Of more than 100 types of headaches, migraine is the most likely to send people to the doctor. Far more than just a bad headache, migraine is a complex neurologic disease that causes intense, throbbing pain along with severe nausea, vomiting and extreme sensitivity to light and sound.
About 12% to 15% of Americans experience migraine, but women are three times more likely than men to get them. Rates are similar in boys and girls until puberty, when migraine prevalence jumps to 18% in women compared to 6% in men.
Migraine attacks often begin during the teen years and in people’s early 20s and 30s, when they’re frequently dismissed as something sufferers should simply “push through.”
Here’s how to tell whether you’re dealing with a migraine or an ordinary headache — plus how to reduce your risk and the fastest ways to find relief.
How to tell a migraine from a headache
Unlike a typical headache, migraine attacks usually involve much more than head pain.
They often come with disabling symptoms such as nausea, vomiting, dizziness and heightened sensitivity to light, sound or even smells.
For many people, the pain is only one part of the condition. A migraine can make it difficult to think clearly, concentrate, work, attend class or carry out everyday activities.
The pain can also interfere with sleep, creating a cycle that makes future attacks even more difficult to manage.
Migraine attacks are also associated with an increased risk of cardiovascular disorders and psychiatric conditions, including depression, anxiety and post-traumatic stress disorder.
It’s important to pay attention to recurring symptoms rather than writing them off as just headaches. Keeping track of when headaches occur, how long they last and whether they’re accompanied by symptoms like nausea or light sensitivity can help doctors determine whether migraine is the cause.
Patients should advocate for themselves and encourage friends and family members with recurring symptoms to seek medical care as well.
Biggest migraine myths and misconceptions
One of the biggest migraine myths is that a migraine attack only counts if the pain is a 10 out of 10 sensation that leaves someone curled up in bed. Many people assume they’re dealing with an ordinary headache because the pain is milder.
Another common misconception is that all migraine attacks are accompanied by a migraine aura, a temporary neurological warning sign that can occur before or during an attack.
Aura typically develops gradually over five minutes to an hour and can include visual, sensory or motor symptoms, although visual disturbances are the most common.
In fact, about two-thirds of people experiencing migraine never have an aura at all.
Many people also mistake a migraine attack for sinus headaches or infection because migraine affects nerves around the face and can cause congestion, a runny nose, watery tearing and facial pain.
As a result, some people visit their primary care doctor or an ear, nose and throat specialist expecting antibiotics, when the real culprit is actually migraine.
What causes migraines — and how to reduce risk
Research suggests migraine can be caused by a combination of genetic and environmental factors.
Stress is one of the biggest contributors, but it’s not always stress itself that’s to blame. Studies have shown that both increases and decreases in the stress hormone cortisol can trigger migraine. Hormone fluctuations — particularly changes in estrogen — can also play a major role, especially for women.
Changes in sleep patterns, dehydration and irregular eating habits can all contribute as well.
Rather than focusing on one trigger, look at the bigger picture.
Someone who slept poorly, skipped lunch and experienced an unusually stressful day may be much more likely to develop migraine than someone exposed to just one of those factors.
To reduce your risk, stay hydrated, eat meals on a consistent schedule, maintain a consistent sleep routine throughout the week and find healthy ways to manage stress.
The most effective and fastest treatments
Migraine treatment falls into two categories: acute treatment, which stop an attack after it starts, and preventive treatment, which reduce how often migraine attacks occur. What’s really exciting is that there are many different options.
For immediate relief, some people benefit from over-the-counter medications like ibuprofen or naproxen, although they shouldn’t be used too frequently because they can cause gastrointestinal side effects.
Prescription options include triptans, which have long been the mainstay treatment for stopping migraines, and gepants, a newer class of migraine medications that can also stop attacks. FDA-approved neuromodulation devices are another option and use electrical stimulation to help interrupt migraine pain.
For people with frequent or severe migraines, preventative treatment may be recommended.
Behavioral therapies may have some of the strongest evidence for migraine prevention. These include cognitive behavioral therapy, which helps manage stress and unhealthy thought patterns; biofeedback, which teaches people to control physical responses like muscle tension; and relaxation techniques, such as deep breathing, to help reduce migraine frequency.
Researchers have also found promising evidence for mind-body approaches such as mindfulness, while acupuncture and yoga may benefit some patients. Regular exercise also has been shown to help reduce migraine frequency.
Certain supplements, including magnesium and riboflavin (vitamin B2), have evidence supporting their use for migraine prevention.
There are also FDA-approved and off-label preventative medications available as pills, injections and other formulations, allowing doctors to tailor treatment based on a patient’s symptoms and how often migraines occur.
Mia T. Minen, MD, MPH, is director of headache research for the Division of Headache in the Department of Neurology at NYU Grossman School of Medicine. She takes a whole-body approach in treating adults and children for a variety of conditions related to migraine and headache.
