Migraine: Symptoms, Causes, and Treatment

A migraine is far more than a bad headache—it’s a neurological event that can bring hours of throbbing pain, nausea, and sensitivity to light so intense that a dimly lit room feels blinding. For the roughly 1 in 8 people who experience migraines, attacks can disrupt work, relationships, and daily routines in ways that are difficult to explain to those who haven’t been through one.

This guide covers how migraines develop through distinct phases, what symptoms to watch for, the triggers and biological mechanisms behind attacks, and the treatment options available for both stopping migraines when they strike and preventing them from occurring in the first place.

What is a migraine?

A migraine is a neurological disorder that causes recurrent, moderate-to-severe headaches—typically throbbing and often felt on one side of the head. Unlike a regular headache, a migraine involves complex changes in brain activity, nerve signaling, and blood vessels. Most attacks last between 4 and 72 hours when untreated, and they often come with nausea, vomiting, and heightened sensitivity to light, sound, or smells.

You might think of a migraine as the brain temporarily misfiring. The trigeminal nerve, which carries sensation from your face to your brain, becomes activated and releases inflammatory substances around blood vessels in the head. This process creates the pulsing pain and other symptoms that make migraines so disruptive.

Migraines affect roughly 1 in 8 people, and women experience them about three times more often than men. While genetics play a role—if your parents had migraines, you’re more likely to have them too—environmental triggers usually set off individual attacks.

Migraine phases and types

A migraine isn’t just a headache that appears and disappears. For many people, it unfolds in distinct phases over hours or even days. Not everyone experiences every phase, and the intensity varies from one attack to the next.

Prodrome

The prodrome phase can begin up to 24 hours before the headache starts. During this time, you might notice subtle changes: mood shifts, food cravings (especially for sweets), fatigue, neck stiffness, or frequent yawning. Some people feel unusually energetic or irritable.

Recognizing prodrome symptoms gives you a window to prepare—whether that means clearing your schedule, staying hydrated, or taking preventive medication if your doctor has prescribed one.

Aura

About one in four people with migraine experience aura, which refers to reversible neurological symptoms that typically appear just before or during the headache. Visual disturbances are most common:

• Flashing or flickering lights
• Blind spots that slowly expand
• Zigzag or wavy lines drifting across your vision
• Tunnel vision or temporary partial vision loss

Some people also experience tingling in the face or hands, difficulty finding words, or brief weakness on one side of the body. Aura symptoms usually build gradually over 5 to 20 minutes and resolve within an hour.

Headache

The headache phase brings the characteristic throbbing or pulsing pain. Movement often makes it worse—bending over, climbing stairs, or even just walking can intensify the discomfort. Many people find relief only by lying still in a dark, quiet room.

The pain typically affects one side of the head, though it can switch sides or spread to both. Along with the headache, you might experience nausea, vomiting, or extreme sensitivity to light, sound, and smells.

Postdrome

After the headache fades, the postdrome phase—sometimes called a “migraine hangover”—can leave you feeling drained, foggy, or generally off for up to another day. Some people describe it as feeling like they’ve run a marathon. Interestingly, a small number of people feel unusually refreshed or even euphoric during this phase.

Common migraine types

• Migraine without aura: The most common form, making up about 75% of all migraines. The headache occurs without any preceding neurological symptoms.
• Migraine with aura: Includes visual, sensory, or speech disturbances before or during the headache phase.
• Chronic migraine: Defined as having headaches on 15 or more days per month for at least three months, with at least 8 of those days meeting migraine criteria. Chronic migraine often develops gradually from less frequent attacks.

Migraine symptoms

Migraine symptoms extend well beyond head pain. Understanding the full picture helps you recognize attacks early and describe them accurately to your doctor.

Visual and aura symptoms:

• Flashing lights or bright spots
• Zigzag lines or shimmering waves
• Blind spots or partial vision loss
• Sensitivity to light (photophobia)

Headache symptoms:

• Throbbing or pulsing pain, often one-sided
• Pain that worsens with movement or physical activity
• Moderate to severe intensity

Other associated symptoms:

• Nausea and vomiting
• Sensitivity to sound (phonophobia) and smells
• Dizziness or lightheadedness
• Neck pain or stiffness
• Difficulty concentrating or thinking clearly

Important: If you experience sudden flashes of light, a gray shadow or curtain moving across your vision, or a sudden increase in floaters, these symptoms could indicate a retinal problem rather than migraine aura. Request an appointment with a retina specialist to rule out conditions like retinal detachment.

What causes migraines?

For a long time, doctors thought migraines were caused by blood vessels expanding and contracting in the brain. We now know the picture is more complex. Migraines begin with abnormal electrical activity in the brain that affects nerve pathways, brain chemicals, and blood flow.

The trigeminal nerve plays a central role. When activated, it releases proteins called neuropeptides—including one called calcitonin gene-related peptide (CGRP)—that cause inflammation and pain around blood vessels in the brain. This understanding has led to newer treatments that specifically target CGRP.

Genetics strongly influence who gets migraines. If one of your parents has migraines, you have about a 50% chance of having them too. If both parents have them, that risk rises to around 75%. However, having a genetic tendency doesn’t mean you’ll have constant attacks—triggers typically set off individual episodes.

Common migraine triggers

Triggers vary widely from person to person. What sets off a migraine in one person might have no effect on another. Keeping a headache journal—recording when attacks occur, what you ate, how you slept, and what was happening in your life—can help you identify your personal patterns.

Trigger Category	Examples
Stress and emotions	Anxiety, tension, or the letdown after stress passes
Hormonal changes	Menstruation, ovulation, menopause, oral contraceptives
Sleep patterns	Too little sleep, too much sleep, irregular sleep schedule, jet lag
Dietary factors	Skipped meals, dehydration, alcohol (especially red wine), caffeine withdrawal, aged cheeses, processed meats
Sensory stimuli	Bright or flickering lights, loud sounds, strong perfumes or chemical smells
Environmental changes	Weather shifts, changes in barometric pressure, high altitude
Physical factors	Intense exercise, physical exhaustion, poor posture

One thing worth noting: triggers don’t always work alone. You might tolerate a glass of wine on a normal day but find it triggers a migraine when you’re also stressed and sleep-deprived. This “stacking” effect explains why migraines can sometimes seem unpredictable.

How migraine is diagnosed

There’s no blood test or brain scan that confirms migraine. Instead, diagnosis relies on your medical history, a description of your symptoms, and a neurological examination.

Your doctor will ask detailed questions about your headaches: Where does the pain occur? What does it feel like? How long do attacks last? What other symptoms accompany the headache? They’ll also want to know about potential triggers, family history, and how migraines affect your daily life.

A headache journal proves invaluable during this process. Recording the date and time of each attack, what you ate and drank, how you slept, stress levels, and any other potential triggers helps establish patterns that guide treatment decisions.

Imaging studies like MRI or CT scans aren’t routinely needed for typical migraine. However, your doctor might order imaging if your symptoms are unusual, if you have abnormalities on neurological examination, or if your headache pattern changes suddenly. These tests help rule out other conditions—like tumors, aneurysms, or structural problems—rather than confirm migraine itself.

Migraine treatment options

Treatment focuses on two goals: stopping attacks when they happen and reducing how often they occur. The right approach depends on your attack frequency, severity, and how well you respond to different medications.

Treating an acute migraine

For mild to moderate attacks, over-the-counter pain relievers often provide relief when taken early. Options include ibuprofen, aspirin, acetaminophen, or combination products that include caffeine. The key is taking medication at the first sign of an attack—waiting until the pain becomes severe makes treatment less effective.

When over-the-counter options aren’t enough, prescription medications called triptans target the specific mechanisms involved in migraine. Triptans—including sumatriptan, rizatriptan, and zolmitriptan—work by narrowing blood vessels and blocking pain pathways in the brain. They’re most effective when taken early in an attack.

Newer medications called gepants and ditans offer alternatives for people who can’t take triptans or don’t respond well to them. Some gepants target CGRP, the inflammatory protein involved in migraine pain.

Tip: Taking pain medications too frequently—more than two or three days per week—can lead to medication overuse headache, where the treatment itself starts causing more headaches. If you find yourself reaching for medication this often, talk to your doctor about preventive strategies.

Preventing future migraines

If you’re having frequent attacks or if migraines significantly disrupt your life, preventive treatment can reduce how often they occur and how severe they are.

• Daily oral medications: Beta-blockers, certain antidepressants, and anti-seizure medications can reduce migraine frequency when taken regularly.
• CGRP inhibitors: Monthly or quarterly injections that block the CGRP pathway. These newer medications were developed specifically for migraine prevention.
• Botox injections: FDA-approved for chronic migraine, administered every 12 weeks at multiple injection sites around the head and neck.

Non-medication management

Lifestyle factors play a significant role in migraine frequency. While they won’t eliminate migraines entirely, consistent habits can reduce how often attacks occur:

• Maintain regular sleep and wake times, even on weekends
• Eat meals at consistent times without skipping
• Stay well-hydrated throughout the day
• Exercise regularly at moderate intensity
• Practice stress management through relaxation techniques, meditation, or biofeedback
• Identify and avoid your personal triggers when possible

When to seek urgent care

Most migraines, while painful and disruptive, aren’t dangerous. However, certain symptoms require immediate medical attention because they could indicate something more serious than migraine:

• A sudden, severe headache unlike any you’ve experienced before (sometimes called a “thunderclap headache”)
• Headache accompanied by fever, stiff neck, confusion, or seizures
• Headache following a head injury
• New or different headache pattern after age 50
• Sudden vision loss in one eye
• A gray curtain or shadow moving across your vision
• New flashes of light with many new floaters
• Weakness, numbness, or difficulty speaking that doesn’t resolve

These symptoms could indicate stroke, bleeding in the brain, meningitis, or retinal detachment—all of which require urgent evaluation.

Migraine and your eyes

Visual symptoms are among the most distinctive features of migraine with aura. The flashing lights, zigzag lines, and blind spots result from temporary changes in brain activity—not problems with the eyes themselves. This type of visual disturbance is sometimes called an “ocular migraine,” though that term can be confusing because it’s used in different ways.

True migraine aura typically affects both eyes (even when it seems one-sided), develops gradually over several minutes, and resolves completely within an hour. The visual changes usually move or shimmer rather than staying fixed in one spot.

Retinal problems, on the other hand, more often affect one eye, may appear suddenly, and don’t always resolve on their own. If you cover one eye and the visual disturbance disappears, that suggests the problem is in the eye you covered rather than in the brain.

If you’re unsure whether your visual symptoms are migraine-related or something else, a retina specialist can examine your eyes and help determine the cause. This is especially important if you experience vision loss, new floaters, or flashing lights that seem different from your usual migraine aura.

Frequently asked questions

What is the difference between migraine and a regular headache?

Tension headaches—the most common type of headache—typically cause mild to moderate pressure or tightness on both sides of the head. They don’t usually come with nausea, vomiting, or sensitivity to light and sound. Migraines, by contrast, tend to be more severe, often affect one side of the head, have a throbbing quality, and worsen with physical activity. The presence of aura, nausea, or light sensitivity strongly suggests migraine rather than tension headache.

How long does a migraine last?

Without treatment, migraine attacks typically last 4 to 72 hours. With effective treatment taken early, many people can shorten this duration significantly. Some people have brief attacks lasting only a few hours, while others experience prolonged episodes that stretch over several days.

Can children get migraines?

Yes, migraines can begin in childhood and even in infancy, though they often look different than adult migraines. Children’s attacks tend to be shorter—sometimes lasting only an hour or two—and may include more prominent stomach symptoms like nausea, vomiting, or abdominal pain. Some children experience “abdominal migraine,” which causes stomach pain without significant headache.

Do I see a neurologist or an eye doctor for migraine?

If your primary symptoms are headaches, a neurologist or headache specialist is typically the best starting point. However, if you’re experiencing visual symptoms and aren’t sure whether they’re related to migraine or an eye condition, an eye examination can help clarify the situation. A retina specialist can evaluate whether your visual symptoms originate in the eye or the brain.

Request an appointment if you have concerns about visual symptoms that may be related to your retinal health.