A migraine is a common neurologic disorder that is more than just “a really bad headache.” It’s a specific and complex type of headache that typically presents with throbbing pain on one side of the head. The pain level can range from moderate to debilitating.
Migraines tend to develop in childhood, adolescence, or young adulthood, peaking between ages 20-40 years. Once they appear, the headaches are considered a recurrent lifelong condition.
About 1 in 5 Americans experience migraine headaches. Two-thirds are women, due to the influence of sex hormones, especially estrogen. Migraines are also hereditary; if one parent has them, their children will have a 50-75% chance of having them, too.
A third factor that affects the frequency and severity of migraines is the environment. Although not every attack can be prevented, learning which situations trigger a headache can help prevent or reduce episodes.
The Four Stages of Migraine Headaches
Migraines follow a pattern with four distinct stages. However, migraines are individual; not everyone experiences all the symptoms of each stage and the stages can even overlap.
Prodrome: A migraine actually begins from a few hours to a few days before the attack. There can be subtle symptoms that warn of an impending headache:
- Unexplained mood changes, such as depression or euphoria
- Food cravings
- Stiff neck
- Frequent yawning
- Increased urination
- Constipation
Aura: About 25-35% of people have neurologic symptoms that occur about 10-60 minutes before the attack. When auras appear, there’s time to prepare by taking medication and finding a dark, quiet space to rest.
Symptoms of an aura can include:
- Vision changes: blurring or blind spots
- Seeing flashing or bright lights
- Tingling sensations in the face or hands
- Difficulty speaking
- Confusion
- Muscle weakness
Attack: A migraine usually starts gradually and becomes intense. If there’s no aura, it happens without warning. The attack stage can last 4-72 hours. In a survey, 44% of respondents reported their attack lasted up to 24 hours; 33% reported it lasted longer than 24 hours.
During the headache, a person can experience any of these symptoms:
- Sensitivity to light, sound, and odors
- Nausea and vomiting
- Confusion
- Blurred vision
- Dizziness
- Fatigue
Postdrome: The postdrome attack can last 24-48 hours before the person feels able to return to normal activities. This stage is sometimes called a “migraine hangover.”
Recovery symptoms can include:
- Exhaustion
- Mild headache
- Dizziness
- Poor concentration
- Mood changes
- Muscle aches
Migraine Triggers: Beyond Hormones and Genetics
Environmental and lifestyle factors can influence the development of migraines. Although triggers vary from one person to another, over 75% of individuals report having triggers. Keeping a diary of migraine attacks, including when they occur, duration, intensity, and if any known triggers are involved, can be extremely helpful. Once sensitivities or triggers are identified, steps can be taken to prevent or minimize an attack.
- Stress or relief after a stressful situation: the most common trigger.
- Caffeine: too much or withdrawal. Includes chocolate and cola.
- Alcohol: especially red wine.
- Skipped meals, fasting, or hypoglycemia (low blood sugar).
- Foods with tyramine: aged cheeses, sourdough breads, foods that are fermented, salted, smoked, pickled, or processed.
- Foods with sulfites: preserved food, dried fruits, shrimp and shellfish, beer and wine, pickled food and sauerkraut, processed meat, soda and fruit juices, condiments.
- Foods with monosodium glutamate (MSG) or artificial sweeteners.
- Lack of sleep or disrupted sleep routine.
- Bright or flashing lights.
- Strong smells: perfume, cigarette smoke, cleaning products, gasoline, incense.
- Physical exhaustion or overexertion from too much exercise.
- Travel or changes in altitude.
- Weather: Sudden temperature or atmospheric pressure change.
Diagnosis and Treatment
There is no single test to diagnose migraines. Providers rely on the patient’s personal and family history, a physical examination, and a neurological assessment. They’ll consider all the symptoms and check for other possible causes of the headaches.
Thankfully, treatment has advanced to include both preventative measures and relief from the acute pain of attacks. Working with the provider, an individual plan is developed—and then adapted as needed. Depending on the frequency and intensity of the headaches, a wide range of medications is available, from over-the -counter (OTC) products such as aspirin, acetaminophen, and ibuprofen, to prescriptions that target specific proteins in the brain.
Non-medication and alternative treatments can be effective holistic methods for dealing with migraine headaches. Stress management can help prevent the most common trigger for attacks. Other useful practices include:
- Hydration: Insufficient water intake is a trigger for migraines.
- Exercise: Daily exercise can prevent or even treat headaches.
- Diet: Eat at regular mealtimes and avoid processed foods.
- Sleep: Lack of sleep releases stress hormones and leads to fatigue.
When you’re dealing with migraines–or any medical condition—remember that it’s important to be a health advocate for yourself. Learn all you can, communicate with your provider, and don’t be shy about putting yourself first.
Sources:
- Alternative Treatments for Migraine. American Migraine Foundation, 28 April 2022. Accessed online 26 May 2025.
- Are Migraines Hereditary? Interview with Julia Bucklan, DO. Cleveland Clinic, 6 June 2023. Accessed online 22 May 2025.
- Gibbs S et al. United States Patients’ Perspective of Living With Migraine: Country-Specific Results From the Global “My Migraine Voice” Survey. Headache: The Journal of Head and Face Pain, 05 May 2020. Accessed online 22 May 2025.
- Grangeon L et al. Genetics of migraine: where are we now? The Journal of Headache and Pain, 20 February 2023. Accessed online 22 May 2025.
- Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. National Library of Medicine, Open Medicine, 23 November 2022. Accessed online 26 May 2025.
- Khorsha F et al. Association of drinking water and migraine headache severity. The Journal of Clinical Neuroscience, July 2020. Accessed online 26 May 2025.
- Low-Tyramine Diet for Individuals with Headache or Migraine. National Headache Foundation, 16 September 2024. Accessed online 23 May 2025.
- Managing Stress. Centers for Disease Control and Prevention, Mental Health. 16 August 2024. Accessed online 26 May 2025.
- Migraine: Symptoms and Causes. Interview with Amaal Starling, MD. Mayo Clinic, 7 July 2023. Accessed online 22 May 2025
- Migraine, reviewed by Howard E. LeWine, MD. Harvard Health Publishing, 7 July 2023. Accessed online 22 May 2025.
- Migraine, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 31 January 2025. Accessed online 22 May 2025.
- Ruschel M, DeJesus O. Migraine Headache. StatPearls, National Center for Biotechnology Information, National Library of Medicine. 5 July 2024. Accessed online 23 May 2025.
- Sulfite Sensitivity. Cleveland Clinic. 24 April 2024. Accessed online 26 May 2025.