Migraine

01

What it is

Migraine is a recurring neurological disorder that can produce head pain, nausea, sensitivity to light, sound or smell, and difficulty thinking or functioning. An attack may include warning symptoms before pain and a recovery phase afterward. Some people have aura—temporary neurological symptoms such as visual changes or tingling—while many do not. Attack frequency and disability range widely, and symptoms can change across the lifespan.

Sources for this section: [1] [3]

02

Symptoms and how it may present

Migraine attacks often produce moderate or severe headache, commonly one-sided and aggravated by activity, with nausea or sensitivity to light and sound. Aura can cause temporary visual, sensory, or language symptoms, but most attacks occur without it. Frequency and form vary widely, and symptoms can begin before pain. Recurrent headache also affects work, school, relationships, sleep, and mental health.

Sources for this section: [1] [3]

03

Causes and risk factors

Migraine reflects altered processing in brain networks and pain pathways, influenced by genetic susceptibility, hormones, sleep, stress, illness, meals, sensory environments, and other factors. A trigger is not the same as a cause and may be inconsistent. Keeping an overly restrictive trigger list can increase anxiety and reduce quality of life. Risk of frequent or chronic migraine can rise with high attack frequency, medication overuse, sleep problems, obesity, stress, and untreated anxiety or depression.

Sources for this section: [1] [2]

04

Diagnosis and tests

Tests should answer a clinical question and be interpreted together with symptoms, examination, and history.

Diagnosis is usually based on a detailed history and neurological examination rather than a scan. A diary can record timing, symptoms, menstrual relationship, sleep, meals, medicines, disability, and possible triggers. Imaging or other tests are selected when the pattern, examination, age, or red flags suggest another cause; routine scanning is not automatically reassuring or necessary.

Sources for this section: [1] [2] [3]

05

Treatment options

The best option depends on severity, other conditions, likely benefit and harm, access, and personal priorities.

Acute treatment may include suitable over-the-counter pain medicines, triptans, gepants, or nausea treatment, chosen around contraindications and taken early in an attack. Preventive options include blood-pressure medicines, antiseizure drugs, certain antidepressants, CGRP-targeted medicines, and botulinum toxin for eligible chronic migraine. Choice depends on attack burden, other conditions, pregnancy, adverse effects, cost, and preference.

Sources for this section: [2] [4]

06

Daily life and supportive care

Regular sleep and meals, hydration, activity, stress skills, and limiting personally confirmed triggers can reduce instability without imposing an extreme lifestyle. Frequent acute medicine can itself sustain headache, so track use. Magnesium or riboflavin may be discussed for prevention, but product quality, dose, kidney function, pregnancy, and interactions matter. Butterbur products carry safety concerns and should not be treated as benign.

Sources for this section: [1] [2] [4]

07

Monitoring and follow-up

Follow trends that can change a decision rather than collecting measurements without a purpose.

A headache diary can record attack days, duration, symptoms, disability, possible menstrual relationship, acute medicine use, response, and adverse effects. Track enough information to guide a decision without turning normal variation into constant surveillance. Review preventive treatment after an agreed interval using attack frequency and function, not pain intensity alone. Frequent acute-medicine use should prompt review for medication-overuse headache and a safer plan rather than abrupt unsupervised withdrawal when risks exist.

Sources for this section: [2] [3] [4]

08

Complications and long-term outlook

Migraine can be episodic or chronic and may improve, worsen, or change with age and hormonal transitions. It is associated with sleep and mood disorders and, for migraine with aura, a small increase in some vascular risks that should be interpreted with the person’s other factors. Effective acute treatment, prevention when indicated, regular routines, and management of coexisting conditions can reduce disability. Persistent change in pattern deserves reassessment rather than assuming every new headache is migraine.

Sources for this section: [1] [2] [4]

09

When to seek urgent help

Seek urgent evaluation for a sudden maximal headache, a new headache with fever or stiff neck, new weakness or confusion, seizure, head injury, pregnancy or postpartum onset, cancer or immune suppression, or a major change in pattern. Aura-like symptoms that are new, prolonged, or unlike prior attacks also need assessment because stroke and other emergencies can look similar.

Sources for this section: [1] [2] [3]

10

Questions to discuss with a care team

A guideline describes what tends to help groups of people, but it cannot decide what matters most in one person’s life. Revisit the plan when symptoms, function, other illnesses, pregnancy plans, medicine access, side effects, or personal priorities change. Ask for plain-language reasoning and say directly when cost, time, transport, caregiving, or treatment complexity makes a recommendation unrealistic.

• What evidence supports this diagnosis, and is there another condition we still need to rule out?
• What is the treatment goal, and how do the main options differ in benefit, harm, burden, and cost?
• What should be monitored, how often, and what result would change the plan?
• Which symptoms require a routine appointment, urgent assessment, or emergency care?

Sources for this section: [2] [4]