man with a migraine touching is face

Migraines can strike at any time. They affect about 15% of Americans, and women are three times more likely to get them than men.

Elizabeth Ekpo and Marc Lenaerts, headache medicine specialists in UC Davis Health’s Department of Neurology, explain migraines and how you can better manage them.

What is migraine?

Migraine is a condition or syndrome, not just a headache. Headache is a key symptom but not always present during a migraine.

The headache pain is caused by nerve-controlled inflammation of the dura, or the membrane between the brain and the skull.

Someone with fewer than 15 headache days per month has episodic migraine. Those who have 15 or more headache days per month have chronic migraine.

Learn more about headache medicine and migraine from UC Davis Health’s Department of Neurology

What causes migraines?

Migraines are likely caused by a nerve that inflames the dura, spreading pain and changing local blood flow.

There may also be genetic causes of migraine. There are multiple triggers that may lead to a migraine attack. Common examples include a drop in estrogen levels (pre-menstruation), alcohol use, stress, cold weather fronts, and sleep deprivation.

What are the treatments for migraines?

These medications can help block pain signals and inflammation in the body:

However, overuse of these medications can lead to medication overuse headaches (formerly known as rebound headaches).

Botulinum toxin (Botox) is one medication approved by the U.S. Food and Drug Administration (FDA) that can help treat chronic migraine. Four other options to help prevent migraines are also available in injectable forms. They include Aimovig, Ajovy, Emgality, and Vyepti. Most patients taking these medications have an average of 50% fewer migraines per month.

Related: UC Davis neurologist talks promising migraine treatments (Sacramento Magazine)

Where is migraine pain typically located?

Migraine headaches bring on throbbing pain, unevenly spread on either side of the head.

What can help prevent migraines?

A healthy lifestyle can help prevent migraines. This includes sticking to an all-natural diet,  regular exercise, and keeping a healthy weight. Regular sleep is paramount. Stress relief techniques such as yoga, pilates, and meditation can also help prevent migraines.

What are migraine symptoms?

Migraine symptoms can include:

  • cravings or loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • lightheadedness
  • tiredness
  • swelling
  • head congestion
  • trouble speaking
  • confusion
  • sensitivity to lights, noises, smells, movements, and temperature

Some migraine sufferers see bright shimmers, zig-zag lines, or other geometric shapes. Others may experience blank or blurred vision or see their surroundings in one color such as yellow or pink. In more complex cases, visual hallucinations can occur.

More severe symptoms include:

  • tingling or numbness on one side of the body, usually in the hands and face
  • weakness
  • language and/or speech impairment
  • loss of balance
  • vertigo
  • loss of consciousness

How is migraine syndrome diagnosed?

The criteria for migraines is at least five headache attacks over your lifetime with the typical symptoms, and no underlying cause. There is also a category of migraine attacks without head pain. There’s no biological marker or specific test for migraine (such as a genetic test or imaging tool). Ultimately, diagnosis is up to your care provider.

What separates migraines from other kinds of headaches?

Because migraines can involve pain in the cheeks or areas near the sinuses, they can often be confused with sinus headaches. Sinus headache is not an official diagnosis but a symptom of acute sinus infection.

A so-called “tension headache” is characterized by general head pain with mild, pressure-type pain without other symptoms.

Cluster headaches are rare and primarily affect men. They’re characterized by attacks of dreadful pain usually around one eye. Symptoms include sweating, teary eyes, drooped eyelid, congested and/or dripping nose. The attacks occur in clusters at certain times (spring and fall, early morning, etc.).

Does every migraine have a trigger?

Most migraines don’t have triggers, or we mischaracterize triggers. For example, before a migraine, a patient may crave chocolate and gets a headache after eating it. The migraine is not actually “triggered” by the chocolate. Instead, the patient’s craving for chocolate can be a pre-symptom of the migraine.

Are some people more at risk for migraines?

Women are three times more likely to have migraines than men and are more likely to develop chronic migraines. Migraines are more common in the Western Hemisphere, likely for genetic reasons.

Hormones play a role in migraines. For example, a woman’s menstrual cycle and the onset of menopause can increase migraine risk. Patients who have migraines (especially a certain type called migraine with aura) can be at risk for strokes.

Migraine is a lifelong condition, but symptoms occur mostly between teenage years and about age 60. Some patients’ migraine days will fade as they age. However, some will continue to experience migraines well into their 80s.