Migraine attacks - Its causes, symptoms, diagnosis, treatment, medications, dietary changes, and home remedies. (March 2025):

 

What is a migraine? Migraine is a health condition that is more than just a bad headache. It is a complex neurological condition that typically involves headaches. However, not everyone with migraine will experience the headache aspect during an episode. Migraine is different from other headaches. It can feel like the world is ending and you can do nothing to make it go away. Even though your symptoms are temporary, the duration of a migraine can make it feel like time is moving slower and against you.  A migraine is a severe headache that causes throbbing, pulsing head pain on one side of your head. The headache phase of a migraine usually lasts at least four hours, but it can also last for days. This headache gets worse with: Physical activity. Bright lights. Loud noises. Strong odors. By far the most common type of headache we see in our practice, migraines are the most frequent cause of disabling, recurring headache pain.

What are the types of migraines? There are different types of migraine. The most common migraine categories are: Migraine with aura (Classic migraine) - An aura is a phase of the migraine before head pain begins. Some people with migraines experience aura symptoms. Aura symptoms are usually vision changes—like seeing dots, zigzags, or sparks—but can also include changes in a person’s ability to speak. They might also include feelings of pins and needles in different body parts. Migraine without aura (common migraine)- More commonly, a person experiences no sensory disturbances before an episode. This type of migraine accounts for around 70–80% of cases. Some other types of migraine include: Chronic migraine: This involves having an episode on more than 15 days per month. Menstrual migraine: This occurs in a pattern that follows the menstrual cycle. Hemiplegic migraine: This causes temporary weakness on one side of the body, and it is very rare. Abdominal migraine: This involves migraine episodes with irregular function in the gut and abdomen, often with nausea or vomiting. It also typically involves abdominal pain. It mainly affects children under 14 years of age. Vestibular migraine: Severe vertigo is a symptom of this type. Vertigo is a symptom that feels like you or the world around you is spinning. Basilar migraine: This rare type is also called “migraine with brainstem aura,” and it can affect neurological functions, such as speech. Migraine without headache (silent migraine). Retinal migraine (ocular migraine). Status migrainous.

What are the symptoms of a migraine attack? The most common symptoms of a migraine attack include: Throbbing headache Sensitivity to light, noise, and smell Nausea (feeling sick) Vomiting (being sick) Lethargy (lack of energy). Other common features of migraine are: Head pain that worsens during physical activity or straining An inability to perform regular activities due to the pain Increased sensitivity to light and sound can sometimes be relieved by lying quietly in a darkened room. Sweating, Feeling unusually hot or cold, Stomachache, Diarrhea. The symptoms of migraine are different from person to person but often include headaches that keep coming back.  Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling (pain) that usually happens on one side of the head. However, they may occur anywhere on the head, neck, and face , or all over. These symptoms can happen all at once during a migraine attack, or they can happen separately in between migraine attacks. Migraine attacks may last from hours to days and make it hard to do everyday activities. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers. In between attacks, people living with migraine may also experience symptoms like having a hard time concentrating, depression, anxiety, difficulty sleeping, and/or body chills. They can also include vomiting, changes in mood, and extreme tiredness. At their worst, they are typically associated with sensitivity to light, noise, and/or smells. The symptoms of a migraine attack come in four phases. The most notable is a headache attack. It can take about eight to 72 hours to go through the four stages. Migraine symptoms vary based on the stage. Every migraine is different, and you won’t necessarily experience symptoms during all four stages of every migraine. You might get one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Each stage can vary in how long and how bad it is. Migraine attacks in children are often much shorter than in adults. It may be easier to tell the different headache stages in a child. Clues to watch for in children who are not able to describe their symptoms include sensitivity to light and noise. For example, they may refuse to watch television or use the computer—or they may stop playing to lie down in a dark room.  Migraine pain can be felt in the face, where it may be mistaken for a sinus headache — or in the neck, where it may be mistaken for arthritis or muscle spasms. Complicating the diagnosis of migraine is that the headaches may be accompanied by other "sinus-like" symptoms, including watering eyes, nasal congestion, and a sense of facial pressure. Most patients who think they have sinus headaches have migraines. In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances (flashing lights, zigzags, blind spots), many people experience numbness, confusion, trouble speaking, vertigo (spinning dizziness), and other strokelike neurological symptoms. Some patients may experience auras without headaches. The four phases of migraine are listed below: 1. Prodrome (Premonitory stage or first phase):  This is sometimes described as the warning stage in which certain physical, mental, and emotional changes occur.  It occurs up to 24 hours before a headache attack. The symptoms of this stage can include: Tiredness, Craving for certain types of food, Mood changes [depression, Europhobia, and irritability (high or low)], Dizziness, Neck stiffness, Sensitivity to light and sound, Excessive yawning, Feeling thirsty, Passing more and more frequent urine (wee), Difficulty concentrating, Trouble sleeping, Fatigue, Nausea. These feelings can last up to 24 hours. 2. Aura (second phase or second stage): Aura is the result of a wave of nerve activity that spreads over the brain (known as cortical spreading depression). As this electrical wave spreads, the nerves fire in an abnormal way and this range of reversible neurological symptoms (aura) develop. It occurs due to a spontaneous, slow-moving wave that passes over the surface of the brain temporarily affecting the functioning of the parts it travels over. Associated symptoms depend upon which parts of the brain are affected. It includes physical, sensory, and motor, symptoms like speech problems and flashing lights in the field of vision.  Aura is a disturbance of the senses in the early stages of a migraine episode. These symptoms are considered a warning sign that a migraine is coming. Some of these symptoms are much less common with migraine headaches. This stage can last from five to 60 minutes and usually happens before the headache. An aura often occurs 10 to 15 minutes before the headache but can occur just a few minutes to 24 hours before. You might experience both the aura and the headache at the same time. In adults, they usually happen before the headache itself, but in children, they may happen at the same time as the headache. It is possible to have the aura symptoms without the headache, this is often referred to as a ‘silent migraine’. A visual aura may feel like the aftermath of a very bright camera flash, but the visual changes may last for several minutes or up to 1 hour. Around 1/3 of migraine patients go through this stage (not necessarily every time).  Migraine without aura does not include this stage.  Anyone experiencing an aura for the first time should contact a healthcare professional to rule out serious neurological problems, such as a stroke or a brain tumor. Your healthcare provider will likely order tests to find the cause. Symptoms during Aura: The aura of migraine includes a wide range of neurological symptoms.  Most often, the vision is affected and can include any or all of the following symptoms: Temporary blind spots, blank patches, or colored spots in the field of vision, Blurred vision, Eye pain, Seeing stars, zigzag lines, or flashing lights, Tunnel vision (only able to see objects close to the center of the field of view), Seeing strange, sparkling, or flashing lights that are not there, Seeing things that are not there out of one eye, such as transparent strings of objects, Not being able to see part of something clearly, Having part of the field of vision disappear, then reappear. The following symptoms can also be experienced during Aura:  Yawning, nausea, trouble finding the right words, Numbness, and tingling, having a pins and needles sensation in an arm or leg, Having difficulty speaking. Having weakness in the shoulders, neck, or limbs. Muscle weakness Dizziness or vertigo (sensation of spinning and poor balance) Hearing changes, Ringing in ears (tinnitus). Sensitivity to touch (feeling like someone is touching you). Some people experience memory changes, confusing thoughts or experiences, difficulty concentrating, feelings of fear,  and more rarely, partial paralysis or fainting. 3. Headache attack (main attack stage or third stage or third phase):  It starts as a dull ache and gets worse within minutes to hours It is throbbing, pounding, or pulsating? It is made worse by moving, light, and sound.  It is worse on one side of the head (especially at the start of the attack) with pain behind the eye or in the back of the head and neck. However, it may be on both sides or all over the head. It lasts 4 to 72 hours. Other symptoms that may occur with the headache include: Chills, Increased urination, Neck pain, Dizziness, Nasal congestion, Fatigue, Loss of appetite, Nausea (sickness) and vomiting (being sick), Sensitivity to light, smell, sound, and movement, Sweating. Painkillers work best when taken early in this stage. Resolution: There may be a stage between the headache attack and the postdrome stage which is called Resolution. Most attacks slowly fade away, but some stop suddenly after the person with migraine is sick, or cries a lot. Sleep seems to help many people, even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack. 4. Postdrome (fourth phase or fourth stage or recovery stage): This is the final stage of an attack, and it can take hours or days for a drained, headache, tiredness, irritability, fatigue, or ‘hangover’ type of feeling to disappear. Symptoms may linger, even after the migraine goes away.  Symptoms feel similar to an alcohol-induced hangover, which is why the postdrome phase is known as a migraine hangover. Symptoms can often mirror symptoms of the first stage ( Predroma or pre-monitoring stage). For example: If the person loses the appetite at the beginning of the attack, might be very hungry now. If you were tired, you might feel full of energy. Symptoms of postdrome can include: Feeling mentally dull, like your thinking is not clear or sharp, Needing more sleep, Neck pain, Fatigue, Stiff neck, Sensitivity to light and sound, Trouble in focussing, Nausea, Dizziness.

What causes a migraine? A migraine episode is different from a typical headache. The experience is different, and they can have different causes. A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues. The exact cause of migraine is not fully understood. However, there are certain factors that experts believe may contribute to the development of the condition. Genetic features may also play a role — having a family history of migraine is a common risk factor. When you have a headache, specific nerves in your blood vessels send pain signals to your brain. This releases inflammatory substances into your head’s nerves and blood vessels. It’s unclear why your nerves do that. Current research shows that this head pain happens when there is abnormal activity among nerve signals, chemical signals, and blood vessels in the brain. What triggers a migraine? A trigger is something that causes symptoms to start. Several factors can trigger a migraine attack or increase a person’s risk of having one. These factors vary from person to person. Some of the triggers are listed below:  Emotional triggers: Stress that causes changes in mental health and well-being, Depression, Anxiety, Excitement.d certain medications a triggering factor, such as: Sleeping pills, Hormone Replacement Therapy (HRT), Use of birth control pills. Various environmental factors can potentially trigger migraine such as: Flickering screens, Strong smells, Odors, or perfumes, Loud or sudden noise, bright or flashing lights. Smoking or exposure to smoke, Weather conditions change, Humidity, Stuffy rooms, Temperature changes, Schedule changes. Certain dietary factors can trigger migraine, This sensitivity makes a migraine more likely to happen, especially if combined with other triggers. These include: Addictive substances like caffeine or tobacco, Dairy foods, especially certain cheeses,  Peanuts and other nuts and seeds, Fruits (avocado, banana, citrus fruit), Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans, Foods containing additives like nitrates (bacon, hot dogs, salami, pepperoni, cured food, and meats), Foods containing additives like Mono Sodium Glutamate (MSG), Beverages containing alcohol, Chocolate, Onions, Caffeine withdrawal, Processed, fermented, pickled, or marinated foods. Some other possible triggers include: Tiredness, Teeth grinding at night, Changes in sleep patterns, such as too much or not enough sleep. Shoulder and neck tension, Poor posture, Low blood sugar, Jet lag, Irregular mealtimes missed meals or hunger, Dehydration, Too much physical activity (overexertion), Changes in Hormonal levels, especially in women  during a menstrual cycle,  Motion sickness, Low blood sugar or skipped meals, Tobacco, Head trauma, Drinking too much alcohol. Your healthcare provider can help you identify your triggers. They might recommend keeping a migraine journal to track similarities between migraine attacks.

Are migraines hereditary? Yes, migraines tend to run in biological families. Up to 80% of people with migraines have a first-degree biological relative with the condition.

Risk factors: Who is more likely to have migraine? A migraine can affect anyone at any age, from children to adults.  Several factors contribute to whether or not a person will have migraine. Migraine is a genetic disorder, meaning most people with migraine have a family history of the disorder.  In general, migraine affects adult females/women more often than males/men. Hormone changes that happen with the menstrual cycle or pregnancy seem to be one important cause of this disparity. Headaches may begin when a woman's first period begins or during pregnancy. Most women see improvement in migraine attacks after menopause, although surgical removal of the ovaries (oophorectomy) usually worsens migraine attacks. Using birth control (contraception) can also affect their frequency and severity. Other migraine disparities may exist. Native Americans are more likely to have migraine than other racial/ethnic groups. People who are unemployed and are experiencing poverty are also more likely to have migraine. Other risk factors that may make you more likely to experience a migraine include: Depression, Bipolar disorder, Fibromyalgia, Irritable bowel syndrome, Overactive bladder, Sleep disorders, Obsessive Compulsive Disorder (OCD), Anxiety, Epilepsy, Regular use of tobacco products.

How is a migraine diagnosed? Your provider can diagnose migraine headaches by asking about your symptoms and family history of migraines. A complete physical and neurological exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder. There is no specific test to prove that your headache is a migraine. Some extremely rare families have migraines as a result of a single genetic mutation in one of four known genes that can lead to the condition called familial hemiplegic migraine. There are no genetic tests for the vast majority of patients. Because the condition cannot be diagnosed by scan or blood test, the diagnosis is "clinical" — made by an experienced physician. Your provider may ask you questions to learn more about your symptoms, including: The time that symptoms start Possible triggers, such as stress or menstruation. The nature of the headache. How long do symptoms last? Any noticeable indicators of migraine, such as an aura. Any medications and their effects. Feeling and location of your headache. The severity of the symptoms. Did anything make your headache better or worse? Any other symptoms? Diagnosis of migraine without aura: The International Headache Society recommends the “5, 4, 3, 2, 1” criteria to diagnose migraine without aura. These numbers stand for: Having 5 or more episodes, each lasting 4 hours to 3 days. Having a headache with at least 2 of the following qualities: Occurring on one side, Pulsating, Causing moderate-to-severe pain aggravated by activity. Having at least 1 additional symptom, such as: Nausea, Vomiting, Sensitivity to light, Sensitivity to sound. Your healthcare provider may order blood tests, a brain CT, or an MRI scan if you have certain neurologic symptoms with your migraine, including weakness, memory problems, or loss of alertness, especially, if you have never had one before. An electroencephalogram (EEG) may be needed to check for seizures. A lumbar puncture (spinal tap) might be done. Such tests are conducted to rule out the possibility of other neurological disorders such as a tumor, meningitis, or a stroke.

Migraine treatment and management: Migraines that are severe, frequent, or accompanied by neurological symptoms are best treated preventively, usually with a combination of dietary modification, lifestyle changes, vitamins, and daily prescription medications. Most of our best preventive medications are often used for other medical purposes as well; the majority are blood pressure drugs, antidepressants, or epilepsy medications. Individual headache attacks are best treated early, often with one or more of the following types of medications: Triptans, Ditan, Non Steroidal Anti Inflammatory Drugs (NSAIDs), antiemetics (anti-nausea), and sometimes narcotics or steroids. Migraines typically last a few hours to a couple of days and respond well to specific treatments. However, in some patients, the migraine is particularly severe and long-lasting — and may even become chronic, occurring continuously for weeks, months, or even years. If improperly managed or left untreated, intermittent migraines may essentially transform into a chronic daily headache, with continuous and smoldering symptoms that periodically erupt into a "full-blown" migraine. This condition is extremely difficult to treat. Other patients may develop increasingly frequent headaches as a result of overusing their short-acting headache medications. While they are considered primary headaches, meaning they have no known underlying cause, migraines are associated with an increased risk of stroke, brain scarring as seen on MRI scans, a heart defect called a Patent Foramen Ovale (PFO), and other medical conditions. There is no cure for migraine. However, medications can help manage the symptoms when they arise, and people can take steps to reduce the frequency and severity of episodes. However, it is important to keep in mind that these medications can have side effects.

What medications treat migraines? A healthcare provider can help you manage migraine symptoms through the following: Taking medications. Avoiding migraine triggers. Using alternative migraine remedies. Drugs for migraine headaches can relieve the pain and symptoms of a migraine attack and help prevent further migraine attacks. Migraines can be treated with two types of drugs: abortive and preventive. Some migraine medications aim to stop a migraine. Others are for migraine prevention. Medications to stop migraines:  You can take these medications at the first sign of a migraine. They stop or reduce migraine symptoms like pain, nausea, sensitivity, and more. Medications to prevent migraines: A healthcare provider usually prescribes preventive medications if you experience severe symptoms that interfere with your routine or have frequent migraines. These medications reduce how often and how severe migraines affect you. You can take these medications as directed, usually daily.

Medications to stop migraines (or Acute or abortive medications for migraine): The goal of acute treatment is also called abortive treatment. It is to stop a migraine once it starts. Acute medications stop a migraine when you feel one coming or once it has begun. You can take acute medications by self-injection, mouth, skin patch, or nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly. Your first line of acute treatment may be one of the Over-The-Counter (OTC) pain medicines and combination pain medicines including Advil Migraine (containing ibuprofen),  Excedrin Migraine (containing aspirin, acetaminophen, caffeine), Isometheptene Dichloralphenazone Aacetaminophen (Midrin), and Motrin Migraine Pain (containing ibuprofen). Prescription NSAIDs (Non-Steroidal Anti Inflammatory Drugs) include Celecoxib (Elyxyb), Diclofenac potassium (Cambia), and Indomethacin (Indocin). Other acute treatments include Triptans (5-hydroxytryptamine),  and Ditans (Lasmiditan)., which specifically target Serotonin. They are all very similar in their action.  The Triptans are used only to treat headaches and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.  If your migraine attacks last a long time i.e. 72 hours or more, a doctor may prescribe the steroid drug Prednisone to shorten them. This drug can have serious side effects, including dizziness, sleep issues, and more headaches. It's important to take it exactly as your doctor tells you to.  Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since some of these can be habit-forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

Some of the acute medications ( medication to stop the migraine) for migraine treatment are listed below:

Medicine categories -  NSAIDS (Non Steroidal Anti Inflammatory Drugs)  and Pain Medicines: Many people find that over-the-counter painkillers, like paracetamol, aspirin, or ibuprofen, can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms. You shouldn’t wait until the headache worsens before taking painkillers as it’s often too late for the medication to work. Soluble painkillers (tablets you dissolve in a glass of water) are a good option because they’re absorbed quickly by your body. Taking too many painkillers can lead to medication overuse headaches. Children under 16 shouldn’t take aspirin unless it’s under the guidance of a healthcare professional. Aspirin and ibuprofen are not recommended for adults who have a history of stomach problems, like stomach ulcers, liver problems, or kidney problems. You shouldn’t take painkillers (paracetamol or non-steroidal anti-inflammatories) for more than 15 days in the long term.  Keep a record of what painkillers you take and how often you take them. If you can’t manage your migraine headaches using over-the-counter medicines, consult with a health care provider (doctor or neurologist).

Generic name - Ibuprofen Examples of Brand Names - Advil, Motrin May it be used during an aura?   -- Side Effects - Stomach upset or bleeding, Rash, and Swelling, may raise the risk of heart attack or stroke.

Generic name - Aspirin + Acetaminophen + Caffeine Examples of Brand Names - Excedrin Migraine, Excedrin, Goody's Side Effects - Heartburn, Anxiety, Insomnia, Allergic reaction, Liver damage, Blood in stool or vomit, Dizziness, and/or Easy bruising.

Generic name - Acetaminophen Example of Brand Names - Tylenol Side Effects - Liver damage, Allergic reactions, and Rashes.

Generic name - Naproxen Examples of Brand Names - Aleve, Anaprox DS (prescription only), and Naprosyn (prescription only). Side Effects -  Stomach upset, Stomach bleeding, Nausea, Vomiting, Rash, and Liver damage, May raise the risk of heart attack or stroke.

Generic name - Celecoxib Example of Brand Names - Celebrex May it be used during an aura?  Yes Side Effects -  Gas, bloating, Constipation, Sore throat, Cold symptoms, Lingering metallic or salty tastes in the mouth.

Medicine categories - Ergot

Generic name - Dihydroergotamine (Prochlorperazine) Examples of Brand Names - D.H.E. 45 Injection, Migranal Nasal Spray, and Ergotamine Tartrate (Cafergot). May it be used during an aura?  Yes Side Effects -  Nausea, Numbness of fingers and toes.

Medicine categories - Triptans If over-the-counter medication is not helping your symptoms, your healthcare provider might recommend a triptan and/or anti-sickness medication. Triptan medicines are a specific painkiller for migraine headaches. They’re thought to work by reversing the changes in the brain that may cause migraine headaches. Triptans are available as tablets, injections, and nasal sprays. Common side effects of triptans include: warm sensations, burning, or tightness, tingling, flushing and lightheadedness, feelings of heaviness in the face, throat, limbs, or chest. Dizziness, Nausea. dry mouth, Drowsiness Palpitations, Headache.  These side effects are usually mild and improve on their own. Taking too many triptans can lead to medication overuse headaches. You should not take them more than 10 days per month. Healthcare will usually recommend having a follow-up appointment once you’ve finished your first course of treatment. This is so that you can discuss their effectiveness and whether you had any side effects. If this treatment is not effective or causes unpleasant side effects, your healthcare may try prescribing a different type of triptan. Everyone reacts differently to each type of triptan.

Generic name - Sumatriptan Succinate Examples of Brand Names - Alsuma, Imitrex, Onzetra, Sumavel, and Zembrace. ( Imitrex injection, oral, intranasal Zembrace injection, Onzetra inhaled, Tosymra nasal spray). May it be used during an aura?  Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, uncontrolled hypertension, or pregnancy.

Generic name - Zolmitriptan Example of Brand Names - Zomig May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Generic name - Rizatriptan Example of Brand Names - Maxalt May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Generic name - Naratriptan Example of Brand Names - Amerge May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Generic name - Almotriptan Example of Brand Names - Axert May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Generic name - Frovatriptan Example of Brand Names - Frova May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Generic name - Eletriptan Example of Brand Names - Relpax May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension.

Medicine categories - Combination Triptan + NSAID

Generic name - Sumatriptan + Naproxen Example of Brand Names - Treximet May it be used during an aura? Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension. Side Effects - Head, jaw, chest, and arm discomfort, tightening, or tingling, Throat discomfort, Muscle cramps, Flushing, Stomach upset or bleeding, Nausea, Vomiting, Rash, and Liver damage.

Medicine categories - Ditan The Ditan interacts with 5-HT1F receptors on the sensory nerves and blood vessels.

Generic name - Lasmiditan Example of Brand Names - Reyvow May it be used during an aura? - yes Side Effects - Dizziness, Sleepiness, Numbness, Feeling tired, Tingling.

Medicine categories - CGRP Antagonists (Gepants ). Gepants block a protein involved in inflammation and pain called Calcitonin Gene Related Peptide (CGRP). Gepants Gepants are a specific painkiller for migraine headaches. Gepants might be prescribed where other medication, like triptans, hasn’t helped your migraine or if triptans aren’t suitable. Gepants are not recommended during pregnancy.

Generic name - Rimegepant Example of Brand Names - Nurtec May it be used during an aura? yes Side Effects - Nausea, UTI, Allergic reaction.

Generic name - Ubrogepant Example of Brand Names - Ubrelvy May it be used during an aura? yes Side Effects - Drowsiness, Nausea, Dry mouth.

Generic name - Zavegepant Example of Brand Names - Zavzpret May it be used during an aura? yes Side Effects - Dizziness, Nausea, Dry mouth.

Preventive medication for migraine: This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily.  It may take several weeks to see an improvement. Preventive medication is not a cure for migraine attacks. The aim is to reduce how severe and often migraine attacks occur. A good response to preventive medication would be a 30% to 50% reduction in frequency and severity. Preventive medications include the following:

Medicine categories - Medications used to treat high blood pressure: Beta-blockers. Calcium channel blockers (Verapamil).

Generic name - Atenolol, Metoprolol, Nadolol, Propranolol, Timolol. Examples of Brand Names - Tenormin, Lopressor, Toprol XL, Corgard, and Inderal. Medication details: Depending on the form, may be taken one to three times a day. Side Effects - Fatigue, Depression, Weight gain, Memory disturbance, Faintness, Diarrhea.

Propranolol: Propranolol is a medication used to treat angina and high blood pressure. It’s also effective in preventing migraine. It’s taken every day in tablet form, regardless of whether you have a headache or not. Propranolol is not suitable for people with asthma, Chronic Obstructive Pulmonary Disease (COPD), and some heart problems. It should be used with caution in people with diabetes. Side effects of propranolol can include: Cold hands and feet, Pins and needles, Problems sleeping Tiredness Light-headedness.

Candesartan Candesartan is a medication used for high blood pressure. Candesartan can cause lightheadedness due to low blood pressure, tiredness, and coughing. It should not be used if you’re pregnant or trying for a baby.

Medicine categories - Tricyclic Antidepressants Amitriptyline (Elavil), Nortriptyline (Aventyl, Pamelor), and Doxepin. Such medication is used for depression but at lower doses can also help prevent migraine.

Generic name - Amitriptyline Medication details: Often started at low dosages and slowly increased to a helpful level. EKG (Electrocardiogram), and blood tests may be needed while taking this medication. This medicine is taken nightly. Side Effects - Fatigue, Dry mouth, Weight gain, Constipation, Drowsiness, Blurred vision,   difficulty passing urine. Older adults also may feel confusion or faintness.

Medicine categories - SNRI (Serotonin Norepinephrine Reuptake Inhibitor) antidepressants.

Generic name - Venlafaxine, Duloxetine Examples of Brand Names - Effexor, Cymbalta, and generics are available Side Effects - Sleep problems, Drowsiness, Dizziness, Vision changes, Less sexual desire or ability, Headaches.

Medicine categories - Anticonvulsants Certain medicines are used to treat seizures, called anticonvulsants. Anti-seizure medications: Gabapentin (Neurontin), Topiramate,  Valproate - Valproic acid.

Topiramate: Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy. It’s now much more commonly used for migraine. It’s been shown to help prevent migraine. It’s taken every day in tablet form regardless of whether you have a headache or not. Topiramate should be used with caution in people with kidney stones, liver problems, or glaucoma. You should not take topiramate during pregnancy as it can harm your unborn baby. You must be on an effective form of contraception when taking topiramate. Topiramate can reduce the effectiveness of hormonal contraceptives. You should discuss alternative methods of contraception if you’re prescribed topiramate. Side effects of topiramate can include: decreased appetite and weight loss nausea and vomiting Constipation or diarrhea tingling sensation memory problems and difficulty finding words problems sleeping Drowsiness. Examples of Brand Names - Qudexy XR, Topamax, Trokendi XR,  Medication details: Often started at low dosages and slowly increased to a helpful level.

Generic name - Valproate Examples of Brand Names - Depakene, Depakote, and Stavzor. Medication details: Depends on the form. Usually once or twice a day. Side Effects - Nausea, Tiredness, Tremor, Dizziness, Weight gain, Hair loss, Birth defects.

Medicine categories - CGRP Antagonists. Gepants and CGRP inhibitors (Monoclonal antibodies):  Used to block the Calcitonin Gene Related Peptide (CGRP):

Generic name - Atogepant Example of Brand Names - Qulipta Side Effects - Constipation, Nausea, Upper respiratory infection.

Generic name - Eptinezumab Example of Brand Names - Vyepti Medication details: Quarterly IV (Intravenous) by the health care provider. Side Effects - Stuffy nose, Scratchy throat, Allergic reactions.

Generic name - Erenumab Examples of Brand Names - Aimovig Medication details: Once a month, self-injections with a prefilled pen. Side Effects - Mild pain and redness at the injection site, Constipation, Allergic reactions.

Generic name - Fremanezumab Example of Brand Names - Ajovy Medication details: It is used monthly or quarterly for self-injection with a prefilled syringe. It should be used with caution in people with heart or blood vessel disease. Side Effects - Mild pain and redness at the injection site, as well as allergic reactions.

Generic name - Galcanezumab Example of Brand Names - Emgality Medication details: Monthly, self-injection with a prefilled pen or syringe. Use with caution in people with heart or blood vessel disease. Side Effects - Mild pain and redness at the injection site, as well as allergic reactions.

Generic name - Rimegepant Example of Brand Names - Nurtec Medication details: Up to 18 doses per month by mouth for both acute and preventive therapy. Side Effects - Nausea, UTI, Allergic reaction.

Generic name - Zavegepant Example of Brand Names - Zavzpret Medication details: --- Side Effects - Dizziness, Nausea, Dry mouth.

Medicine categories - Botulinum toxin type A

Generic name - Onabotulinumtoxin A Example of Brand Names - Botox Medication details: Multiple injections are given about every 3 months to prevent chronic headaches. Side Effects - Headache, Neck pain.

Other less common options of preventative medications for migraine include: Pizotifen Flunarizine

Nausea drugs for migraine: Many people who have migraines often have nausea and vomiting along with head pain. Those symptoms usually get better when you treat the migraine. But sometimes, the nausea and vomiting are bad enough to keep a person from taking their migraine medications. In these cases, a nausea drug can ease your symptoms so you can get the treatment you need. Most nausea medicines come in pill form, but if the problem is severe, you can take them as a rectal suppository. Some of the nausea drugs for migraine are listed below:

Generic name - Promethazine hydrochloride (tablet, syrup, injection, or suppository). Example of Brand Names - Phenergan Possible Side Effects - Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements.

Generic name - Chlorpromazine  (suppository) Example of Brand Names - Thorazine Side Effects - Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements.

Generic name - Prochlorperazine (tablet and suppository)  Examples of Brand Names - Compazine, and Compro. Possible Side Effects - Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements.

Generic name - Trimetho-benzamide hydrochloride (capsule, injection, syrup, or suppository). Example of Brand Names - Tigan Possible Side Effects - Low blood pressure, blurred vision, drowsiness, dizziness, feeling disoriented, uncontrollable muscle movements, lip smacking or chewing movements.

Anti-sickness medicines or Antiemetics to manage any nausea and vomiting: Anti-sickness medicines, known as anti-emetics, can treat migraine in some people. They can be effective even if you don’t experience nausea or vomiting. They can be taken alongside painkillers and triptans. Anti-sickness medicines work better if they’re taken as soon as your migraine symptoms begin. They usually come in the form of a tablet. Some anti-sickness medications can cause involuntary movements, normally in the face. Speak to your healthcare provider if you experience involuntary movements.

Generic name - Metoclopramide hydrochloride (syrup, tablet, or injection). Antiemetic medications Example of Brand Names - Reglan Possible Side Effects - Uncontrollable muscle movements, lip smacking or chewing movements, sensitivity to sunlight, aching in the lower legs, drowsiness, and diarrhea.

Droperidol is also an antiemetic medicine and is used as a nausea drug for migraine.

Warning:  You should not take Triptans with SSRI ( Selective Serotonin Reuptake Inhibitor) or SNRI. (Serotonin Norepinephrine Reuptake Inhibitor) antidepressants. You may get a life-threatening condition called Serotonin syndrome. Check all your medications with your doctor.

What are the different forms of Medications, and which is the best for treatment? Medications come in different forms, like: An injection under your skin (subcutaneous). An oral medication (taken by mouth). A nasal spray. Through an IV (intravenously). Suppository. You and your healthcare provider will discuss the specific medication, combination of medications, and formulations to best manage your symptoms. All medications should be used under the direction of a headache specialist, neurologist, or healthcare provider. As with any medication, it’s important to carefully follow your provider’s instructions.

How to avoid migraine triggers? A healthcare provider can help you identify what triggers your migraines. They may ask you to keep a migraine journal or diary. A migraine journal can help you keep track of when a migraine happened, how you felt, and how long it lasted. You can also add details about the foods you ate or the activities you participated in to learn more about any possible triggers. There are some smartphone apps available to help you keep a migraine journal. Once you identify a trigger, you can take steps to avoid it. This isn’t always possible, but awareness of your triggers is helpful to identify them and treat a migraine when it starts. For example, if stress is a trigger, you may want to speak with a mental health professional to help you manage your stress. If you get migraine symptoms when you miss a meal, set an alarm on your phone to remind you to eat meals on a regular schedule. It may be particularly helpful to avoid: Low blood sugar, Physical overexertion, Stress, Certain foods, such as chocolate and any that contain tyramine or MSG, Certain medications, including HRT and some birth control pills, Bright lights and flickering screens. The following strategies may help reduce the frequency of migraine episodes: Getting enough sleep, Reducing stress, Drinking plenty of water, Having healthy posture, Avoiding known dietary triggers, Getting regular physical exercise. If making these changes does not ease the severity and frequency of migraine episodes, a healthcare professional may suggest medication or other options.

What are the alternative migraine remedies? or What are the nontraditional supplements for migraine prevention? or What are the natural or home remedies for migraine? or What is the complementary therapy? If you want to try alternative therapies, nontraditional supplements, or natural or home remedies, to help you manage migraines, such are listed below: Taking vitamins, minerals, or herbal extracts like Riboflavin (vitamin B2), Magnesium, Feverfew, certified PA-free butterbur, or co-enzyme Q10. Using flexible cold packs or masks Biofeedback. Botulinum toxin type A injections (Botox®). It may also help reduce migraine attacks if they occur more than 15 days a month. Lifestyle changes include: Healthier sleep habits, such as getting enough sleep and going to bed at the same time each night. Healthier eating habits, including not skipping meals and avoiding your food triggers. Managing stress. Losing weight, if you're overweight. Staying in a quiet, darkened room. Relaxation techniques like yoga. Acupuncture, neck exercise, or physical therapy. Please note: Alternative medications are not regulated like prescription medicines and they may contain substances that are not safe. Some of these medicines may not be safe for a pregnant or breastfeeding woman to take. Research has not shown that these approaches work. Before trying any of these, speak with a healthcare professional. Anyone looking for an alternative therapy, such as acupuncture, should go to a qualified and experienced professional.

Migraine devices: If you can't take medication or wish not to, a device might be worth considering. These include: Transcranial magnetic stimulation. External trigeminal nerve stimulator. Cefaly - a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked with migraines. Spring TMS or eNeura sTM - a device for people who have an aura before migraine headaches. You hold it at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain. Noninvasive vagus nerve stimulator (nVS)-  GammaCore is a hand-held portable device placed over the vagus nerve in the neck. It releases a mild electrical stimulation to the nerve fibers to relieve pain. Nerivio - a wireless remote electrical neuromodulation device that is self-applied to the upper arm and should be used in the home environment at the onset of migraine headaches. Newer devices that provide different kinds of nerve stimulation or magnetic stimulation are also being evaluated for the treatment of migraine headaches. Their exact role in treating migraines remains unclear.

What migraine treatments are available during pregnancy and breastfeeding? Talk to your healthcare provider if you’re breastfeeding, pregnant, or plan on becoming pregnant and experiencing migraines. Your provider might suggest avoiding medications for migraines. In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding. Instead, you should try to identify and avoid potential migraine triggers. If medication is essential, paracetamol and sumatriptan are safe to take during pregnancy and when breastfeeding. High doses of aspirin should not be taken to treat headaches during pregnancy. Some medications can negatively affect the fetus’s development. Your provider can recommend alternative treatment options like an acetaminophen pain reliever for migraines.

Frequently Asked Questions (FAQ):

What are the precautions for using Over-The-Counter (OTC) migraine medications?  Over-the-counter migraine medications are effective if you have mild to moderate migraine symptoms.  Some over-the-counter (OTC) pain relief medications that may benefit people with migraine include: Naproxen (Aleve) Ibuprofen (Advil) Acetaminophen (Tylenol) Aspirin Caffeine. Taking medicines more than 3 days a week may lead to rebound headaches or a dependency problem.  These are headaches that keep coming back due to overuse of pain medicine. Taking too much Acetaminophen can damage your liver. Too much Naproxen, Ibuprofen, or Aspirin can irritate your stomach or damage your kidneys. If you’re taking any over-the-counter pain medications more than two to three times a week, let your healthcare provider know. They may suggest more effective prescription medications.

Can a migraine be prevented? You can’t prevent all migraines. However, you can take preventive migraine medications as directed by your healthcare provider to reduce how often and how severe migraine symptoms affect you. You can also learn more about your triggers and work with your healthcare provider to avoid them.

What’s the Outlook (Prognosis) for a migraine? Each person responds differently to treatment. Some people have migraines only rarely and need little to no treatment. Others need to take several medicines or even go to the hospital sometimes. Migraine headache is a risk factor for stroke. The risk is higher in people who smoke, more so in women who have migraines that occur with aura. In addition to not smoking, people with migraines should avoid other risk factors for stroke. These include: Taking estrogen-containing birth control pills. Eating unhealthy foods can cause high cholesterol or high blood pressure. Migraines are different for each person. They’re temporary but recurring throughout your life. It may take time to find a treatment option that’s right for you. There’s also no available cure. Your healthcare provider can help you manage migraines so they go away faster and are less intense.

When should I see a healthcare provider or call an emergency number? Schedule an appointment or contact your healthcare provider if: It seems like a first migraine episode, Your headache pattern or pain changes, Treatments that once worked no longer help, You have side effects from your medicine, You are taking birth control pills and have migraine headaches, Your headaches are more severe when lying down, Worsening or unusual migraine symptoms. Severe symptoms. If any of the following occur, seek immediate medical help: An unusually severe headache, A loss of sensation You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before. A headache starts suddenly. Experience the worst headache of your life (thunderclap headache). Have new neurological symptoms that you’ve never had before, like difficulty speaking, balance/movement problems, vision issues, confusion, seizures, or numbing/tingling sensations. Have a headache after experiencing a head injury. These could indicate another condition that may need urgent attention, such as a stroke.

What questions should I ask my healthcare provider? There are several questions to be asked of the healthcare provider. Some are listed below: Will I grow out of migraines? What medications do you recommend? How can I prevent migraines? What type of migraine do I have? Are my migraines considered chronic? What precautions should I take at home? What home remedy will help me to recover fast and lower the risk for further migraine attacks? What are the interactions with other medicines (if any) that I am already taking?  What should I do if any prescribed medicines interact with the other medicines that I am already taking for other health conditions?

How do I deal with a migraine as it happens? There are certain things you can do to help you feel better when a migraine attack happens. It includes: Resting in a dark, quiet, cool room. Apply a cold or warm compress or washcloth to your forehead or behind your neck. Massaging your scalp. Apply pressure to your temples in a circular motion. Keeping yourself in a calm state (meditating).

How common are migraines? Migraines are common. Studies show that an estimated 12% of people in the United States experience migraines.

What does a migraine feel like? Migraine headache pain may feel like the following: Throbbing. Pulsing. Pounding. Dull. A migraine can feel different for each person. A migraine headache ranges from mild to severe. Head pain can start on one side and shift to the opposite side. You may also have pain around your eyes or temple, and sometimes, around your face, sinuses, jaw, or neck.

How often do migraines happen? The frequency of migraine varies from person to person. You might have one migraine per year or one per week. On average, most people experience two to four per month. They’re most common in the morning. Most migraines are unpredictable, but sometimes, you can have an idea of when a migraine will happen, like before menstruation or after feeling stressed.

How can you prevent a migraine attack? It’s important to maintain a generally healthy lifestyle, including: Regular exercise, sleep, and meals. Ensuring you stay well hydrated. Limiting your intake of caffeine. Limiting your intake of alcohol. One of the best ways of preventing migraine is recognizing the things that trigger an attack and trying to avoid them. Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you’re taking is working.

What are menstrual-related migraines? And How it can be treated? Menstrual-related migraine usually occurs between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments. Non-hormonal treatments: The non-hormonal treatments that are recommended are: Non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller (usually naproxen) Triptans – a type of medication used to treat a migraine attack (usually naratriptan or frovatriptan) These medications are taken as tablets. You should usually take these twice a day from either the start of your period or 2 days before, until the last day of bleeding. Hormonal treatments: Hormonal treatments that may be recommended include: Combined hormonal contraceptives, like the combined contraceptive pill, patch, or vaginal ring (usually taken continuously for at least 3 months). Progesterone-only contraceptives, like progesterone-only pills, implants or injections. Oestrogen patches or gels, can be used from 3 days before the start of your period and continued for 7 days. Hormonal contraceptives like the combined contraceptive pill or vaginal ring are not used if you have migraine with aura symptoms. This is because this can increase your risk of having a stroke.

How prevalent are migraines? Migraines are about three times more common in women than men and may affect more than 12 percent of the U.S. adult population. Migraines often run in families and can start as early as elementary school but most often in early adulthood. They often fade away later in life but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain.

What precautions are needed to take the medicines for the treatment of migraine? Some migraine medicines narrow the blood vessels. If you are at risk of having a heart attack or heart disease, talk with your provider before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your provider about which medicine is right for you if you are pregnant or planning to become pregnant. Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other medicines that treat the migraine itself. Feverfew is an herb that may be used for migraines. It can be effective for some people. Before using feverfew, make sure your provider approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Gist of the blog:

Migraine: In common terms,  migraine attacks are referred to as “migraines” or “migraine headaches.” Or vascular headache?  Migraine is a medical condition that involves a headache and other symptoms. It is not just a bad headache and it can have a significant impact on daily life, making it difficult to work,  meet personal and social obligations, and do everyday activities.

Migraine triggers: Movement, lights, sounds, and other triggers may cause symptoms like fatigue, nausea, vision changes, irritability, and more. Identifying and avoiding triggers can often help reduce the frequency or severity of episodes, though it is not always possible to prevent them. A healthcare provider can help you manage symptoms so migraines don’t take over your life.

Migraine Symptoms: Migraines are disruptive. It can cause debilitating, throbbing, one-sided head pain that can leave you in bed for days. People living with migraine more commonly experience mental health concerns (like depression and anxiety) and sleep disorders than the general population. Other medical conditions that are more common in people living with migraine include bipolar disorder and epilepsy. People with migraines may have trouble reading dark text on a white background. Your browser may offer dark mode or other options for this. For many people, migraine may be worse in the morning. Some may also experience an episode at a predictable time, such as during menstruation or at the weekend following a stressful working week. While most people may feel weak or exhausted following a migraine episode, they generally experience times being symptom-free in between episodes. Migraine can affect people in different ways, and the triggers, severity, symptoms, and frequency can vary. Some people have more than one episode each week, while others have them only occasionally.

Migraine stages: Being aware of the different stages of the migraine attack can be helpful. It can help you prepare for an attack, get a diagnosis, and decide when to take acute treatment, such as painkillers, or adapt your activities. It is useful to have a rescue treatment plan for when attacks occur. This may include painkillers such as triptan, an NSAID (e.g. ibuprofen) or paracetamol. It often also includes anti-sickness medication. For other people, being aware of the stages and symptoms of a migraine attack can help their understanding. It may also help with the frustration and lack of understanding people often face around migraine, especially at work and in education.

Migraine treatment: There is currently no cure for migraine, but treatments can help manage symptoms. Taking medication as soon as you notice the pain may stop or shorten an attack. There are treatments available to help reduce the symptoms. During an attack, many people find that sleeping or lying in a darkened room can help. Hydration with fluids is often helpful, with or without the use of medicines. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. Always make sure you read the medication instructions and follow the dosage recommendations. You shouldn’t take Triptans or a combination of treatments more than 10 days per month in the long term. If you can’t swallow painkillers because of nausea or vomiting, you should speak to your healthcare provider about anti-sickness medication or suppository options. Suppositories are capsules that you insert into the anus (back passage). Opiates like codeine should not be prescribed as a treatment for migraine. They’re not any more effective than Triptans and painkillers and can cause nausea and medication overuse headaches. Avoiding triggers, when possible, may help reduce the frequency of migraine episodes. The best treatment in children or adolescents may be different from that in adults. A healthcare professional can help recommend the most effective approach. Medication and other treatments can help manage migraine symptoms. Anyone who has concerns should contact a healthcare professional.

Side effects: Medications have their side effects also. It is important to avoid overusing medication because overuse can cause a rebound headache. A healthcare professional can help inform an individual how much of each medication is safe and effective.

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant. True migraine headaches are not a result of a brain tumor or other serious medical problem. Only your healthcare provider can determine if your symptoms are due to a migraine disorder or other condition.

Recognising different symptoms at different times during your migraine attack can give your doctor information which may help them make a diagnosis. Anyone who may be experiencing any new neurological symptoms or migraine should seek medical attention.

Disclaimer: We try to provide authentic and updated information on the Migraine attack and its treatment. This blog is prepared using data compiled from various websites, including those mentioned in the blog. The information given in this blog is only for information purposes. It is not intended to serve as medical advice and can not replace medical advice in any form. It is not a legal document. Always keep in mind that the particular medications and their dosages are decided by the health care provider (doctor or specialist) as per the needs of the individual. It varies from one person to another. I am not a health professional, and this blog is not AI-generated, instead, it is manually written. Therefore, I do not take any responsibility (legal or otherwise) for its typographical error, correctness, completeness, consequences, etc. Before following anything from this blog, it is strongly requested to consult a specialist, doctor, or healthcare provider. Self-medication can be harmful. https://www.webmd.com https://my.clevelandclinic.org/ https://www.ninds.nih.gov https://www.nhsinform.scot https://www.medicalnewstoday.com https://migrainetrust.org https://medlineplus.gov

My personal opinion: Health conditions and diseases are the parts of my life. Migraine is one of them. I believe in fighting, treating, and defeating any problem that comes into my life. With proper medications and lifestyle changes, migraine attacks will not create any problems in my life. Therefore, try hard to win over the migraine and enjoy life. ===The end ===