Migraines are chronic headaches that can cause sig­nif­i­cant pain for hours or even days. Symp­toms can be so severe that all you can think about is find­ing a dark, quiet place to lie down.

Some migraines are pre­ceded or accom­pa­nied by sen­sory warn­ing symp­toms or signs (auras), such as flashes of light, blind spots or tin­gling in your arm or leg. A migraine is often accom­pa­nied by nau­sea, vom­it­ing, and extreme sen­si­tiv­ity to light and sound.

Although there’s no cure, med­ica­tions can help reduce the fre­quency and sever­ity of migraines. If treat­ment hasn’t worked for you in the past, it’s worth talk­ing to your doc­tor about try­ing a dif­fer­ent migraine med­ica­tion. The right med­i­cines com­bined with self-help reme­dies and lifestyle changes may make a tremen­dous dif­fer­ence.
Migraines usu­ally begin in child­hood, ado­les­cence or early adult­hood. A typ­i­cal migraine attack pro­duces some or all of these signs and symptoms:

* Mod­er­ate to severe pain, which may be con­fined to one side of the head or may affect both sides
* Head pain with a pul­sat­ing or throb­bing qual­ity
* Pain that wors­ens with phys­i­cal activ­ity
* Pain that inter­feres with your reg­u­lar activ­i­ties
* Nau­sea with or with­out vom­it­ing
* Sen­si­tiv­ity to light and sound

When untreated, a migraine typ­i­cally lasts from four to 72 hours, but the fre­quency with which headaches occur varies from per­son to per­son. You may have migraines sev­eral times a month or much less frequently.

Not all migraines are the same. Most peo­ple expe­ri­ence migraines with­out auras, which were pre­vi­ously called com­mon migraines. Some peo­ple have migraines with auras, which were pre­vi­ously called clas­sic migraines. Auras can include changes to your vision, such as see­ing flashes of light, and feel­ing pins and nee­dles in an arm or leg.

Whether or not you have auras, you may have one or more sen­sa­tions of pre­mo­ni­tion (pro­drome) sev­eral hours or a day or so before your headache actu­ally strikes, including:

* Feel­ings of ela­tion or intense energy
* Crav­ings for sweets
* Thirst
* Drowsi­ness
* Irri­tabil­ity or depression

Although much about the cause of migraines isn’t under­stood, genet­ics and envi­ron­men­tal fac­tors seem to both play a role.

Migraines may be caused by changes in the trigem­i­nal nerve, a major pain path­way. Imbal­ances in brain chem­i­cals, includ­ing sero­tonin — which helps reg­u­late pain in your ner­vous sys­tem — also may be involved.

Sero­tonin lev­els drop dur­ing migraines. This may trig­ger your trigem­i­nal sys­tem to release sub­stances called neu­ropep­tides, which travel to your brain’s outer cov­er­ing (meninges). The result is headache pain.

Migraine trig­gers
What­ever the exact mech­a­nism of the headaches, a num­ber of things may trig­ger them. Com­mon migraine trig­gers include:

* Hor­monal changes in women. Fluc­tu­a­tions in estro­gen seem to trig­ger headaches in many women with known migraines. Women with a his­tory of migraines often report headaches imme­di­ately before or dur­ing their peri­ods, when they have a major drop in estro­gen. Oth­ers have an increased ten­dency to develop migraines dur­ing preg­nancy or menopause. Hor­monal med­ica­tions — such as oral con­tra­cep­tives and hor­mone replace­ment ther­apy — also may worsen migraines, though some women find it’s ben­e­fi­cial to take them.
* Foods. Some migraines appear to be trig­gered by cer­tain foods. Com­mon offend­ers include alco­hol, espe­cially beer and red wine; aged cheeses; choco­late; aspar­tame; overuse of caf­feine; monosodium glu­ta­mate — a key ingre­di­ent in some Asian foods; salty foods; and processed foods. Skip­ping meals or fast­ing also can trig­ger migraines.
* Stress. Stress at work or home can insti­gate migraines.
* Sen­sory stim­uli. Bright lights and sun glare can pro­duce migraines, as can loud sounds. Unusual smells — includ­ing pleas­ant scents, such as per­fume, and unpleas­ant odors, such as paint thin­ner and sec­ond­hand smoke, can also trig­ger migraines.
* Changes in wake-sleep pat­tern. Either miss­ing sleep or get­ting too much sleep may serve as a trig­ger for migraine attacks in some indi­vid­u­als, as can jet lag.
* Phys­i­cal fac­tors. Intense phys­i­cal exer­tion, includ­ing sex­ual activ­ity, may pro­voke migraines.
* Changes in the envi­ron­ment. A change of weather or baro­met­ric pres­sure can prompt a migraine.
* Med­ica­tions. Cer­tain med­ica­tions can aggra­vate migraines.
Sev­eral fac­tors make you more prone to hav­ing migraines.

* Hav­ing a fam­ily his­tory. Many peo­ple with migraines have a fam­ily his­tory of migraine. If one or both of your par­ents have migraines, there’s a good chance you will too.
* Being younger than 40. Half the peo­ple who suf­fer from migraines started get­ting them before they were 20 and migraines are most com­mon in peo­ple who are between 30 and 39 years old.
* Being female. Women are three times as likely to have migraines as men are. Headaches tend to affect boys more than girls dur­ing child­hood, but by the time of puberty, more girls are affected.
* Expe­ri­enc­ing hor­monal changes. If you’re a woman with migraines, you may find that your headaches begin just before or shortly after onset of men­stru­a­tion. They may also change dur­ing preg­nancy or menopause. Some women report that their migraines got worse dur­ing the first trimester of a preg­nancy. Though for many, the migraines improved dur­ing later stages in the preg­nancy.
Some­times your efforts to con­trol your pain cause problems.

* Abdom­i­nal prob­lems. Non­s­teroidal anti-inflammatory drugs (NSAIDs), such as ibupro­fen (Advil, Motrin, oth­ers) and aspirin, may cause abdom­i­nal pain, bleed­ing and ulcers — espe­cially if taken in large doses or for a long period of time.
* Rebound headaches. In addi­tion, if you take over-the-counter or pre­scrip­tion headache med­ica­tions more than nine days per month or in high doses, you may be set­ting your­self up for a seri­ous com­pli­ca­tion known as rebound headaches. Rebound headaches occur when med­ica­tions not only stop reliev­ing pain, but actu­ally begin to cause headaches. You then use more pain med­ica­tion, which traps you in a vicious cycle.
* Sero­tonin syn­drome. This poten­tially life-threatening drug inter­ac­tion can occur if you take migraine med­i­cines called trip­tans, such as suma­trip­tan (Imitrex) or zolmitrip­tan (Zomig), along with anti­de­pres­sants known as selec­tive sero­tonin reup­take inhibitors (SSRIs) or sero­tonin and nor­ep­i­neph­rine reup­take inhibitors (SNRIs). Some com­mon SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cym­balta and Effexor. For­tu­nately, sero­tonin syn­drome is rare.

Non­tra­di­tional ther­a­pies may be help­ful if you have chronic headache pain:

* Acupunc­ture. In this treat­ment, a prac­ti­tioner inserts many thin, dis­pos­able nee­dles into sev­eral areas of your skin at defined points. A num­ber of clin­i­cal tri­als have found that acupunc­ture may be help­ful for headache pain.
* Biofeed­back. Biofeed­back appears to be espe­cially effec­tive in reliev­ing migraine pain. This relax­ation tech­nique uses spe­cial equip­ment to teach you how to mon­i­tor and con­trol cer­tain phys­i­cal responses related to stress, such as mus­cle ten­sion.
* Mas­sage. Mas­sage may help reduce the fre­quency of migraines. And it can improve the qual­ity of your sleep, which can, in turn, help pre­vent migraines.
* Herbs, vit­a­mins and min­er­als. There is some evi­dence that the herbs fever­few and but­ter­bur may pre­vent migraines or reduce their sever­ity. A high dose of riboflavin (vit­a­min B-2) also may pre­vent migraines by cor­rect­ing tiny defi­cien­cies in the brain cells. Coen­zyme Q10 sup­ple­ments may be help­ful in some indi­vid­u­als. Oral mag­ne­sium sul­fate sup­ple­ments may reduce the fre­quency of headaches in some peo­ple, although stud­ies don’t all agree on this issue. Mag­ne­sium taken intra­venously seems to help some peo­ple dur­ing an acute headache, par­tic­u­larly peo­ple with mag­ne­sium defi­cien­cies. Ask your doc­tor if these treat­ments are right for you. Don’t use fever­few or but­ter­bur if you’re preg­nant.
Whether or not you take pre­ven­tive med­ica­tions, you may ben­e­fit from lifestyle changes that can help reduce the num­ber and sever­ity of migraines. One or more of these sug­ges­tions may be help­ful for you:

* Avoid trig­gers. If cer­tain foods seem to have trig­gered your headaches in the past, avoid those foods. If cer­tain scents are a prob­lem, try to avoid them. In gen­eral, estab­lish a daily rou­tine with reg­u­lar sleep pat­terns and reg­u­lar meals. In addi­tion, try to con­trol stress.
* Exer­cise reg­u­larly. Reg­u­lar aer­o­bic exer­cise reduces ten­sion and can help pre­vent migraines. If your doc­tor agrees, choose any aer­o­bic exer­cise you enjoy, includ­ing walk­ing, swim­ming and cycling. Warm up slowly, how­ever, because sud­den, intense exer­cise can cause headaches. Obe­sity is also thought to be a fac­tor in migraines, and reg­u­lar exer­cise can help you keep your weight down.
* Reduce the effects of estro­gen. If you’re a woman with migraines and estro­gen seems to trig­ger or make your headaches worse, you may want to avoid or reduce the amount of med­ica­tions you take that con­tain estro­gen. These med­ica­tions include birth con­trol pills and hor­mone replace­ment ther­apy. Talk with your doc­tor about the best alter­na­tives or dosages for you.