Diagnosis
Migraine FAQs
Amaal Starling, M.D., a neurologist at the Mayo Clinic, answers the important questions you may have about migraine.
Hi, I'm Dr. Amaal Starling, a neurologist at the Mayo Clinic. And I'm here to answer some of the important questions you may have about migraine.
Why doesn't migraine show up on MRI?
Migraine is a disease of abnormal function within the normal structure of the brain. MRI of the brain only tells you about the structure of the brain, but tells you very little about the function of the brain. And that's why a migraine doesn't show up on an MRI. Because it is abnormal operation within the normal structure.
How can this much pain be just a migraine?
Migraine is particularly disabling for some people. In fact, it is the second leading cause of disability worldwide. Disabling symptoms are not only pain, but also sensitivity to light and sound, as well as nausea and vomiting.
Do I need daily treatment if I don't have daily attacks?
There is a wide range of disease severity in migraine. There are some people who only need a rescue or acute migraine treatment because they have infrequent migraine attacks. But there are other people who experience frequent migraine attacks, perhaps two or three times a week. If they used rescue treatments for every attack, it could potentially lead to other complications. These individuals need a preventive treatment regimen to reduce the frequency and severity of attacks. These preventative treatments can be daily medications. It can be injections once a month or other injectable drugs given once every three months.
What should I do on the days I can't take the rescue medicine?
This is why preventive treatment is so important. With preventive treatment, we can reduce the frequency as well as the severity of attacks so that you don't have attacks more than twice a week. However, for some people, despite preventive treatment, they may have migraine symptoms more often during the week. For them, there are non-drug options for treating pain, such as biofeedback, relaxation techniques, cognitive behavioral therapy, as well as a number of devices that are non-drug options for treating migraine pain.
Should I Consider Neurotoxin Injections for Migraine?
Yes, this is an option for the preventive treatment of chronic migraine. These onabotulinum toxin A injections are given by your doctor once every 12 weeks to reduce the frequency and severity of migraine attacks. However, there are many different preventive treatment options. And it's important to talk to your doctor about which option is best for you.
How can I be the best partner to my medical team?
The best way to work with your medical team is, number one, to get a medical team. Many people living with migraines have never even spoken to a doctor about their symptoms. If you have headaches where you have to rest in a dark room, where you may get sick to your stomach. Talk to your healthcare professional about your symptoms. You may have a migraine and we can treat migraine. Migraine is a chronic disease. And to better manage this disease, patients need to understand the disease. This is why I prescribe advocacy to all my patients. Learn about migraine, join patient advocacy organizations, share your journey with others, and become empowered through advocacy and efforts to break the migraine stigma. And together, the patient and the medical team can manage the disease of migraine. Never hesitate to ask your medical team any questions or concerns you have. Update makes all the difference. Thanks for your time and we wish you well.
If you have migraines or a family history of migraines, a doctor trained in the treatment of headaches (a neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological exam.
If your condition is unusual, complicated, or suddenly becomes severe, tests to rule out other causes of your pain may include:
- Magnetic resonance imaging (MRI).OneMRIThe scan uses a strong magnetic field and radio waves to produce detailed images of the brain and blood vessels.MRIThe scans help doctors diagnose tumors, strokes, brain bleeds, infections, and other brain and nervous system (neurological) conditions.
- Computed tomography (CT).ONECTThe scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors diagnose tumors, infections, brain damage, bleeding in the brain, and other possible medical problems that may be causing headaches.
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More information
- Migraine care at the Mayo Clinic
- The CT scan
- Lumbar puncture (spinal tap)
- MRI
Treatment
Migraine treatment aims to stop symptoms and prevent future attacks.
Many medications are designed to treat migraine. Medicines used to combat migraines fall into two broad categories:
- Medicines to relieve pain.Also known as acute or failed therapy, these types of medications are taken during migraine attacks and are designed to stop symptoms.
- Preventive drugs.These types of medications are taken regularly, often daily, to reduce the severity or frequency of migraines.
Your treatment options depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
Medicines for relief
Medicines used to relieve migraine pain work best when taken at the first sign of an oncoming migraine - as soon as migraine signs and symptoms begin. Medicines that can be used to treat it include:
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Painkillers.These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken for too long, they can cause medication overuse headaches and possibly gastrointestinal ulcers and bleeding.
Migraine relief medications that combine caffeine, aspirin, and acetaminophen (Excedrin Migraine) can be helpful, but usually only against mild migraine pain.
- Triptans.Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraines because they block pain pathways in the brain. Taken as pills, shots, or nasal sprays, they can relieve many migraine symptoms. They may not be safe for those at risk of stroke or heart attack.
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Dihydroergotamine (D.H.E. 45, Migranal).Available as a nasal spray or injection, this medication is most effective when taken shortly after the onset of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects may include worsening of migraine-related vomiting and nausea.
People with coronary heart disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamine.
- Lasmiditan (Reyvow).This newer oral tablet is approved for the treatment of migraine with or without aura. In drug trials, lasmiditan significantly improved headache. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours.
- Ubrogepant (Ubrelvy).This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without aura in adults. It is the first drug of its type to be approved for the treatment of migraine. In drug trials, ubrogepant was more effective than placebo at relieving pain and other migraine symptoms, such as nausea and sensitivity to light and sound two hours after taking it. Common side effects include dry mouth, nausea, and excessive sleepiness. Ubrogepant should not be taken with strong CYP3A4 inhibitor drugs.
- CGRPcompetitors.Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oralCGRPantagonists recently approved for the treatment of acute migraine with or without aura in adults. In drug trials, drugs in this class were more effective than placebo at relieving pain and other migraine symptoms, such as nausea and sensitivity to light and sound two hours after taking it. Common side effects include dry mouth, nausea, and excessive sleepiness. Ubrogepant and Rimegepant should not be taken with strong CYP3A4 inhibitor drugs.
- Opioid drugs.For people who can't take other migraine medications, narcotic opioid medications may help. Because they can be highly addictive, they are usually only used if other treatments are not effective.
- Anti-nausea medication.These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea medications include chlorpromazine, metoclopramide (Reglan), or prochlorperazine (Compro). These are usually taken with painkillers.
Some of these medications are not safe to take during pregnancy. If you are pregnant or trying to become pregnant, do not use any of these medicines without first talking to your doctor.
Preventive drugs
Medicines can help prevent frequent migraines. Your doctor may recommend preventive medications if you have frequent, long-lasting, or severe headaches that do not respond well to treatment.
Preventive medication aims to reduce the frequency of migraines, the severity of attacks and their duration. Options include:
- Medicines to lower blood pressure.These include beta blockers such as propranolol (Inderal, InnoPran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Verelan) may be helpful in preventing migraines with aura.
- Antidepressants.A tricyclic antidepressant (amitriptyline) can prevent migraines. Because of the side effects of amitriptyline, such as drowsiness, other antidepressants may be prescribed.
- Anticonvulsant drugs.Valproate and topiramate (Topamax, Qudexy XR, others) may help if you have less frequent migraines, but they can cause side effects such as dizziness, weight changes, nausea, and more. These medicines are not recommended for pregnant women or women who are trying to become pregnant.
- Botox injections.Onabotulinum toxin A (Botox) injections about every 12 weeks help prevent migraines in some adults.
- CGRPmonoclonal antibodies.Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti) are newer drugs approved by the Food and Drug Administration to treat migraine. They are given monthly or quarterly by injection. The most common side effect is an injection site reaction.
Ask your doctor if these medicines are right for you. Some of these medications are not safe to take during pregnancy. If you are pregnant or trying to become pregnant, do not use any of these medicines without first talking to your doctor.
More information
- Migraine care at the Mayo Clinic
- Migraine medications and antidepressants
- Migraine Treatment: Can Antidepressants Help?
- Occipital Nerve Stimulation: Effective Migraine Treatment?
- Acupuncture
- Biofeedback
- Botox injections
- Chiropractic adjustment
- Massage therapy
- Migraine FAQs
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Clinical tests
Explore the Mayo Clinic studiestesting new treatments, interventions and tests as a means of preventing, detecting, treating or managing this condition.
Lifestyle and home remedies
When migraine symptoms start, try heading to a quiet, dark room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead and drink plenty of water.
These practices may also soothe migraine pain:
- Try relaxation techniques.Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which may help reduce the number of migraines you get.
- Develop a sleeping and eating routine.Don't sleep too much or too little. Set and follow a consistent sleep and wake schedule every day. Try to eat meals at the same time every day.
- Drink plenty of fluids.Staying hydrated, especially with water, can help.
- Keep a headache journal.Recording your symptoms in a headache diary will help you learn more about what triggers your migraines and what treatment is most effective. It will also help your doctor diagnose your condition and monitor your progress between visits.
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Exercise regularly.Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose aerobic activity that you enjoy, such as walking, swimming, and cycling. Warm up slowly, though, because sudden, vigorous exercise can cause headaches.
(Video) What Is a Migraine Headache?Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.
More information
- Migraine care at the Mayo Clinic
- Migraine pain relief
Alternative medicine
Non-traditional treatments may help chronic migraine pain.
- Acupuncture.Clinical trials have found that acupuncture can be helpful for headache. In this treatment, a practitioner inserts many fine, single-use needles into different areas of your skin at designated points.
- Biofeedback.Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical reactions associated with stress, such as muscle tension.
- Cognitive behavioral therapy.Cognitive behavioral therapy may benefit some people with migraines. This type of psychotherapy teaches you how your behaviors and thoughts affect the way you perceive pain.
- Meditation and yoga.Meditation can relieve stress, which is a known migraine trigger. If done on a regular basis, yoga can reduce the frequency and duration of migraines.
- Herbs, vitamins and minerals.There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity, although study results are mixed. Butterbur is not recommended for safety reasons.
A high dose of riboflavin (vitamin B-2) can reduce the frequency and severity of headaches. Coenzyme Q10 supplements may reduce the frequency of migraines, but larger studies are needed.
Magnesium supplements have been used to treat migraine, but with mixed results.
Ask your doctor if these treatments are right for you. If you are pregnant, do not use any of these treatments without first talking to your doctor.
Preparing for your appointment
You will likely see a primary care provider first, who may then refer you to a doctor trained in the evaluation and treatment of headaches (a neurologist).
Here is some information to help you prepare for your appointment.
What can you do
- Monitor your symptoms.Keep a headache journal by writing a description of each incident of visual disturbances or unusual sensations, including when they occurred, how long they lasted, and what triggered them. A headache diary can help your doctor diagnose your condition.
- Record basic personal information,including major stressors or recent life changes.
- Make a list of all medications,vitamins or supplements you take, including dosages; It is especially important to list all the medicines you have used to treat your headaches.
- Write questions to askyour doctor.
Take a family member or friend with you, if possible, to help you remember the information you receive.
For migraines, questions to ask your doctor include:
- What is likely to trigger my migraines?
- Are there other possible causes for my migraine symptoms?
- What tests do I need?
- Are my migraines likely to be temporary or chronic?
- What is the best course of action?
- What are the alternatives to the mainstream approach that you suggest?
- What lifestyle or dietary changes do you suggest I make?
- I have these other health conditions. How can I best manage them together?
- Is there any printed material you can give me? What sites do you recommend?
Feel free to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- How often do your headaches occur?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to make your symptoms worse?
- Does anyone else in your family get migraines?
By the Mayo Clinic staff
FAQs
What is the best way to diagnose migraines? ›
If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.
What is the first line treatment for migraines? ›Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Although triptans are effective, they may be expensive.
What is the best treatment for migraine? ›- painkillers such as ibuprofen and paracetamol.
- medicines called triptans.
- medicines that stop you feeling sick or being sick.
You may be asked to complete a computerized questionnaire to provide in-depth information to the doctor. Your neurologist might also perform eye exams, X-rays of your sinuses, a spinal tap, blood tests, or urine tests to check for various health disorders that could cause your headaches.
What conditions can be mistaken for migraine? ›Migraine auras can be confused with transient ischaemic attack (TIA), where someone has stroke symptoms that pass in a short time. For instance, a migraine with only a visual aura but no headache may be mistaken for TIA. Like a stroke, a migraine can be sudden and can lead to mild confusion.
What is the er migraine cocktail? ›The ER typically administers a combination of medications. The migraine cocktail includes a mix of non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, triptans, and IV fluids.
What are the top 3 migraine medicine? ›- Acetaminophen. Acetaminophen is a pain reliever that works well for migraine treatment. ...
- Ibuprofen. Ibuprofen belongs to a group of medications called non-steroidal anti-inflammatory drugs (NSAIDs). ...
- Naproxen. ...
- Aspirin.
ANTIEMETICS — Intravenous (IV) metoclopramide and IV or intramuscular (IM) prochlorperazine can be used as monotherapy for acute migraine headache. These medications act as antiemetics mainly because they are dopamine receptor antagonists. In addition, they are effective for reducing migraine headache pain.
What medications does the ER give for migraines? ›Treatments in the ER
Some pain medications you may get at the ER as an IV treatment for migraine include: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac. Acetaminophen. Corticosteroids such as dexamethasone (Decadron), which can prevent recurring migraines.
Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.
What's the difference between a headache and a migraine? ›
Headaches cause pain in the head, face, or upper neck, and can vary in frequency and intensity. A migraine is an extremely painful primary headache disorder. Migraines usually produce symptoms that are more intense and debilitating than headaches. Some types of migraines do not cause head pain, however.
Do migraines show up on MRI? ›An MRI can't diagnose migraines, cluster, or tension headaches, but it can help doctors rule out other medical conditions that may cause your symptoms, such as: A brain tumor. An infection in your brain, called an abscess. The buildup of fluid in the brain, called hydrocephalus.
Can MRI tell if you have migraines? ›It's important to understand that you can't use an MRI scan to diagnose migraines or any type of headaches. However, with these scans, your doctor can see if you have any other medical conditions including: A brain tumor. An abscess (an infection in your brain)
Do you need an MRI to diagnose migraines? ›While many people with migraine don't need an MRI, your doctor might recommend it if you have any headache red flags. These are sudden changes in headache patterns or certain signs that there may be a more serious underlying problem, including: Increase in frequency or changes in the intensity of headache.
Can migraines be a symptom of something? ›Hormonal changes, specifically fluctuations and estrogen that can occur during menstrual periods, pregnancy and perimenopause can trigger a migraine attack. Other known triggers include certain medications, drinking alcohol, especially red wine, drinking too much caffeine, stress.
What are the 3 most reported non headache migraine symptoms? ›- Food cravings.
- Neck stiffness.
- Sensitivity to light and/or sound.
- Brain fog.
- Extreme fatigue.
- Increased urine production.
- Frequent yawning.
Cluster headaches can be more severe than a migraine, but they usually don't last as long. These are the least common type of headaches, affecting fewer than one in 1,000 people. Men get them more than women do.
Why do hospitals give Benadryl for migraines? ›Benadryl can block histamine circulation and prevent migraine from occurring. Additionally, by blocking histamine, Benadryl can help calm the nervous system.
Why does the ER give Benadryl for migraines? ›Some have adverse reaction to reglan (extrapyramidal effects) displayed by acute anxiety and claustrphobia. However, giving benadryl prior to reglan prevents this negative reaction. Benadryl also promotes sleep of which also plays an important role in relieving the migraine.
What is the strongest migraine pill? ›In clinical studies, some people had pain freedom within 2 hours. UBRELVY is the #1 prescribed branded treatment for migraine attacks † in adults—it's not for prevention of migraine.
What is the new FDA approved migraine treatment? ›
QULIPTA® (atogepant) is FDA-approved for the preventive treatment of migraine in adults. It is the only oral calcitonin gene-related peptide (CGRP) receptor antagonist approved to prevent migraine across frequencies, including episodic and chronic.
Is magnesium good for migraines? ›When taken in safe doses, magnesium can effectively prevent migraines for many people. Since magnesium generally has fewer side effects than prescription migraine medication, it may be a more suitable option.
What is the gold standard for migraine treatment? ›Triptans (the modern “gold standard” for migraine relief) helps in the pain relief; the drugs are synthetic serotonin receptor agonists that are used in the therapy of migraine and vascular headache.
Does CBD work for migraines? ›Research links cannabis to headache and migraine relief; one 2021 literature review reports that a combination of CBD and THC had encouraging short- and long-term outcomes for people suffering from migraines. When examining CBD alone, studies show the cannabinoid can be an effective treatment option for chronic pain.
How long is too long for a migraine? ›How long is too long? If a migraine headache lasts longer than 72 hours without responding to regular migraine medication, the person may need additional treatment. Anyone who has experienced this pain for longer than 3 days should speak with a doctor as soon as they can.
What type of migraine is the most serious? ›Sometimes called an intractable migraine, status migrainosus is a very serious and very rare migraine variant. It typically causes migraine attacks so severe and long lasting — typically more than 72 hours — that you must be hospitalized.
What is the most painful migraine called? ›Cluster headaches are considered by many experts to be the most painful type of headache a person could ever experience, affecting an estimated one in 1,000 people in the United States.
What happens in the brain before a migraine? ›At the start of a migraine, an external or internal trigger causes neurons in the brain to fire abnormally. These triggers are vast and varied, and include lack of sleep, increase in stress, dietary choices, strong scents, shift in weather, or hormonal changes during a woman's menstrual cycle.
What is a migraine that won't go away? ›Intractable migraine, also known as status migrainosus, is a severe migraine headache that lasts for longer than 72 hours. The defining characteristic of this type of migraine is its duration.
Can dehydration cause migraines? ›People who aren't hydrated have a higher risk of heat exhaustion and other heat illness. Dehydration can trigger (cause) a migraine headache. If you get migraines, it's essential to drink plenty of water. Staying hydrated may help you prevent a migraine attack.
Is it a migraine or aneurysm? ›
Important Differences Between Migraine and Aneurysm Symptoms
The pain from a ruptured brain aneurysm is often described as the worst headache of a person's life. The pain comes on more suddenly and is more severe than any previous headaches or migraines. In contrast, migraine headaches usually come on gradually.
If a scan is ordered to evaluate a headache disorder, MRI with contrast is preferred as it is a more sensitive test than CT and does not involve any radiation. However, as it is so sensitive, there are often abnormal findings unrelated to the headache that may lead to further testing.
Do you get a CT or MRI for migraines? ›MRI or CT scans? There are several types of imaging tests that can be used for headache and migraine: An MRI or a CT scan are the most commonly ordered. A CT scan, or a CAT scan, uses X-rays to create images and show cross-sections of your body. The test typically takes only a few minutes.
What imaging is best for migraines? ›A computerized tomography (CT) scan, also known as a CAT scan, may help diagnose headaches by providing images of the brain. A CT scan works similarly to traditional x-ray exams. Parts of the body absorb different amounts of x-rays, with the difference allowing physicians to identify separate body parts.
What could be the cause of daily headaches? ›Conditions that might cause nonprimary chronic daily headaches include: Inflammation or other problems with the blood vessels in and around the brain, including stroke. Infections, such as meningitis. Intracranial pressure that's either too high or too low.
Do migraines and MS look the same on MRI? ›Autopsy and MRI studies have shown that cortical lesions are characteristic of MS, but MRI studies have suggested that migraineurs generally do not have cortical lesions. Although neurologists can see these lesions in vivo on 7-T MRI, 3-T MRI is not as sensitive and makes cortical lesion detection challenging.
When should you get a brain scan for a headache? ›You may also need a CT scan or an MRI if you have unusual headaches. See your health care provider right away if: You suddenly develop a very severe headache which feels like something is bursting inside your head. Your headaches are different from other headaches you've had, especially if you are age 50 or older.
What blood test is done for headaches? ›Laboratory tests for patients with headache include a complete blood count (CBC), thyroid function, erythrocyte sedimentation rate (ESR), glucose levels, electrolyte and fluid balance, and kidney function such as blood urea nitrogen (BUN). Hypothyroidism or hyperthyroidism may be associated with headaches.
What are the white spots on a migraine MRI? ›White matter hyperintensities (WMH): These lesions appear bright white on certain sequences of MRI scans. These abnormalities can also be seen in elderly people and patients with stroke and dementia. In migraineurs, they're typically found in the frontal lobe, limbic system, and parietal lobe of the brain.
Does migraine need surgery? ›You may have heard it called “migraine surgery.” This procedure is an outpatient treatment that releases, or decompresses, the nerves directly under the skin that might be triggering your migraines. Nerve decompression surgery for migraines began in the mid-2000s and is still relatively new.
What are the red flags for headaches in MRI? ›
Get MRI with contrast if you need to get imaging for HA. “Red flag signs and symptoms include focal neurologic signs, papilledema, neck stiffness, an immunocompromised state, sudden onset of the worst headache in the patient's life, personality changes, headache after trauma, and headache that is worse with exercise.”
Is there a definitive test for migraines? ›Headache Diagnosis: Advanced Diagnosis Techniques
Erythrocyte sedimentation rate (ESR), a blood test that can detect inflammation. MRI. CT scan. Digital subtraction angiography, a minimally invasive test that uses X-ray and iodine contrast to produce picture of blood vessels in the brain.
MRI scans are often used to help diagnose migraine because they can provide a complete and detailed picture of the brain's structure. They're also used to research the cause of migraine and the effects on the brain.
Are chronic migraines considered a disability? ›Chronic migraines may qualify as a disability under the American Disabilities Act (ADA) if they affect your ability to do certain activities, such as working or concentrating.