Migraines: Your GoodRx Guide

Many people believe that migraines and headaches are the same thing. But a migraine is more than just a severe headache. Migraine headaches are a complex neurological disorder that can cause other symptoms, such as nausea, sensitivity to light and/or sound, and vision changes. Many people also have a severe headache during a migraine — but it’s possible to have a migraine without a headache.

Migraines are pretty unpredictable. They can last anywhere from 4 to 72 hours — and the symptoms can make people who get them unable to work, go to school, or participate in other activities. 

There are several different types of migraine:

• Migraine with aura (involves changes in vision, sensation, or speech)

• Migraine without aura

• Brainstem aura

• Retinal migraine

• Hemiplegic migraine

• Menstrual migraine

• Chronic migraine 

• Abdominal migraine

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Symptoms

The symptoms of a migraine aren’t the same for everybody, and they might not even be the same for one person from migraine to migraine. The headache is usually pain on one side of the head (occasionally both sides), and it might feel like it’s pulsating. The pain is usually moderate or severe, and movement can worsen it. 

In addition to the headache symptoms, a migraine might also cause:

• Nausea

• Vomiting 

• Sensitivity to light, sound, movement, or odor

• Vision changes 

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Causes

The exact cause of migraines hasn’t quite been pinned down. But experts are beginning to understand more about what happens in the brain during migraines, why some people are more likely to get them, and why certain things can bring them on.

Just as people can experience different migraine symptoms, their migraine triggers can vary as well. Identified triggers include:

• Emotional stress

• Changes in sleeping or eating habits

• Odors

• Menstrual cycles

Other triggers include certain foods (such as chocolate) and drinks (such as alcohol). It’s helpful to keep a headache diary so you can see any patterns in what might be bringing on your migraines.

Common Causes of Migraines

Written by Kerry R. McGee, MD, FAAP

Diagnosis

If you think you might have migraines, the first step is to see your primary care provider. They can help you determine whether your symptoms are due to migraines or a different kind of headache. 

When you meet with your provider, they’ll probably ask you questions about your symptoms, such as:

• Where are your symptoms? 

• How often are they happening? 

• How long do they last? 

• Do you have any other symptoms along with the headaches? 

• Are your symptoms brought on by anything in particular? 

• Do you feel bad before the headache starts or after it goes away? 

• Have you tried any over-the-counter medications?

• Does anything make your symptoms worse or better?

To make the diagnosis, your provider may also ask you some other questions about your health history, like: 

• Do you have any other medical problems?

• Do any medical problems run in your family?

• Do you take any medications?

• Do you drink or smoke?

Imaging scans and blood work are not usually necessary, unless your provider wants to rule out other conditions that could be causing your headaches.

Medications

There are many migraine medications available in the U.S. The number of options might be overwhelming, so in this section, we aim to help you understand the differences between them. 

The best way to look at migraine treatments is to divide them into acute treatments and preventive treatments.

Acute treatments are medications that you take when you have a migraine. These usually work best if you take them as soon as you feel the migraine coming on. Some of these medications are available over the counter, such as ibuprofen and acetaminophen. But a commonly used class of medications called triptans is available only by prescription. A prescription is also required for newer acute migraine treatments that target a protein called calcitonin gene-related peptide (CGRP). 

Preventive treatments are those you take regularly, not just when you have a migraine. Some preventive medications — such as beta blockers, antidepressants, and anti-seizure medications — were originally developed to treat other medical conditions. Newer preventive treatments, called CGRP antagonists, were developed specifically for migraines. These medications are available only by prescription. 

Another option is Botox (botulinum toxin injection), which is FDA approved for treatment of chronic migraines. Chronic migraines are defined as more than 15 days with headache per month, with at least 8 of those being migraines.

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Treatments

Whether or not you take medications to treat your migraines, there are adjustments you can make to your lifestyle to ease your symptoms. Primary care physicians recently put together a practical list of recommendations to help people with migraines, using the acronym SEEDS, to help you remember the necessary steps to take: 

• S: Sleep quantity and quality 

• E: Exercise three to five times per week for 30 to 60 minutes 

• E: Eat regular, healthy meals; stay hydrated; and opt for low (or stable) amounts of caffeine

• D: Diary of migraines and how you respond to treatment 

• S: Stress-relieving techniques, such as cognitive behavioral therapy (CBT), mindfulness, and relaxation

There are also alternative therapies that can help you manage your migraines without regular medications: 

• Adding acupuncture to treatment may decrease the frequency of attacks.

• Behavioral techniques, such as CBT or biofeedback, can be beneficial. 

• Some supplements may be helpful for migraine prevention. Because these are not regulated by the FDA and may interact with other medications, speak with your healthcare provider before starting them.

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Prevention

Migraine prevention starts with avoiding your triggers, so a diary is often helpful. A food diary helps you keep track of what and when you are eating and drinking, as well as your headaches and other migraine symptoms. But you can also make a record of anything else that could be a trigger — for example, your menstrual cycle or environmental exposures. 

You may need to maintain the diary over the course of several weeks or months to see whether there is a pattern in any factor that might be triggering your migraines. Once you have an idea of what your triggers may be, you can start avoiding them when possible. 

When trigger avoidance and lifestyle measures (see ‘Treatments’ above) aren’t enough, preventive medication may be necessary. Experts recommend preventive medication for anyone who has migraine headaches 4 or more days every month. Nonpharmacologic, behavioral techniques may also be helpful in addition to medication.

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