stiff neck, new neurologic symptoms such as weakness or confusion, headache after head injury, or a new severe headache during pregnancy.

If migraine is already diagnosed, follow-up is useful when treatment stops working, side effects occur, or attacks become more frequent. Many people benefit from a written plan for what to take early in an attack and when to escalate care.

Limitations and open questions

Migraine is well studied, but important gaps remain. People with the same diagnosis can have very different symptoms, triggers, and treatment responses, so care often requires trial and adjustment rather than a single best treatment for everyone.

Newer migraine medicines have improved options for some patients, but long-term comparative data, affordability, and access remain issues. Evidence is also still evolving on which patients benefit most from specific preventive therapies and how best to combine medicines with behavioral treatment.

Another limitation is underdiagnosis and undertreatment. Many people normalize recurrent headaches or rely on over-the-counter painkillers without recognizing migraine. That can delay effective treatment and increase the risk of medication-overuse headache. If headaches are recurrent or disabling, a clinician can help confirm the diagnosis and build a safer long-term plan.