Migraine

Introduction

Photo of woman holding her head in pain
PantherMedia / Ruslan Huzau

Migraine is not the same as the usual kind of headaches that most people have every now and then. A migraine attack starts suddenly with severe pain on only one side of your head. The pain is much worse than a normal headache and usually accompanied by other symptoms as well.

But these headaches are only considered to be migraines if the typical symptoms have occurred at least five times.

Migraines can greatly affect everyday life. Some people only get them occasionally, while others are knocked out by migraines on several days every month. Different types of medicine can help you cope with migraines.

Symptoms

Migraines are typically associated with moderate to severe headaches that only affect one side of the head. People usually describe the pain as pulsating, throbbing or pounding. It often gets worse during physical activity or even if you move a little. The headaches may be accompanied by nausea or vomiting. When children have migraines, they may not have a headache – instead, the main symptoms might be nausea, vomiting or dizziness.

Some people also become very sensitive to light or noise during migraine attacks. Left untreated, the symptoms last between four hours and three days.

Before the actual migraine becomes noticeable, some people see flashing lights or strange shapes. Others might see everything as a blur or through wavy lines. People may temporarily have trouble speaking, experience paralysis in some parts of their body or have abnormal sensations such as tingling. Doctors call these kinds of disturbances "auras." They usually go away within an hour and are then followed by more typical migraine symptoms.

Causes and risk factors

It’s not clear exactly what causes migraines. According to one theory, it has something to do with inflamed blood vessels in the brain. The way in which the brain processes pain signals may play a role too. Stress is often an important factor when it comes to pain: Feeling nervous or tense can make the pain worse or more likely to arise in the first place. So hectic days without enough breaks may increase the risk of getting a migraine. Migraines may also start once stress has subsided – for instance, on the weekend or during the first few days of vacation.

An irregular eating and sleeping schedule can increase the likelihood of migraine attacks too. There is probably also a connection between migraines, diet and exercise. If you have migraines, you can find out for yourself whether these factors affect you. Keeping a migraine diary can help you do so.

Learn more

Migraine diary

Prevalence

Migraines are more common in women than in men. About 14 out of 100 women and 7 out of 100 men have recurring migraines. This is different for children, where migraines are equally common in boys and girls: About 4 to 5 out of 100 children are affected.

Outlook

Migraines sometimes go away on their own over time. Young women often have their first migraine once they start having periods. In a lot of women, migraine attacks go away during pregnancy and disappear completely after menopause.

It's very rare for migraines to become chronic. They are considered to be chronic if the headaches occur on more than 15 days per month over a period of at least three months. Fewer than 2 out of 100 people with migraines have a chronic form.

Prevention

Certain sleeping patterns or other habits may increase the risk of developing migraines. The things that trigger migraines vary from person to person. Keeping a migraine or headache diary may help you get an idea of what triggers your migraines. The diary can be used to record things like how long and severe a migraine attack was, what was happening around the time the attack occurred, what you ate or drank beforehand, and what medicine you took.

This will make it easier to find any links between migraine attacks and possible triggers. The diary entries can also show whether avoiding a possible trigger, like red wine for example, actually helps to reduce the frequency and severity of migraine attacks.

Some people try to prevent migraine attacks using dietary supplements, herbal medicinal products or relaxation techniques. People who have very severe or very frequent migraine attacks also have the option of preventive medication or psychological treatment. This involves things like learning more about the condition or practicing techniques that can help to cope with stressful situations.

Treatment

A lot of people who have migraines know from experience what helps them. This often involves lying down in a quiet and dark room and putting cool wet towels or cooling pads on the side of their head that hurts.

Most people take medicine to get through attacks that are especially painful. Medications used for migraine attacks include, in particular, acetaminophen (paracetamol), non-steroidal (NSAIDs) such as acetylsalicylic acid (the drug in medicines like Aspirin), diclofenac or ibuprofen, as well as special migraine medications like triptans. Acetaminophen (paracetamol), acetylsalicylic acid and ibuprofen are available without a prescription, as are two of the triptan drugs. But before using medication yourself it’s a good idea to see a doctor to find out if the headaches are actually migraines.

Using painkillers and migraine medication too often can itself make the headaches worse. For this reason, people are advised not to take painkillers and migraine medications on more than ten days per month.

Everyday life

Many people have such severe or regular migraines that it makes their life difficult. Recurring migraines can really wear you down. Severe migraines can make it impossible to carry on day-to-day activities at home or at work, having a major impact on your performance and ability to concentrate.

Migraine attacks may happen at specific times – for instance, in the days leading up to a woman's monthly period. But they are often unpredictable, which can make it difficult to plan activities or stick to appointments. It’s not just the attacks themselves that are so distressing that they affect people's ability to enjoy life, but also the fear of having more attacks and worries about the consequences at home and at work.

Negative feelings and thoughts can also lead to behavior that affects people's quality of life. For example, they might avoid activities that they would normally enjoy for fear of having a migraine attack. Cognitive behavioral therapy can help to change those negative thoughts and behavior. Some people try out this method to help them cope better with migraines. Others try relaxation techniques like autogenic training, where you learn how to enter a deep state of relaxation. And some find that exercise makes them feel better.

Further Information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

In Germany there are numerous sources of support if you have migraines, including self-help groups and information centers. There are many regional differences in how these services are organized, and they aren’t always easy to find. You can use our list to help find and make use of local services.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

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Updated on May 30, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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