A migraine is a neurological condition that causes episodes of moderate to severe head pain, usually with a pulsating or throbbing quality, lasting anywhere from 4 to 72 hours. Unlike a regular tension headache, migraine comes with a package of other symptoms: nausea, vomiting, and intense sensitivity to light and sound. About one in three adults worldwide experiences some form of headache disorder, and migraine is among the most disabling of them.
How Migraine Differs From a Regular Headache
A tension headache typically feels like a band of pressure around your head. It’s uncomfortable, but you can usually push through your day. A migraine is a different experience entirely. The pain tends to concentrate on one side of the head, throbs in rhythm with your pulse, and gets noticeably worse with basic physical activity like walking up stairs or bending over. Many people find themselves retreating to a dark, quiet room because light and sound become almost unbearable.
To qualify as migraine clinically, attacks need to meet a specific pattern: at least five episodes of headache lasting 4 to 72 hours, with at least two pain characteristics (one-sided, pulsating, moderate to severe intensity, or worsened by routine movement) plus nausea, vomiting, or sensitivity to both light and sound. In children and adolescents, attacks can be shorter, lasting as little as two hours.
The Four Phases of a Migraine Attack
A migraine isn’t just a headache that switches on and off. It unfolds in up to four distinct phases, though not everyone experiences all of them.
Prodrome
Hours or even days before the pain starts, your body may send warning signals. These include mood changes like irritability or depression, difficulty concentrating, fatigue, neck stiffness, food cravings, frequent urination, and excessive yawning. Some people learn to recognize these early signs and use them as a cue to prepare or start treatment early.
Aura
About 25 to 30 percent of people with migraine experience aura, a set of temporary neurological symptoms that develop gradually over at least five minutes and last up to an hour. The most common form is visual: geometric patterns, flashing or shimmering lights, or blind spots that expand across your field of vision. Some people get sensory aura instead, like tingling that creeps up one arm, or speech difficulties.
What’s happening in the brain during aura is a phenomenon called cortical spreading depression. A slow wave of intense nerve cell activity sweeps across the surface of the brain at roughly 3.5 millimeters per minute, followed by a prolonged period of suppressed activity. Functional MRI studies have captured this wave moving across the visual cortex, closely matching the expanding visual disturbances people describe.
Headache
The pain phase typically lasts several hours to three days. Beyond the throbbing head pain, this phase often brings nausea, anxiety, inability to sleep, and heightened sensitivity to sound, light, and even smell. For some people, vomiting actually provides partial relief.
Postdrome
After the pain fades, many people feel drained for hours or longer. Fatigue, body aches, trouble concentrating, dizziness, and lingering light sensitivity are common. Some describe it as a “migraine hangover.” This phase is often overlooked, but it can be just as disruptive to your day as the headache itself.
What Happens in the Brain During a Migraine
Migraine is fundamentally a problem with how the brain processes sensory information, not a problem with blood vessels (though blood vessels are involved). The current understanding centers on the trigeminal nerve system, which is the main pain pathway for the head and face.
During an attack, the trigeminal system becomes activated and releases signaling molecules from nerve endings surrounding the brain’s blood vessels and protective membranes. These molecules trigger a cascade of local inflammation: blood vessels dilate, surrounding tissue swells, and pain-sensing nerve fibers become increasingly sensitized. This is why the pain can start mild and build, and why even normal stimuli like light or the pulsing of blood vessels become painful.
One key signaling molecule in this process has become a major target for newer treatments. When the trigeminal system fires, it floods the local area with this peptide, which drives both the blood vessel dilation and the inflammatory response. Blocking its activity is the basis for an entire class of migraine medications developed in recent years.
What Triggers an Attack
Triggers don’t cause migraine. A migraine-prone brain is the underlying issue, and triggers are the environmental or behavioral factors that can tip that brain into an attack. Common triggers include:
- Irregular sleep: both too little and too much sleep can provoke attacks
- Stress: not just during stressful periods, but also the “let-down” period after stress passes (like weekends or the first day of vacation)
- Skipping meals or dehydration: the migraine brain thrives on consistency, and fasting has been directly linked to a lower threshold for head pain
- Hormonal changes: fluctuations in estrogen around menstruation are a well-established trigger, which is one reason migraine is roughly three times more common in women than men
- Specific foods and drinks: red wine and caffeine are frequently reported, though food triggers vary widely between individuals
- Caffeine withdrawal: if you regularly drink coffee and then skip it, the withdrawal itself can set off an attack
- Weather changes and sensory overload: bright lights, strong smells, and barometric pressure shifts are commonly reported
Keeping a headache diary is one of the most practical things you can do. Tracking your attacks alongside sleep patterns, meals, stress levels, and menstrual cycles helps identify your personal trigger profile and gives your doctor useful information for choosing treatments.
Genetics and Who Gets Migraine
Migraine runs in families. Twin and family studies estimate that 30 to 60 percent of the risk is inherited. If one of your parents has migraine, your chances are significantly higher than average. The genetics aren’t simple, though. Dozens of gene variants each contribute a small amount of risk, affecting everything from how your nerve cells handle electrical signals to how your brain regulates inflammation.
Migraine most commonly begins during adolescence or early adulthood and is more prevalent in women, largely due to hormonal factors. It tends to improve with age for many people, particularly after menopause.
Episodic vs. Chronic Migraine
Most people with migraine have episodic migraine, meaning they get attacks periodically but have more headache-free days than not. The clinical line between episodic and chronic migraine is crossed when you have 15 or more headache days per month, with at least 8 of those days meeting the criteria for migraine. This threshold matters because chronic migraine often requires different treatment strategies and has a significantly greater impact on daily life and work.
One important factor that can push episodic migraine toward chronic: medication overuse. Taking pain relievers (including over-the-counter options) on 10 or more days per month for triptans or opioids, or 15 or more days per month for common pain relievers like ibuprofen or acetaminophen, can paradoxically increase headache frequency over time. This creates a cycle that’s difficult to break without medical guidance.
How Migraine Is Treated
Treatment falls into two categories: stopping an attack once it starts (acute treatment) and reducing how often attacks happen (preventive treatment).
Acute Treatment
For mild to moderate attacks, over-the-counter anti-inflammatory medications or acetaminophen can be effective, especially when taken early. For more severe attacks, triptans are the most widely used prescription option. They work by constricting dilated blood vessels and reducing the inflammatory signaling in the trigeminal system. Timing matters: taking acute medication at the first sign of an attack is consistently more effective than waiting until pain is fully established.
Preventive Treatment
If you’re getting four or more migraine days per month, or your attacks are severe enough to significantly disrupt your life, preventive medication becomes worth considering. Several classes of medications originally developed for other conditions have proven effective. These include certain blood pressure medications (beta-blockers), anti-seizure medications, and specific antidepressants.
The newer class of preventive treatments targets the signaling molecule central to migraine inflammation. These are injectable medications given monthly or quarterly that block either the molecule itself or its receptor. In clinical trials, monthly injections reduced migraine days by roughly 3 to 4 days per month compared to about 2 days with placebo, in people averaging about 8 migraine days monthly. That may sound modest, but for someone losing a week or more each month, cutting attacks nearly in half is meaningful.
Lifestyle as Treatment
Non-medication approaches aren’t just add-ons. Regular sleep schedules, consistent meal timing, regular aerobic exercise, stress management techniques, and staying hydrated form the foundation of migraine management. Clinicians often use the acronym SEEDS to summarize these: sleep, exercise, eat, diary, and stress. These changes alone won’t eliminate migraine, but they reduce the frequency and severity of attacks for many people, and they make medications work better.
For menstrual migraine specifically, starting a short course of preventive treatment a few days before the expected onset of menstruation can help prevent attacks during that vulnerable window.