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TDD: 1-888-220-5446
Q: How common are migraines?
A: Migrainepainandsymptomsaffect
29.5millionAmericans.Migraineis
themostcommonformofdisabling
headachethatsendspatientstoseetheir
doctors.
Q: What causes migraines?
A: Theexactcauseofmigraineisnotfully
understood.Mostresearchersthinkthat
migraineisduetoabnormalchanges
inlevelsofsubstancesthatarenaturally
producedinthebrain.Whenthelevels
ofthesesubstancesincrease,theycan
causeinf lammation.Thisinf lammation
thencausesbloodvesselsinthebrainto
swellandpressonnearbynerves,caus-
ingpain.
Genesalsohavebeenlinkedto
migraine.Peoplewhogetmigraines
mayhaveabnormalgenesthatcontrol
thefunctionsofcertainbraincells.
Expertsdoknowthatpeoplewith
migrainesreacttoavarietyoffactors
andevents,calledtriggers.Thesetrig-
gerscanvaryfrompersontoperson
anddontalwaysleadtomigraine.A
combinationoftriggersnotasingle
thingoreventismorelikelytoset
offanattack.Apersonsresponseto
triggersalsocanvaryfrommigraineto
migraine.Manywomenwithmigraine
tendtohaveattackstriggeredby:
lackofortoomuchsleep
skippedmeals
brightlights,loudnoises,orstrong
odors
hormonechangesduringthemen-
strualcycle
Migraine
Q: What is migraine?
A: Migraineisamedicalcondition.Most
peoplewhosufferfrommigrainesget
headachesthatcanbequitesevere.A
migraineheadacheisusuallyanintense,
throbbingpainonone,orsometimes,
bothsidesofthehead.Mostpeople
withmigraineheadachefeelthepainin
thetemplesorbehindoneeyeorear,
althoughanypartoftheheadcanbe
involved.Besidespain,migrainealso
cancausenauseaandvomitingandsen-
sitivitytolightandsound.Somepeople
alsomayseespotsorf lashinglightsor
haveatemporarylossofvision.
Migrainecanoccuranytimeofthe
day,thoughitoftenstartsinthemorn-
ing.Thepaincanlastafewhoursor
uptooneortwodays.Somepeople
getmigrainesonceortwiceaweek.
Others,onlyonceortwiceayear.Most
ofthetime,migrainesarenotathreat
toyouroverallhealth.Butmigraine
attackscaninterferewithyourday-to-
daylife.
Wedontknowwhatcausesmigraine,
butsomethingsaremorecommonin
peoplewhohavethem:
Mostoften,migraineaffectspeople
betweentheagesof15and55.
Mostpeoplehaveafamilyhistoryof
migraineorofdisablingheadache.
Theyaremorecommoninwomen.
Migraineoftenbecomeslesssevere
andlessfrequentwithage.
stressandanxiety,orrelaxationafter
stress
weatherchanges
alcohol(oftenredwine)
caffeine(toomuchorwithdrawal)
foodsthatcontainnitrates,suchas
hotdogsandlunchmeats
foodsthatcontainMSG(monoso-
diumglutamate),af lavorenhancer
foundinfastfoods,broths,season-
ings,andspices
foodsthatcontaintyramine,such
asagedcheeses,soyproducts,fava
beans,hardsausages,smokedfish,
andChiantiwine
aspartame(NutraSweetand
Equal)
Topinpointyourmigrainetriggers,
keepaheadachediary.Eachdayyou
haveamigraineheadache,putthatin
yourdiary.Alsowritedownthe:
thetimeofdayyourheadachestart-
ed
whereyouwereandwhatyouwere
doingwhenthemigrainestarted
whatyouateordrank24hours
beforetheattack
eachdayyouhaveyourperiod,not
justthefirstday(Thiscanallow
youandyourdoctortoseeifyour
headachesoccuratthesameorsim-
ilartimeasyourperiod.)
Talkwithyourdoctoraboutwhatsets
offyourheadachestohelpfindthe
righttreatmentforyou.
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Q: Are there different kinds of
migraine?
A: Yes,therearemanyformsofmigraine.
Thetwoformsseenmostoftenare
migrainewithauraandmigrainewith-
outaura.
Migrainewithaura(previouslycalled
classicalmigraine).Withamigraine
withaura,apersonmighthavethese
sensorysymptoms(theso-called
aura)10to30minutesbeforean
attack:
seeingf lashinglights,zigzaglines,or
blindspots
numbness;ortinglinginthefaceor
hands
disturbedsenseofsmell,taste,or
touch
feelingmentallyfuzzy
Onlyoneinfivepeoplewhoget
migraineexperienceanaura.Women
havethisformofmigrainelessoften
thanmen.
Migrainewithoutaura(previously
calledcommonmigraine).Withthis
formofmigraine,apersondoesnot
haveanaurabuthasalltheotherfea-
turesofanattack.
Q: How can I tell if I have a
migraine or just a bad tension-
type headache?
A: Comparedwithmigraine,tension-type
headacheisgenerallylesssevereand
rarelydisabling.Compareyoursymp-
tomswiththoseinthefollowingchart
toseewhattypeofheadacheyoumight
behaving.
SYMPTOM TENSION MIGRAINE
Intensity and quality of pain
Mild-to-moderate x x
Moderate-to-severe x
Intense pounding or throbbing and/or debilitating x
Distracting, but not debilitating x
Steady ache x x
Location of pain
One side of head x
Both sides of head x x
Other symptoms
Nausea, vomiting x
Sensitivity to light and/or sounds rare x
Aura before onset of headache x
Note: Rebound headache may have features of tension and/or migraine headache
Adapted from a table produced by the American Council for Headache Education
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Althoughfatigueandstresscanbring
onbothtensionandmigrainehead-
aches,migrainescanbetriggeredby
certainfoods,changesinthebodys
hormonelevels,andevenchangesin
theweather.
Therealsoaredifferencesinhowtypes
ofheadachesrespondtotreatmentwith
medicines.Althoughsomeover-the-
counterdrugsusedtotreattension-type
headachessometimeshelpmigraine
headaches,thedrugsusedtotreat
migraineattacksdonotworkforten-
sion-typeheadachesformostpeople.
Youcan'ttellthedifferencebetweena
migraineandatension-typeheadache
byhowoftentheyoccur.Bothcan
occuratirregularintervals.Also,inrare
cases,bothcanoccurdailyoralmost
daily.
Q: How can I tell if I have a
migraine or a sinus headache?
A: Manypeopleconfuseasinushead-
achewithamigrainebecausepainand
pressureinthesinuses,nasalconges-
tion,andwateryeyesoftenoccurwith
migraine.Tofindoutifyourheadache
issinusormigraine,askyourselfthese
questions:
Inadditiontomysinussymptoms,doI
have:
1. moderate-to-severeheadache
2. nausea
3. sensitivitytolight
Ifyouansweryestotwoorthreeof
thesequestions,thenmostlikelyyou
havemigrainewithsinussymptoms.A
truesinusheadacheisrareandusually
occursduetosinusinfection.Inasinus
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infection,youwouldalsolikelyhavea
feverandthicknasalsecretionsthatare
yellow,green,orblood-tinged.Asinus
headacheshouldgoawaywithtreat-
mentofthesinusinfection.
Q: When should I seek help for my
headaches?
A: Sometimes,headachecansignalamore
seriousproblem.Youshouldtalkto
yourdoctoraboutyourheadachesif:
youhaveseveralheadachesper
monthandeachlastsforseveral
hoursordays
yourheadachesdisruptyourhome,
work,orschoollife
youhavenausea,vomiting,vision,
orothersensoryproblems(suchas
numbnessortingling)
youhavepainaroundtheeyeorear
youhaveasevereheadachewitha
stiffneck
youhaveaheadachewithconfusion
orlossofalertness
youhaveaheadachewithconvul-
sions
youhaveaheadacheafterablowto
thehead
youusedtobeheadache-free,but
nowhaveheadachesalot
Q: What tests are used to find out
if I have migraine?
A: Ifyouthinkyougetmigrainehead-
aches,talkwithyourdoctor.Before
yourappointment,writedown:
1. howoftenyouhaveheadaches
2. wherethepainis
3. howlongtheheadacheslast
4. whentheheadacheshappen,suchas
duringyourperiod
5. othersymptoms,suchasnauseaor
blindspots
6. anyfamilyhistoryofmigraine
7. allthemedicinesthatyouaretak-
ingforallyourmedicalproblems,
eventheover-the-countermedicines
(betterstill,bringthemedicinesin
theircontainerstothedoctor)
8. allthemedicinesyouhavetakenin
thepastthatyoucanrecalland,if
possible,thedosesyoutookandany
sideeffectsyouhad
Yourdoctormayalsodoanexamand
askmorequestionsaboutyourhealth
history.Thiscouldincludepasthead
injuryandsinusordentalproblems.
Yourdoctormaybeabletodiagnose
migrainejustfromtheinformationyou
provide.
Youmaygetabloodtestorothertests,
suchasCTscanorMRI,ifyourdoc-
torthinksthatsomethingelseiscausing
yourheadaches.Workwithyourdoctor
todecideonthebesttestsforyou.
Q: Are migraine headaches more
common in women than men?
A: Yes.Aboutthreeoutoffourpeople
whohavemigrainesarewomen.
Migrainesaremostcommoninwomen
betweentheagesof20and45.Atthis
timeoflifewomenoftenhavemore
job,family,andsocialduties.Women
tendtoreportmorepainfulandlonger
lastingheadachesandmoresymptoms,
suchasnauseaandvomiting.Allthese
factorsmakeithardforawomantoful-
fillherrolesatworkandathomewhen
migrainestrikes.
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Q: I get migraines right before my
period. Could they be related to
my menstrual cycle?
A: Morethanhalfofmigrainesinwomen
occurrightbefore,during,oraftera
womanhasherperiod.Thisoftenis
calledmenstrualmigraine.But,just
asmallfractionofwomenwhohave
migrainearoundtheirperiodonly
havemigraineatthistime.Mosthave
migraineheadachesatothertimesof
themonthaswell.
Howthemenstrualcycleandmigraine
arelinkedisstillunclear.Weknowthat
justbeforethecyclebegins,levelsofthe
femalehormones,estrogenandpro-
gesterone,godownsharply.Thisdrop
inhormonesmaytriggeramigraine,
becauseestrogencontrolschemicals
inthebrainthataffectawomanspain
sensation.
Talkwithyourdoctorifyouthinkyou
havemenstrualmigraine.Youmayfind
thatmedicines,makinglifestylechang-
es,andhometreatmentmethodscan
preventorreducethepain.
Q: Can migraine be worse during
menopause?
A: Ifyourmigraineheadachesareclosely
linkedtoyourmenstrualcycle,meno-
pausemaymakethemlesssevere.As
yougetolder,thenauseaandvomiting
maydecreaseaswell.Abouttwo-thirds
ofwomenwithmigrainesreportthat
theirsymptomsimprovewithmeno-
pause.
Butforsomewomen,menopause
worsensmigraineortriggersthemto
start.Itisnotclearwhythishappens.
Menopausalhormonetherapy,which
isprescribedforsomewomenduring
menopause,maybelinkedtomigraines
duringthistime.Ingeneral,though,
theworseningofmigrainesymptoms
goesawayoncemenopauseiscomplete.
Q: Can using birth control pills
make my migraines worse?
A: Insomewomen,birthcontrolpills
improvemigraine.Thepillsmayhelp
reducethenumberofattacksandtheir
attacksmaybecomelesssevere.But
inotherwomen,thepillsmayworsen
theirmigraines.Instillotherwomen,
takingbirthcontrolpillshasnoeffect
ontheirmigraines.
Thereasonforthesedifferentresponses
isnotwellunderstood.Forwomen
whosemigrainesgetworsewhenthey
takebirthcontrolpills,theirattacks
seemtooccurduringthelastweekof
thecycle.Thisisbecausethelastseven
pillsinmostmonthlypillpacksdont
havehormones;theyaretheretokeep
youinthehabitoftakingyourbirth
controldaily.Withoutthehormones,
yourbodysestrogenlevelsdropsharp-
ly.Thismaytriggermigraineinsome
women.
Talkwithyourdoctorifyouthinkbirth
controlpillsaremakingyourmigraines
worse.Switchingtoapillpackinwhich
allthepillsfortheentiremonthcon-
tainhormonesandusingthatforthree
monthsinarowcanimprovehead-
aches.Lifestylechanges,suchasgetting
onaregularsleeppatternandeating
healthyfoods,canhelptoo.
Q: Can stress cause migraines?
A: Yes.Stresscantriggerbothmigraine
andtension-typeheadache.Events
likegettingmarried,movingtoanew
home,orhavingababycancause
stress.Butstudiesshowthateveryday
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stressesnotmajorlifechangescause
mostheadaches.Jugglingmanyroles,
suchasbeingamotherandwife,having
acareer,andfinancialpressures,canbe
dailystressesforwomen.
Makingtimeforyourselfandfind-
inghealthywaystodealwithstressare
important.Somethingsyoucandoto
helppreventorreducestressinclude:
eatinghealthyfoods
beingactive(atleast30minutes
mostdaysoftheweekisbest)
doingrelaxationexercises
gettingenoughsleep
Trytofigureoutwhatcausesyouto
feelstressed.Youmaybeabletocutout
someofthesestressors.Forexample,if
drivingtoworkisstressful,trytaking
thebusorsubway.Youcantakethis
timetoreadorlistentomusic,rather
thandealwithtraffic.Forstressorsyou
cantavoid,keepingorganizedand
doingasmuchasyoucanaheadoftime
willhelpyoutofeelincontrol.
Q: How are migraines treated?
A: Migrainehasnocure.Butyour
migrainescanbemanagedwithyour
doctorshelp.Together,youwillfind
waystotreatmigrainesymptomswhen
theyhappen,aswellaswaystohelp
makeyourmigraineslessfrequent
andsevere.Yourtreatmentplanmay
includesomeorallofthesemethods.
Medicine.Therearetwowaysto
approachthetreatmentofmigraines
withdrugs:stoppingamigrainein
progress(calledabortiveoracute
treatment)andprevention.Many
peoplewithmigraineusebothformsof
treatment.
Acute treatment.Over-the-counter
pain-reliefdrugssuchasaspirin,acet-
aminophen,orNSAIDs(nonsteroidal
anti-inf lammatorydrugs)likeibuprofen
relievemildmigrainepainforsome
people.Ifthesedrugsdontworkfor
you,yourdoctormightwantyouto
tryaprescriptiondrug.Twoclassesof
drugsthatdoctorsoftentryfirstare:
Triptans,whichworkbybalancing
thechemicalsinthebrain.Examples
includesumatriptan(Imitrex),
rizatriptan(Maxalt),zolmitriptan
(Zomig),almotriptan(Axert),
eletriptan(Relpax),naratrip-
tan(Amerge),andfrovatriptan
(Frova).Triptanscancomeas
tabletsthatyouswallow,tablets
thatdissolveonyourtongue,nasal
sprays,andasashot.Theyshould
notbeusedifyouhaveheartdisease
orhighbloodpressure.
Ergotderivatives(ergotaminetar-
trateanddihydoergotamine),which
workinthesamewayastriptans.
Theyshouldnotbeusedifyouhave
heartdiseaseorhighbloodpressure.
Mostacutedrugsformigrainework
bestwhentakenrightaway,when
symptomsfirstbegin.Alwayscarry
yourmigrainemedicinewithyou
incaseofanattack.Forpeoplewith
extrememigrainepain,apowerful
rescuedrugmightbeprescribed,
too.Becausenoteveryonerespondsthe
samewaytomigrainedrugs,youwill
needtoworkwithyourdoctortofind
thetreatmentthatworksbestforyou.
Prevention.Somemedicinesused
dailycanhelppreventattacks.Manyof
thesedrugsweredesignedtotreatother
healthconditions,suchasepilepsyand
depression.Someexamplesare:
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antidepressants,suchasamitriptyline
(Elavil)orvenlafaxine(Effexor)
anticonvulsants,suchasdivalproex
sodium(Depakote)ortopiramate
(Topamax)
beta-blockers,suchaspropranolol
(Inderal)ortimolol(Blocadren)
calciumchannelblockers,suchas
verapamil
Thesedrugsmaynotpreventall
migraines,buttheycanhelpalot.
Hormonetherapymayhelpprevent
attacksinwomenwhosemigraines
seemtobelinkedtotheirmenstrual
cycle.Askyourdoctoraboutpreven-
tiondrugsif:
yourmigrainesdonotrespondto
drugsforsymptomrelief
yourmigrainesaredisablingorcause
youtomisswork,familyactivities,
orsocialevents
youareusingpain-reliefdrugsmore
thantwotimesaweek
Lifestyle changes.Practicingthese
habitscanreducethenumberof
migraineattacks:
Avoidorlimittriggers.
Getupandgotobedthesametime
everyday.
Eathealthyfoodsanddonotskip
meals.
Engageinregularphysicalactivity.
Limitalcoholandcaffeineintake.
Learnwaystoreduceandcopewith
stress.
Alternative methods.Biofeedback
hasbeenshowntohelpsomepeople
withmigraine.Itinvolveslearninghow
tomonitorandcontrolyourbodys
responsestostress,suchaslowering
heartrateandeasingmuscletension.
Othermethods,suchasacupunc-
tureandrelaxation,mayhelprelieve
stress.Counselingalsocanhelpifyou
thinkyourmigrainesmayberelatedto
depressionoranxiety.Talkwithyour
doctoraboutthesetreatmentmethods.
Q: What are rebound migraines?
A: Womenwhouseacutepain-relief
medicinemorethantwoorthreetimes
aweekormorethan10daysoutof
themonthcansetoffacyclecalled
rebound.Aseachdoseofmedicine
wearsoff,thepaincomesback,lead-
ingthepatienttotakeevenmore.This
overusecausesyourmedicinetostop
helpingyourpainandactuallystart
causingheadaches.Reboundheadaches
canoccurwithbothover-the-counter
andprescriptionpain-reliefmedicines.
Theycanalsooccurwhetheryoutake
themforheadacheorforanothertype
ofpain.Talktoyourdoctorifyoure
caughtinareboundcycle.
Q: Im pregnant. Can my migraines
still be treated?
A: Somemigrainemedicinesshould
notbeusedwhenyouarepregnant
becausetheycancausebirthdefects
andotherproblems.Thisincludes
over-the-countermedicines,suchas
aspirinandibuprofen.Talkwithyour
doctorifmigraineisaproblemwhile
youarepregnantorifyouareplan-
ningtobecomepregnant.Yourdoctor
mightsuggestamedicinethatwillhelp
youandthatissafeduringpregnancy.
Hometreatmentmethods,suchas
doingrelaxationexercisesandusing
coldpacks,alsomighthelpeaseyour
pain.Thegoodnewsisthatformost
oago 8
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womenmigrainesimproveorstop
fromaboutthethirdmonthofthe
pregnancy.
Q: I am breastfeeding. Will taking
medicine for migraine hurt my
baby?
A: Askyourdoctoraboutwhatmigraine
medicinesaresafetotakewhilebreast-
feeding.Somemedicinescanbepassed
throughbreastmilkandmightbe
harmfultoyourbaby.
Q: What are some ways I can pre-
vent migraine?
A: Thebestwaytopreventmigraineis
tofindoutwhattriggersyourattacks
andavoidorlimitthesetriggers.Since
migraineheadachesaremorecommon
duringtimesofstress,findinghealthy
waystocutdownonandcopewith
stressmighthelp.Talkwithyourdoctor
aboutstartingafitnessprogramortak-
ingaclasstolearnrelaxationskills.
Talkwithyourdoctorifyouneedto
takeyourpain-reliefmedicinemore
thantwiceaweek.Doingsocanlead
toreboundheadaches.Ifyourdoctor
hasprescribedmedicineforyoutohelp
preventmigraine,takethemexactly
asprescribed.Askwhatyoushoulddo
ifyoumissadoseandhowlongyou
shouldtakethemedicine.Talkwith
yourdoctoriftheamountofmedicine
youareprescribedisnothelpingyour
headaches.
Q: What should I do when a
migraine begins?
A: Workwithyourdoctortocome
upwithaplanformanagingyour
migraines.Keepingalistofhometreat-
mentmethodsthathaveworkedforyou
inthepastalsocanhelp.Whensymp-
tomsbegin:
Ifyoutakemigrainemedicine,take
itrightaway.
Drinkf luids,ifyoudon'thavenau-
seaduringyourmigraine.
Liedownandrestinadark,quiet
room,ifthatispractical.
Somepeoplefindthefollowinguseful:
acoldclothonyourhead
rubbingorapplyingpressuretothe
spotwhereyoufeelpain
massageorotherrelaxation
exercisesn
oago
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AllmaterialcontainedintheFAQsisfreeofcopyrightrestrictions,andmaybecopied,
reproduced,orduplicatedwithoutpermissionoftheOfficeonWomen'sHealthinthe
DepartmentofHealthandHumanServices.Citationofthesourceisappreciated.
ThisFAQwasreviewedby:
PeterJ.Goadsby,M.D.,Ph.D.
DepartmentofNeurology
UniversityofCalifornia,SanFrancisco
SusanHutchinson,M.D.
Director,OrangeCountyMigraine&HeadacheCenter
B.LeePeterlin,D.O.
Director,HeadacheClinic
DrexelUniversityCollegeofMedicine
ContentlastupdatedMay2008
For More Information
Formoreinformationonmigraine,pleasecallwomenshealth.govat1-800-994-9662or
contactthefollowingorganizations:
National Institute of Neurological
Disorders and Stroke (NINDS),
NIH, HHS
PhoneNumber:(800)352-9424
InternetAddress:
http://www.ninds.nih.gov
American Council for Headache
Education (ACHE)
Phone:(856)423-0258
InternetAddress:http://www.achenet.org
Migraine Awareness Group: A
National Understanding For
Migraineurs (MAGNUM)
PhoneNumber:(703)349-1929
InternetAddress:http://www.migraines.
org
National Headache Foundation
PhoneNumber:(888)643-5552
InternetAddress:
http://www.headaches.org
National Menstrual Migraine
Coalition
InternetAddress:
http://www.headachesinwomen.org