Living With Migraine, Informed and Supported

A migraine attack can include up to four phases:

• Prodrome: subtle warning signs hours to a day before, like mood changes, food cravings, neck stiffness, or yawning.
• Aura (in about 25% of patients): temporary neurological symptoms such as flashing lights, blind spots, zigzag lines, tingling, or trouble speaking, usually lasting under an hour.
• Headache: the main pain phase, lasting hours to days.
• Postdrome: a "migraine hangover" of fatigue or fogginess afterward.

Most people have migraine without aura. Some have migraine with aura. Chronic migraine is diagnosed when headaches occur 15 or more days a month for 3 or more months.

Triggers vary person to person, but common ones include: stress, hormonal changes (menstruation, pregnancy, menopause), skipped meals, dehydration, poor or irregular sleep, weather and barometric pressure changes, bright lights, strong smells, certain foods (aged cheese, processed foods), alcohol (especially red wine), and too much caffeine or withdrawal from it. Identifying and tracking personal triggers with a headache diary is one of the most useful tools for managing migraine.

Treatment generally falls into two categories:

• Acute (abortive) treatment, taken at the onset of an attack to stop it: over-the-counter pain relievers (NSAIDs, acetaminophen) for mild attacks, triptans for moderate-to-severe attacks, and newer options like gepants (for example ubrogepant, rimegepant) for people who cannot take triptans.
• Preventive treatment, for frequent or disabling migraines: daily medications (beta-blockers, certain antidepressants, anti-seizure medications), Botox injections for chronic migraine, and newer CGRP-targeted therapies (monthly or quarterly injections, or daily oral gepants) developed specifically to prevent migraine.

Lifestyle steps, including regular sleep, consistent meals, hydration, stress management, and trigger avoidance, are an important complement to medication.

See a doctor if your headaches are new, becoming more frequent or severe, not responding to usual treatment, or interfering with daily life. A primary care doctor can diagnose migraine and may refer you to a neurologist or headache specialist for ongoing or complex cases.

Seek emergency care immediately for: a sudden, severe "worst headache of your life" (thunderclap headache); a headache with fever, stiff neck, confusion, seizures, or vision loss; new weakness, numbness, or trouble speaking that is unfamiliar to you; a headache after a head injury; or a new headache pattern after age 50. These can signal something more serious than migraine and need prompt evaluation.