Migraine is the most common cause of disabling headache, affecting 35 million Americans. About 18 percent of women and 6 percent of men experience migraine in any year.
Migraine is most often hereditary. If you have migraines, it's likely that a family member suffers from them too. However, the severity and frequency of migraine attacks can differ dramatically between relatives. One family member may experience very rare migraine attacks, such as just after consuming alcohol ("hangover headache") or with menstrual cycles, while another may have very difficult daily, debilitating migraine.
Migraine attacks are characterized by recurrent episodes of pain, often on one side of the head, that may be throbbing or pounding. The headache is accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound, as well as sensitivity to head movement. Migraine can occur at any time of day or night.
As you age, migraine may subside. Studies show that migraine attacks peak between the age of 35 and 45 and then begin to decline.
Our approach to migraine
Our headache specialists – neurologists who focus on treating headaches – provide comprehensive assessments and care. We offer the full range of treatments for migraines, including combination drug therapy and botulinum toxin (Botox) injections. We see patients from around the world who have difficult-to-treat headache disorders, and are committed to delivering effective care with the utmost compassion and respect. When needed, our specialists work closely with other experts at UCSF, such as alternative medicine providers, to better manage migraines.
Awards & recognition
Among the top hospitals in the nation
Best in California and No. 2 in the nation for neurology & neurosurgery
Signs & symptoms
Signs and symptoms of migraine headaches include:
- Abnormal body sensations, called paresthesias, such as tingling, numbing or prickling
- Dizziness or vertigo
- Nausea and vomiting
- Scalp tenderness
- Sensitivity to light or sound
- Throbbing or pounding pain, often on one side of the head
- Visual disturbances, such as flashes of light or blind spots in your vision
- Worsening of pain with movement
Migraines are diagnosed, based on the description of your symptoms. There's no medical test that can specifically identify the condition. Your doctor will ask about the severity, frequency and duration of your headaches as well as other symptoms you experience and any medications you take.
Before meeting with a headache specialist, maintaining a headache journal that tracks headache patterns — can provide helpful information for your diagnosis and treatment. Information to note in your journal includes:
- Duration of pain
- Location and severity of pain
- Medications taken
- Possible headache triggers
If your headache is associated with visual symptoms such as flashing or zig-zagging lights, blind spots or numbness on one side of the head, it is called migraine with "aura," previously known as classic or classical migraine. About 20 percent of people with migraine experience this type of headache.
Migraines can be triggered by a number of factors. By identifying and avoiding these triggers, you can help manage your headaches. Keeping a headache journal that tracks the date, time and onset of your headache, a list of medications, and other external factors can help you and your doctor track patterns and plan treatment.
- Diet. For some people, certain foods trigger migraines, although this is rarely the only cause. Alcohol, especially red wine, the sugar substitute aspartame, caffeine, the food seasoning monosodium glutamate (MSG), foods such as aged cheese that contain tyramine, and nitrites in foods such as preserved meats may cause migraines.
- Environmental factors. Migraine headaches can be triggered by environmental conditions including weather or temperature changes, glaring or fluorescent lights, computer screens, strong odors and high altitude.
- Hormones. Many women have migraine attacks just prior to or during the first few days of their menstrual period. Fluctuating estrogen may play a role. Menstrual migraines can be more debilitating, difficult to treat and longer lasting than other migraines. They may worsen in early pregnancy and improve in late pregnancy. They typically subside as women age, particularly after menopause. Oral contraceptives or estrogen-replacement therapy can provoke or worsen migraines.
- Sleep. Too much or too little sleep can trigger a migraine in some people.
- Stress and Anxiety. People who suffer from migraines tend to be sensitive to stress. Emotional stress or daily pressure can trigger a migraine attack in some people. Managing stress can help alleviate migraines. For example, it might help to complete large jobs in small increments over time instead of all at once. Learning to relax and "let go" of events beyond your control also may help. Practicing stress-relieving techniques, such as yoga, transcendental meditation, hypnosis and biofeedback may be helpful.
Typically, pain relievers such as aspirin, acetaminophen and ibuprofen are recommended as initial treatments. If they don't relieve the pain, your doctor may prescribe other drugs or drug combinations. Your doctor will work with you to determine the drugs best for you, based on the severity of your attacks. Drugs, however, don't cure the condition.
Some medications used to treat other conditions — such as beta-blockers for hypertension and tricyclic for depression — are effective in treating migraines. The benefits and dosages of these drugs when used for migraines, however, are different than those in the treatment of other conditions.
- Tricyclic antidepressants. Antidepressant drugs have analgesic or pain-relief qualities. Although you may not be depressed, your doctor may prescribe drugs such as amitriptyline or doxepin to help reduce the frequency and severity of your headaches.
- Beta-blockers. A drug such as propranolol may be combined with an antidepressant, such as amitriptyline, to prevent chronic daily headaches.
- Anti-seizure medications. Most recently a number of medicines used in epilepsy (seizures) have been found to be very effective in migraine and may be used to prevent attacks.
- Combination therapy. Each symptom of a migraine headache may have a separate cause or mechanism. A new fixed-dose tablet combining the medications sumatriptan and naproxen targets more than one of these mechanisms. Some doctors have been combining the two drugs. Two studies assessing the effectiveness and safety of the combination drug suggest that the combination provides more effective headache relief than either drug alone. The combination did have some minor side effects including dizziness, drowsiness and paresthesias or abnormal body sensations.
Many drugs for acute migraine attacks work best when taken as soon as you feel a migraine coming on. It's important that you take the medications as prescribed, not more often or in higher doses.
If you experience frequent attacks, medication to prevent migraines may be prescribed so that headaches will strike less often and last for shorter periods of time. Be sure to continue taking your preventive medications even while being treated for an acute attack.
If your doctor prescribes medication, be sure to ask:
- How often to take the medication
- Should the medication be taken with meals or on an empty stomach
- What to do if pain or other symptoms persist
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.