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  • Causes & Risk Factors
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What Is Migraine?

Migraine is a common and potentially debilitating neurological disorder, featuring the predominant symptom of headache pain that throbs or pulses, usually on one side of the head.1,2 This pain can range from moderate to severe and typically lasts between 4 and 72 hours.2

Migraine affects more than 1 billion people worldwide and about 40 million people in the U.S.3,4 During a migraine attack, people may experience nausea and vomiting and be extra sensitive to light, sounds, or smells.2 Even simple activities, such as sneezing, coughing, or moving, can worsen symptoms.2 Collectively, these symptoms make migraine attacks different from other common headaches, such as tension headaches, which usually affect both sides of the head and typically don’t have other symptoms.1

Research has yet to reveal the exact cause of migraine. However, it’s clear that migraine occurs when nerves within the skull are stimulated, ultimately triggering the trigeminal nerve and its corresponding blood vessels.5 The trigeminal nerve is a cranial nerve that carries information from the face and head to the brain.6,7 This sequence of nerve activation then gives rise to inflammation, which a person experiences as headache.5

Migraine headaches can be episodic (1-14 headache days per month) or chronic (15 or more headache days per month for at least 3 months)1,8 These attacks can be severe, often leading to work disability, stress, depression, or anxiety.2 Managing this condition involves avoiding triggers, anticipating when an attack might occur, and planning accordingly.1,2

Migraine is considered a leading cause of disability worldwide, with headache disorders accounting for the third most common cause of years lived with disability in 2019.9

 

Prevalence of Migraine

Around the world, migraine accounts for the second-leading source of years lived with a disabling condition.4 Among all households in the U.S., nearly 25% have at least one family member who has this type of headache.4

Most people with migraine have a family history of the disease, indicating a genetic origin.2 Having family members who experience migraine makes a person three times more likely to have them.1 While researchers have not identified specific genes or causes, some believe migraine stems from a mix of genetic and environmental factors.1 Identifying genes related to migraine could help develop new preventive measures.1

Migraine affects people of all genders and ages, but it’s three times more common in adults assigned female at birth, compared with people assigned male at birth.2 In the U.S., about 6% of males and 17% of females experience migraine attacks each year.1 This trend is thought to be related to hormones, as some people with migraine first experience the condition during their first menstruation or concurrent with pregnancy.2

Children and adults both experience migraine, typically occurring between the ages of 15 and 49.10 Among children, migraine tends to occur more frequently among females, compared with males.1 Migraine prevalence begins to rise near puberty and continues to trend upward until the ages of 35 to 39.1 Prevalence tapers afterward, particularly after menopause.1

Other risk factors for migraine include:11

  • Using caffeine or other medications in excess
  • A history of head injury
  • Stress
  • Having diseases or conditions that make one prone to blood clots or inflammation
  • Having obesity
  • Having a lower-income status
  • Sleep disorders

Causes and Risk Factors

What Causes Migraine?

While it’s unclear what exactly causes migraine, research has revealed that this severe headache stems from the stimulation of nerves inside the skull. That stimulation then triggers the trigeminal nerve and nearby blood vessels.5 This nerve is essential for relaying information between the head, face, and brain.6,7 When this happens, inflammation occurs, causing a headache.5

Migraine Triggers

Certain environmental or behavioral factors may lead to migraine onset. Possibilities include:

  • Weather changes1
  • Anxiety and stress12
  • Alcohol consumption12
  • Intense light or sound12
  • Smoking or secondhand smoke12
  • Insufficient caffeine intake among those who consume it regularly12
  • Insufficient sleep or changes to sleep schedule12
  • Missing a meal or meals12
  • Exercise-induced stress or other physical stress12
  • Perfumes or other strong smells12
  • Hormonal changes in females that may stem from hormonal birth control or the menstrual cycle12
  • Neck pain1
  • Heat1
  • Sex1

Specific foods may also trigger migraine attacks. For example, foods containing monosodium glutamate (MSG) or foods containing tyramine may lead to attacks.12 MSG can be found in high-protein foods, such as fish, meat, cheese, and poultry.13 Tyramine-rich foods include some kinds of beans, red wine, figs, aged cheeses, chicken liver, and smoked fish.12

Other foods that are known to trigger attacks include:12

  • Meats that contain nitrates, such as cured meats, bacon, salami, and hot dogs
  • Nuts, seeds, and peanuts
  • Marinated, processed, pickled, or fermented foods
  • Avocados, citrus fruits, and bananas
  • Onions
  • Chocolate
  • Cheese and dairy
Migraine and Genetics

Among people who experience migraine, the majority have a family history of this type of headache, suggesting that migraine is hereditary.2 Genetic data indicate that having a family member who experiences migraine can increases a person’s likelihood of having migraine three-fold.1

Research has yet to reveal specific genes that are associated with migraine, though identifying these genes could lead to new preventive measures.1 Researchers suspect that inherited and environmental influences both may cause migraine.1

 

Migraine Risk Factors

Migraine occurs in children and adults, most commonly between the ages of 15 and 49.10 While migraine affects people of all genders, it’s more prevalent in females, who experience migraine three times more often than males.2 This trend is thought to be related to changes in hormones, as some people with migraine first experience the condition at the start of the first menstrual cycle or during pregnancy.2 An estimated 6% of males and 17% of females experience migraine in the U.S. each year.1

Among children, migraine tends to occur more often in females than in males.1 From childhood onward, the rate of migraine increases with the onset of puberty and plateaus between the ages of 35 and 39 years.1 Rates decrease as people age beyond 39 years, with a prominent drop among females who reach menopause.1

Other risk factors include using caffeine or medications excessively; having a history of head injury; experiencing stress; being prone to blood clots or inflammation because of certain diseases or conditions; experiencing sleep disorders; having a lower income; and having obesity.11

Types of Migraine

There are two major types of migraine: Migraine with aura and migraine without aura.2

  • Aura occurs in about 25% of migraine cases.1 A person experiencing migraine with aura will first notice changes in their vision and other neurological symptoms.2 These symptoms typically appear between 10 and 60 minutes before the headache starts and can last up to an hour.2 However, aura may occur without headache pain.2 Light and sound sensitivity, appetite loss, or nausea may precede headache pain.2

    People who experience migraine with aura may describe the aura as flashing or bright lights, or say that it resembles heat waves.2 Aura may take the form of muscle weakness.2 It also may make the person having a migraine feel like they are being grabbed or touched.2

    Migraine with aura may also cause:2

    • Difficulty speaking
    • Temporary vision loss
    • Tingling in the face or hands
    • Confusion
    • Muscle weakness, numbness, or strange sensation occurring on one side of the body

  • Migraine without aura is the more common type of migraine.2 In migraine without aura, headache pain typically starts suddenly and focuses on one side of the head.2 Associated symptoms include light and sound sensitivity, nausea, fatigue, confusion, changes in mood, and blurred vision.2

  • There are other rarer types of migraine, each with its own distinct symptoms. They include:2

    • Abdominal migraine: Occurring little or no headache, this migraine occurs more often in children and creates moderate to severe abdominal pain that lasts between one and 72 hours.
    • Basilar-type migraine: This type of migraine typically occurs in female teenagers and is linked to their menstrual cycles. Basilar-type migraine may cause fainting, vision loss, ringing in the ears, difficulty with muscle coordination, or slurred speech.
    • Hemiplegic migraine: This rare form of migraine results in temporary paralysis of one side of the body that can last multiple days.
    • Menstrual migraine: This form of migraine coincides with the female menstrual cycle. People who experience menstrual migraine may also experience other types of migraine that are not linked to the menstrual cycle.
    • Migraine without headache: This type of migraine does not produce pain in the head, but may include visual disturbances or other common symptoms, such as nausea, constipation, vomiting, or aura.
    • Ophthalmoplegic migraine: An uncommon type of migraine that includes head pain with a dilated pupil and droopy eyelid.
    • Retinal migraine: Visual loss and disturbances confined to one eye.
    • Status migrainosus: This rare type of migraine includes severe and disabling pain that can linger beyond 72 hours.

Migraine Symptoms

The primary symptom of migraine is moderate to severe throbbing, pulsating pain on one side of the head.2 While migraine attacks can vary significantly from person to person, common symptoms include nausea, vomiting, and increased sensitivity to noise, light, and odors.2 Sneezing, coughing, and simply moving around can exacerbate migraine pain.2

Many different factors can trigger a migraine episode. These factors vary from one person to the next, but some common triggers include strong fumes or odors, stress, changes in weather, missing meals, and hormonal fluctuations.1,2

How Long Do Migraines Last?

The headache portion of a migraine attack can last from 4 to 72 hours, but the entire migraine, including its various stages, can stretch slightly beyond a week.14 Migraine is divided into four stages, which can all occur during an attack.2

Phases of Migraine

  • Most patients experience symptoms like food cravings, yawning, mood changes, lethargy, and more for up to 24 to 48 hours before headache onset.1,2

  • About 25% of people experience aura immediately before or during the migraine headache.1 This most commonly presents as bright or flashing lights, or visual heat waves, though some experience muscle weakness or the feeling of being touched.2

  • Migraine headaches typically begin gradually and grow in intensity, which correlates with associated nausea, vomiting, light sensitivity, and sound sensitivity.2

  • Migraine attacks often leave individuals exhausted or confused, with difficulty concentrating, lasting for up to one day before they feel well again.2

Migraine Complications

Migraine Complications

Migraine disrupts the work, cognitive function, and emotional health of 90% of people who experience this type of headache.15 People who experience migraine also typically see their work productivity drop by more than 50% during an attack.15 Furthermore, people with migraine are more likely to experience epilepsy, sleep disorders, anxiety, depression, and bipolar disorder than people who do not experience migraine.2

Diagnosis and Treatment

Migraine Diagnosis

There is no single test for migraine.12 If a healthcare professional suspects that a person has migraine, they typically gather a medical history and conduct physical and neurological examinations to confirm a migraine diagnosis.12,16

During these examinations, a healthcare professional may ask questions about pain, other symptoms, and the frequency and duration of migraine episodes.16 Typically, neuroimaging tests, such as an MRI, only are used if the healthcare professional suspects that a patient’s headaches stem from another condition.16

Headache diaries and calendars cataloging the pattern and frequency of headaches and symptoms can support a diagnosis.16 They can also help to identify migraine triggers.12

 

Migraine Treatment

Migraine medications and devices are classified as either acute or preventive1,2

 

Acute Migraine Treatments and Devices

Acute treatments aim to reduce the severity of a headache once a migraine attack has started.1,2 To be most effective, these treatments should be taken early in the headache phase of an attack.1,2

Acute treatment includes:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), a type of medication available without a prescription that can reduce pain and/or inflammation1,17
  • Triptans, a type of medication that attaches to specific receptors in the brain, blocking the production of chemicals that cause blood vessels to swell and preventing the transmission of pain signals to the brain1,18
  • Calcitonin gene–related peptide (CGRP) receptor antagonists, a type of medication that treats migraine by blocking the release of CGRP, a protein known to cause headache pain in most people with migraines1,19
  • Antiemetics, or medications that can reduce nausea, which can be used when this symptom is present1,20
  • Ergots, a type of medication that targets specific receptors in the brain, which then leads to narrowing of brain blood vessels1,21
  • Selective serotonin 1F receptor agonists, a medication that targets specific serotonin receptors to prevent headache without narrowing blood vessels in the brain1,22
  • Transcutaneous supraorbital nerve stimulation: A medical device that stimulates a nerve associated with migraine through the skin1,23
  • Transcranial magnetic stimulation: A procedure that uses pulses of magnetic waves, sent through the scalp, to stimulate brain tissue1,24
  • Nonpainful remote electric neurostimulation: Electrical stimulation of nerves in the upper arm, which aims to reduce pain1,25
Migraine Prevention

Migraine prevention falls into two broad categories: behavior/lifestyle modification, and the use of medication or devices.1

  • People who report migraine symptoms to a healthcare provider may be asked to keep a log of when and how migraine attacks occur.1 This diary may help identify migraine triggers, such as anxiety and stress, intense light or sound, sleep disturbances or changes, or strong smells, among others.1,12

    Prevention may involve avoiding the triggers that a person discovers in the migraine diary process or implementing the following behavior changes:12

    • Improving sleep habits, such as having a consistent bedtime and/or getting sufficient sleep
    • Managing stress
    • Eating healthier, more consistent meals while avoiding foods that trigger migraine
    • Losing weight, for people who have overweight or obesity


    A healthcare provider may also advise someone trying to prevent migraine to exercise consistently, implement relaxation techniques, practice yoga, undergo cognitive-behavioral therapy, or try biofeedback.26

  • Healthcare providers may turn to medications and devices to prevent migraine from occurring.1 Some of these medications may be prescribed off-label, meaning the medications are approved for other conditions but also may be effective for migraine.27 Preventive treatments, which aim to reduce the frequency or severity of future attacks, include:

    • Calcitonin gene-related peptide (CGRP) monoclonal antibodies: A protein that attaches to CGRPs or its receptors to prevent inflammation1,28
    • CGRP receptor antagonists: A medication that blocks the CGRP receptor, preventing CGRP from attaching and causing a migraine1,29
    • Beta-blockers: A medication that alters how the heart beats, reducing blood pressure1,30
    • Antidepressants: A type of medication used to lessen symptoms of depression1,31
    • Anticonvulsants: A medication that alters the brain’s electrical signals to lessen the risk of seizures1,32
    • Calcium channel blockers: A medication that helps blood vessels open, lowering blood pressure1,33
    • OnabotulinumtoxinA: An injection used to alter pain signaling in the face and head34
    • Transcutaneous supraorbital nerve stimulation: A medical device that targets a nerve linked to migraine pain with stimulation through the skin1,23,35
Migraine Treatment Challenges

With many first-, second-, and third-line medications for migraine, finding the right treatment option often requires a trial-and-error approach.16,36 Individual migraine symptoms must be taken into consideration. Nausea, for example, might make it difficult for an individual to take pills.1

Side effects and other health conditions can also complicate migraine treatment.1,2 Some options can lead to significant side effects, such as headaches due to overuse of medication.37 Additionally, certain medications may have contraindications, which means they might not be suitable for everyone.1,38

 

Stigma Associated With Migraine

Despite its prevalence, many stigmas surround migraine, framing the condition as “just a headache” or a woman’s disease.39 This has far-reaching implications, including under-diagnosis and under-treatment of the disorder, especially in primary-care settings.39,40

Only a small percentage of eligible patients receive preventive medications, compounded by an average delay of four years between symptom onset and starting preventive treatment.40

The wide range of migraine experiences can contribute to the underdiagnosis of migraine. General practitioners may attribute common migraine symptoms to stress or sinus headaches. Clinicians can improve their recognition of migraine by understanding this variability, following diagnostic protocols, and conducting thorough clinical examinations, which will ultimately lead to improved patient outcomes.41

Global Impact of Migraine

Estimates indicate that about 14% to 15% of people experience migraine globally.41 Rates of migraine are highest in North America, followed by South America, Central America, Europe, Asia, and Africa.1

Headache disorders, which include migraine, rank third among the top three global causes of disability-adjusted life years (DALYs).9 Stroke and dementia disorders were the first- and second-leading causes.9 While previous research suggests that migraine prevalence may be increasing globally over time, a recent analysis questions whether this is the case.41

Around the globe, migraine attacks often keep people out of the workplace, limit their productivity, and strain their relationships.9 This has implications for job security, financial security, and mental health. Companies and society as a whole experience economic losses stemming from migraine.9

Frequently Asked Questions About Migraine

  • Though the two words are often used interchangeably, a headache is a general term for any head pain, while migraine is a neurological disease in which a recurring headache is a primary and often disabling condition.1,39

  • Though people with migraine report a wide range of symptoms and experiences, the main symptom is a headache that typically produces throbbing or pulsing pain on a single side of the head.2 The pain can be moderate or severe in intensity and is often accompanied by increased sensitivity to light, noise, and odors, along with nausea and vomiting.2 Migraine attacks can last anywhere from four to 72 hours.1,2

  • If a healthcare provider suspects that you have migraine, they may conduct a thorough medical history examination to determine whether your symptoms align with migraine and rule out any other potential diagnoses.16 Primary care providers manage migraine treatment for most patients. Providers may refer patients to a neurologist who specializes in migraine care if standard treatment is not working or patients have additional health problems.16

  • If a healthcare provider suspects that you have migraine or confirms the diagnosis of migraine, they may ask you to keep a headache diary.1 Headache diaries are useful for noting the frequency, associated symptoms, and any patterns surrounding migraine.16

    A healthcare provider may also ask you to maintain a headache calendar. Headache calendars are not as detailed as headache diaries but are useful for noting when migraine attacks occur, how intense they are, and other pertinent details, such as concurrence with menstruation or the use of medication.16

  • If a healthcare provider confirms the diagnosis of migraine, they likely will prescribe acute treatment or recommend over-the-counter pain medications to manage symptoms.1,2,16 People who experience severe and/or frequent migraine attacks may also be eligible for preventive treatments that can help reduce the number or severity of migraine symptoms.1,2,16

    Some preventive and acute treatment options include:1

    • Dihydroergotamine (DHE) to treat acute migraine
    • Sumatriptan to treat acute migraine
    • Calcitonin gene-related peptide receptor agonists -- such as galcanezumab, erenumab, or  fremanezumab – to prevent and treat acute migraine42
    • OnabotulinumtoxinA to prevent migraine


    Before turning to prescription medications, healthcare providers typically try non-steroidal anti-inflammatory drugs (NSAIDs,) such as ibuprofen or naproxen. The efficacy of these over-the-counter medications is supported by clinical research.42

    Healthcare providers may also turn to other medications to manage symptoms. For example, they may prescribe an antiemetic to alleviate vomiting or nausea.42

    To prevent migraine, healthcare providers also may prescribe medications that may also be used for other conditions, such as beta-blockers, antiepileptics, calcium channel blockers, and antidepressants.42,43
     

  • Despite its prevalence, stigma surrounding migraine persists.39 People who suspect they may have migraine can make the most out of their time with a healthcare provider by accurately describing their headache, using words such as “throbbing,” “stabbing,” “constant,” or “persistent,” if applicable.44 Documenting any apparent triggers, symptoms, and relevant family history can all be useful to healthcare providers.44

  • While people of all genders can experience migraine, this severe headache is three times as prevalent in females as it is in males.2 Analysis reveals that 17% of females and 6% of males have a migraine attack each year.1

    The prevalence of migraine in women possibly is linked to hormonal fluctuations associated with the menstrual cycle.2 Migraine may first appear concurrently with a female’s first menstruation, or with pregnancy.2 Migraine prevalence also tends to trend downward as a female reaches menopause.1

  • A 2022 study determined that in 2008, migraine was the reason for more than 63% of hospitalizations stemming from headache.45 These hospitalizations tended to last an average of 2.7 days, compared with the overall hospitalization length of 4.6 days.45

    A 2020 article examining the number of hospitalizations due to migraine between 1997 and 2012 found that hospital stays due to migraine increased rapidly over the study period. These hospital stays accounted for more than $1 billion in healthcare costs in 2012.46

  • Vestibular migraine is a type of migraine that can occur with or without headache.41 Symptoms can include vertigo. Vertigo is the sensation that a person is in motion even though they are not.47

    People experiencing dizziness or vertigo associated with vestibular migraine may also have the following symptoms:47

    • Distorted vision
    • Brain fog
    • Tenderness of the scalp
    • Fatigue
    • Tingling
    • Trouble with recalling words
    • Yawning
    • Dry mouth
    • Diarrhea
    • Sweating

The information contained on this page is provided for your general information only. It is not intended as a substitute for seeking medical advice from a healthcare provider. Pfizer is not in the business of providing medical advice and does not engage in the practice of medicine. Pfizer under no circumstances recommends particular treatments for specific individuals and in all cases recommends consulting a physician or healthcare center before pursuing any course of treatment.