View source for Migraine

{{Short description|Disorder resulting in recurrent moderate–severe headaches}}
{{About|the disorder}}
{{Use dmy dates|date=November 2025}}
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{{Good article}}
{{Infobox medical condition
| name = Migraine
| image = Migraine.jpg
| caption = Woman during a migraine attack
| field = [[Neurology]]
| symptoms = [[Headaches]] coupled with sensory disturbances such as [[nausea]], [[photophobia|sensitivity to light]], [[hyperacusis|sound]], and [[osmophobia|smell]]
| complications = 
| onset = Around [[puberty]]
| duration = Recurrent, long term
| causes = Environmental and genetic
| risks = [[Family history (medicine)|Family history]], [[female|female sex]]
| diagnosis = 
| differential = [[Subarachnoid hemorrhage]], [[venous thrombosis]], [[idiopathic intracranial hypertension]], [[brain tumor]], [[tension headache]], [[sinusitis]], [[cluster headache]]
| prevention = [[Propranolol]], [[amitriptyline]], [[topiramate]], [[calcitonin gene-related peptide receptor antagonists]] (CGRPs)
| treatment = 
| medication = [[Ibuprofen]], [[paracetamol]] (acetaminophen), [[triptan]]s, [[ergotamine]]s
| prevalence = ~15%
| deaths = 
}}

<!-- Definition and symptoms -->
'''Migraine''' ({{IPA-cen|UK|ˈ|m|iː|ɡ|r|eɪ|n}}, {{IPA-cen|US|ˈ|m|aɪ|-}})<ref>{{cite LPD|3}}</ref><ref>{{cite EPD|18}}</ref> is a complex [[neurological disorder]] characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, [[Photophobia|light sensitivity]] and [[Hyperacusis|sound sensitivity]].<ref name="Pescador_Ruschel_2024">{{cite book | vauthors = Pescador Ruschel MA, De Jesus O | chapter = Migraine Headache |date=2024 |title = StatPearls | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK560787/ |access-date=13 September 2024 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32809622 }}</ref><ref name="Cephalalgia_2018">{{Cite journal |date=January 2018 |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |journal=Cephalalgia: An International Journal of Headache |volume=38 |issue=1 |pages=1–211 |doi=10.1177/0333102417738202 |pmid=29368949}}</ref> Other characteristic symptoms include vomiting, [[cognitive dysfunction]], [[allodynia]], dizziness,<ref name="Pescador_Ruschel_2024" /> and/or exacerbation of symptoms by routine physical activity.<ref>{{cite journal | vauthors = Martins IP, Gouveia RG, Parreira E | title = Kinesiophobia in migraine | journal = The Journal of Pain | volume = 7 | issue = 6 | pages = 445–451 | date = June 2006 | pmid = 16750801 | doi = 10.1016/j.jpain.2006.01.449 |doi-access=free}}</ref> Some people with migraine experience [[Aura (symptom)|aura]], a premonitory period of sensory disturbance widely accepted to be caused by [[cortical spreading depression]] at the onset of a migraine attack.<ref name="Cephalalgia_2018" />

Although primarily considered to be a headache disorder, migraine is highly [[heterogenous]] in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity.<ref name="Katsarava_2012">{{cite journal | vauthors = Katsarava Z, Buse DC, Manack AN, Lipton RB | title = Defining the differences between episodic migraine and chronic migraine | journal = Current Pain and Headache Reports | volume = 16 | issue = 1 | pages = 86–92 | date = February 2012 | pmid = 22083262 | pmc = 3258393 | doi = 10.1007/s11916-011-0233-z }}</ref> Disease burden can range from episodic discrete attacks to chronic disease.<ref name="Katsarava_2012" /><ref>{{cite web |vauthors=Shankar Kikkeri N, Nagalli S |title=Migraine With Aura |date=December 2022 |url=https://www.ncbi.nlm.nih.gov/books/NBK554611/ |access-date=23 August 2023 |publisher=StatPearls Publishing |pmid=32119498 |id=Bookshelf ID: NBK554611 |archive-date=8 June 2023 |archive-url=https://web.archive.org/web/20230608145627/https://www.ncbi.nlm.nih.gov/books/NBK554611/ |url-status=live }}</ref> Incidence of migraines may increase over time, evolving from episodic migraine to chronic migraine. Overuse of acute pain medications may hasten this process of chronification, and is a risk factor in developing [[medication overuse headache]].<ref>{{cite journal |last1=Mungoven |first1=TJ |last2=Henderson |first2=LA |last3=Meylakh |first3=N |title=Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives. |journal=Frontiers in Pain Research (Lausanne, Switzerland) |date=2021 |volume=2 |article-number=705276 |doi=10.3389/fpain.2021.705276 |doi-access=free |pmid=35295486 |pmc=8915760 }}</ref><ref>{{cite journal |last1=Walling |first1=A |title=Frequent Headaches: Evaluation and Management. |journal=American Family Physician |date=1 April 2020 |volume=101 |issue=7 |pages=419–428 |pmid=32227826}}</ref><ref>{{cite journal |last1=Lipton |first1=RB |last2=Buse |first2=DC |last3=Nahas |first3=SJ |last4=Tietjen |first4=GE |last5=Martin |first5=VT |last6=Löf |first6=E |last7=Brevig |first7=T |last8=Cady |first8=R |last9=Diener |first9=HC |title=Risk factors for migraine disease progression: a narrative review for a patient-centered approach. |journal=Journal of Neurology |date=December 2023 |volume=270 |issue=12 |pages=5692–5710 |doi=10.1007/s00415-023-11880-2 |pmid=37615752 |pmc=10632231 }}</ref>

<!-- Cause and mechanism -->
Migraine is believed to be caused by a combination of genetic, environmental, and neurological factors that influence the behavior of nerve cells, chemical signals and blood vessels within the brain. The accepted hypothesis suggests that multiple primary neuronal impairments lead to a series of intracranial and extracranial changes, triggering a physiological cascade that leads to migraine symptomatology.<ref name="Bentivegna">{{cite journal |last1=Ashina |first1=S |last2=Bentivegna |first2=E |last3=Martelletti |first3=P |last4=Eikermann-Haerter |first4=K |date=June 2021 |title=Structural and Functional Brain Changes in Migraine |journal=Pain and Therapy |volume=10 |issue=1 |pages=211–223 |doi=10.1007/s40122-021-00240-5 |pmid=33594593 |pmc=8119592 }}</ref><ref name="Levy"/><ref>{{cite journal | vauthors = Burstein R, Noseda R, Borsook D | title = Migraine: multiple processes, complex pathophysiology | journal = The Journal of Neuroscience | volume = 35 | issue = 17 | pages = 6619–6629 | date = April 2015 | pmid = 25926442 | pmc = 4412887 | doi = 10.1523/JNEUROSCI.0373-15.2015 }}</ref>

<!-- Management-->
A migraine management plan often includes lifestyle modifications to cope with migraine triggers and reduce the impact of [[Comorbidity|comorbidities]].<ref name=":0" /><ref name="Elmazny">{{cite journal |last1=Elmazny |first1=A |last2=Magdy |first2=R |last3=Hussein |first3=M |last4=Ismaeel |first4=AY |last5=Essmat |first5=A |last6=Elbeltagy |first6=KE |last7=Hussein |first7=SMM |last8=Hassan |first8=NS |last9=Elbehiry |first9=NM |last10=Osama |first10=W |last11=Abdelazeem |first11=HN |last12=Elshebawy |first12=H |date=1 September 2025 |title=Migraine triggers and lifestyle modifications: an assessment of patients' awareness and the role of healthcare providers in patient education |journal=The Journal of Headache and Pain |volume=26 |issue=1 |page=189 |doi=10.1186/s10194-025-02107-y |pmc=12400567 |pmid=40890611 |doi-access=free}}</ref><ref>{{cite journal |last1=Buse |first1=DC |last2=Reed |first2=ML |last3=Fanning |first3=KM |last4=Bostic |first4=R |last5=Dodick |first5=DW |last6=Schwedt |first6=TJ |last7=Munjal |first7=S |last8=Singh |first8=P |last9=Lipton |first9=RB |title=Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. |journal=The Journal of Headache and Pain |date=2 March 2020 |volume=21 |issue=1 |pages=23 |doi=10.1186/s10194-020-1084-y |doi-access=free |pmid=32122324 |pmc=7053108 }}</ref> Non-pharmacological preventive therapies include stress management,<ref name="Stubberud">{{cite journal |last1=Stubberud |first1=A |last2=Buse |first2=DC |last3=Kristoffersen |first3=ES |last4=Linde |first4=M |last5=Tronvik |first5=E |title=Is there a causal relationship between stress and migraine? Current evidence and implications for management |journal=The Journal of Headache and Pain |date=20 December 2021 |volume=22 |issue=1 |page=155 |doi=10.1186/s10194-021-01369-6 |doi-access=free |pmid=34930118 |pmc=8685490 }}</ref> sleep improvement,<ref name=":2">{{cite journal |last1=Daou |first1=M |last2=Vgontzas |first2=A |title=Sleep Symptoms in Migraine |journal=Current Neurology and Neuroscience Reports |date=August 2024 |volume=24 |issue=8 |pages=245–254 |doi=10.1007/s11910-024-01346-x |pmid=38864968}}</ref><ref name=":4">{{cite journal |last1=Waliszewska-Prosół |first1=M |last2=Nowakowska-Kotas |first2=M |last3=Chojdak-Łukasiewicz |first3=J |last4=Budrewicz |first4=S |title=Migraine and Sleep-An Unexplained Association? |journal=International Journal of Molecular Sciences |date=24 May 2021 |volume=22 |issue=11 |page=5539 |doi=10.3390/ijms22115539 |doi-access=free |pmid=34073933 |pmc=8197397 }}</ref><ref name=":5">{{cite journal |last1=Duan |first1=S |last2=Ren |first2=Z |last3=Xia |first3=H |last4=Wang |first4=Z |last5=Zheng |first5=T |last6=Liu |first6=Z |title=Association between sleep quality, migraine and migraine burden |journal=Frontiers in Neurology |date=2022 |volume=13 |article-number=955298 |doi=10.3389/fneur.2022.955298 |doi-access=free |pmid=36090858 |pmc=9459411 }}</ref> dietary interventions,<ref name="Gazerani">{{cite journal |last1=Gazerani |first1=P |title=Migraine and Diet |journal=Nutrients |date=3 June 2020 |volume=12 |issue=6 |page=1658 |doi=10.3390/nu12061658 |doi-access=free |pmid=32503158 |pmc=7352457 }}</ref> and aerobic exercise.<ref name="Barber">{{cite journal |last1=Barber |first1=M |last2=Pace |first2=A |title=Exercise and Migraine Prevention: a Review of the Literature |journal=Current Pain and Headache Reports |date=11 June 2020 |volume=24 |issue=8 |page=39 |doi=10.1007/s11916-020-00868-6 |pmid=32529311}}</ref><ref name=":0">{{cite journal |vauthors=Haghdoost F, Togha M |date=January 2022 |title=Migraine management: Non-pharmacological points for patients and health care professionals |journal=Open Medicine |volume=17 |issue=1 |pages=1869–1882 |doi=10.1515/med-2022-0598 |pmc=9691984 |pmid=36475060 |doi-access=free |title-link=doi}}</ref><ref name="Elmazny" /> Initial recommended [[Migraine treatment|treatment]] for acute attacks is with [[Over-the-counter drug|over-the-counter]] (OTC) pain medications (such as [[ibuprofen]] and [[paracetamol]]) and [[antiemetic|anti-nausea medications]].<ref name=Gilmore2011>{{cite journal | vauthors = Gilmore B, Michael M | title = Treatment of acute migraine headache | journal = American Family Physician | volume = 83 | issue = 3 | pages = 271–280 | date = February 2011 | pmid = 21302868 }}</ref> The approval of [[calcitonin gene-related peptide receptor antagonists|CGRP inhibitors]] is seen as a major advance in migraine treatment:<ref name="Zobdeh" /> According to the [[American Headache Society]], CGRP targeting therapies are a [[First-line drug|first-line]] option for migraine prevention.<ref>{{cite journal | vauthors = Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A | title = Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update | journal = Headache | volume = 64 | issue = 4 | pages = 333–341 | date = April 2024 | pmid = 38466028 | doi = 10.1111/head.14692 | doi-access = free | title-link = doi }}</ref><ref name=":3">{{Cite web |last=Gibb |first=Vera |date=2024-04-26 |title=American Headache Society Position Statement: Calcitonin Gene-Related Peptide (CGRP) Inhibitors should now be considered a first-line option for migraine prevention |url=https://www.migrainedisorders.org/ahs-statement-cgrp/ |access-date=2025-11-05 |website=Association of Migraine Disorders }}</ref> Specific medications such as [[triptan]]s or [[ergotamine]]s may be used by those experiencing headaches that do not respond to over-the-counter pain medications.<ref>{{cite journal | vauthors = Tzankova V, Becker WJ, Chan TL | title = Diagnosis and acute management of migraine | journal = CMAJ | volume = 195 | issue = 4 | pages = E153–E158 | date = January 2023 | pmid = 36717129 | pmc = 9888545 | doi = 10.1503/cmaj.211969 }}</ref>

<!-- Prevention-->
Commonly prescribed prophylactic medications include [[beta blocker]]s, [[anticonvulsant]]s, tricyclic antidepressants, calcium channel blockers, various other [[Off-label use|off-label]] classes of medications, and [[calcitonin gene-related peptide receptor antagonists|CGRP inhibitors]].<ref name="Zobdeh">{{cite journal |last1=Zobdeh |first1=F |last2=Ben Kraiem |first2=A |last3=Attwood |first3=MM |last4=Chubarev |first4=VN |last5=Tarasov |first5=VV |last6=Schiöth |first6=HB |last7=Mwinyi |first7=J |title=Pharmacological treatment of migraine: Drug classes, mechanisms of action, clinical trials and new treatments |journal=British Journal of Pharmacology |date=December 2021 |volume=178 |issue=23 |pages=4588–4607 |doi=10.1111/bph.15657 |pmid=34379793}}</ref><ref name="Aguilar-Shea">{{cite journal |last1=Aguilar-Shea |first1=AL |last2=Membrilla Md |first2=JA |last3=Diaz-de-Teran |first3=J |title=Migraine review for general practice |journal=Atencion Primaria |date=February 2022 |volume=54 |issue=2 |article-number=102208 |doi=10.1016/j.aprim.2021.102208 |pmid=34798397 |pmc=8605054 }}</ref><ref name="NBK507873">{{cite web |vauthors=Kumar A, Kadian R |title=Migraine Prophylaxis |date=September 2022 |url=https://www.ncbi.nlm.nih.gov/books/NBK507873/ |access-date=22 August 2023 |publisher=StatPearls Publishing |pmid=29939650 |archive-date=8 March 2023 |archive-url=https://web.archive.org/web/20230308191413/https://www.ncbi.nlm.nih.gov/books/NBK507873/ |url-status=live | id=Bookshelf ID: NBK507873 }}</ref> Medications inhibit migraine pathophysiology through various mechanisms, such as blocking [[Calcium channel|calcium]] and [[sodium channel]]s, activation of [[serotonin]] by 5-HT receptor agonists, and blocking of CGRP transmission in the trigeminovascular system.<ref name="Zobdeh"/>

<!-- Epidemiology, society and culture -->
Globally, approximately 15% of people are affected by migraine,<ref name=LancetEpi2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, etal | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–96 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref> making it the third-most prevalent disorder in the world<ref>{{cite web|vauthors=Gobel H|title=1. Migraine|url=https://ichd-3.org/1-migraine/|access-date=22 October 2020|website=ICHD-3 The International Classification of Headache Disorders 3rd edition|archive-date=24 October 2020|archive-url=https://web.archive.org/web/20201024210813/https://ichd-3.org/1-migraine/|url-status=live}}</ref> and one of the most common causes of disability.<ref>{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 | journal = Lancet | volume = 390 | issue = 10100 | pages = 1211–1259 | date = September 2017 | pmid = 28919117 | pmc = 5605509 | doi = 10.1016/S0140-6736(17)32154-2 | collaboration = GBD 2016 Disease and Injury Incidence and Prevalence Collaborators | vauthors = Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adamu AA, Adetokunboh O, Afarideh M, Afshin A, Agarwal SK, Aggarwal R, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MT, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al Lami FH }}</ref><ref>{{cite book |last1=Treadwell |first1=Jonathan R. |last2=Tsou |first2=Amy Y. |last3=Rouse |first3=Benjamin |last4=Ivlev |first4=Ilya |last5=Fricke |first5=Julie |last6=Buse |first6=Dawn |last7=Powers |first7=Scott W. |last8=Minen |first8=Mia |last9=Szperka |first9=Christina L. |last10=Mull |first10=Nikhil K. |title=Behavioral Interventions for Migraine Prevention |date=18 September 2024 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/AHRQEPCCER270 |pmid=39471258 }}</ref> Beginning at puberty, women experience higher rates than men of incidence, severity of symptoms, and disability related to migraines.<ref name="Allais"/><ref name="Kuruvilla"/><ref name="Denney"/> From age 30 to 50, up to 4 times as many women experience migraine attacks as men.<ref name=Ferrari2022/> Estrogen levels may impact migraine mechanisms of action through neurotransmitters, ion levels, and blood flow.<ref name="Allais">{{cite journal |last1=Allais |first1=G |last2=Chiarle |first2=G |last3=Sinigaglia |first3=S |last4=Airola |first4=G |last5=Schiapparelli |first5=P |last6=Benedetto |first6=C |title=Gender-related differences in migraine |journal=Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology |date=December 2020 |volume=41 |issue=Suppl 2 |pages=429–436 |doi=10.1007/s10072-020-04643-8 |pmid=32845494 |pmc=7704513 }}</ref><ref name="Kuruvilla">{{cite journal |last1=Kuruvilla |first1=DE |last2=Hutchinson |first2=S |last3=Moriarty |first3=M |last4=Abbott |first4=C |last5=Brown |first5=A |last6=Leroue |first6=C |last7=Sheikh |first7=H |title=Understanding migraine throughout a woman's life and the role of calcitonin gene-related peptide: A narrative review |journal=Women's Health (London, England) |date=January 2025 |volume=21 |article-number=17455057251376878 |doi=10.1177/17455057251376878 |pmid=41109841 |pmc=12547133 }}</ref><ref name="Denney">{{cite journal |last1=Denney |first1=Delora E. |last2=Hendry |first2=Matthew |last3=Pahlevan |first3=Nader |last4=Ayaz |first4=Ahmed |last5=Denney |first5=Delora Ann |title=Migraine Throughout a Woman's Life: A Guide to Management |journal=Journal of the Mississippi State Medical Association |date=16 May 2024 |volume=65 |issue=5/6 |url=https://jmsma.scholasticahq.com/article/117919-migraine-throughout-a-woman-s-life-a-guide-to-management |language=en}}</ref>

== Signs and symptoms ==
Migraine typically presents with self-limited, recurrent severe headaches associated with [[Autonomic nervous system|autonomic]] symptoms.<ref name="Bart10">{{cite journal |vauthors=Bartleson JD, Cutrer FM |date=May 2010 |title=Migraine update. Diagnosis and treatment |journal=Minnesota Medicine |volume=93 |issue=5 |pages=36–41 |pmid=20572569}}</ref><ref name="Prognosis2008">{{cite journal|vauthors=Bigal ME, Lipton RB|date=June 2008|title=The prognosis of migraine|journal=Current Opinion in Neurology|volume=21|issue=3|pages=301–8|doi=10.1097/WCO.0b013e328300c6f5|pmid=18451714|s2cid=34805084}}</ref> About 15–30% of people living with migraine experience episodes with [[aura (symptom)|aura]],<ref name=Gilmore2011/><ref>{{cite book| vauthors = Gutman SA |title=Quick reference neuroscience for rehabilitation professionals: the essential neurologic principles underlying rehabilitation practice|year=2008|publisher=SLACK|location=Thorofare, NJ|isbn=978-1-55642-800-5|page=231|url=https://books.google.com/books?id=Ea0czzNxpkQC&pg=PA231|edition=2nd |url-status=live|archive-url=https://web.archive.org/web/20170312220316/https://books.google.com/books?id=Ea0czzNxpkQC&pg=PA231|archive-date=12 March 2017}}</ref> and they also frequently experience episodes without aura.<ref name = "Olesen_2006" /> The severity of the pain, duration of the headache, and frequency of attacks are variable.<ref name=Bart10/> A migraine attack lasting longer than 72 hours is termed status migrainosus.<ref>{{cite book| vauthors = Tfelt-Hansen P, Young WB, Silberstein | chapter = Antiemetic, Prokinetic, Neuroleptic and Miscellaneous Drugs in the Acute Treatment of Migraine | veditors = Olesen J |title=The Headaches |year=2006 |publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|page=512| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA512|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20161222063613/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA512|archive-date=22 December 2016}}</ref> There are four possible phases to a migraine attack, although not all the phases are necessarily experienced:<ref name="ICHD2004">{{cite journal |vauthors=((Headache Classification Subcommittee of the International Headache Society)) |year=2013 |title=The International Classification of Headache Disorders: 3rd edition |journal=Cephalalgia |volume=33 |issue=9 |pages=644–648 |doi=10.1177/0333102413485658 |pmid= 23771276|doi-access=free |title-link=doi}}</ref>
* The premonitory phase or [[prodrome]], which occurs hours or days before the headache
* The aura, which immediately precedes the headache
* The [[pain]] phase, also known as the headache phase
* The [[postdrome]], the effects experienced following the end of a migraine attack

Migraine is associated with [[major depression]], [[bipolar disorder]], [[anxiety disorder]]s, and [[obsessive–compulsive disorder]]. These psychiatric disorders are approximately 2–5 times more common in people without aura, and 3–10 times more common in people with aura.<ref name=Baskin06>{{cite journal | vauthors = Baskin SM, Lipchik GL, Smitherman TA | title = Mood and anxiety disorders in chronic headache | journal = Headache | volume = 46 | issue = Suppl 3 | pages = S76-87 | date = October 2006 | pmid = 17034402 | doi = 10.1111/j.1526-4610.2006.00559.x | s2cid = 35451906 | doi-access = free | title-link = doi }}</ref>

=== Prodrome phase ===
[[Prodromal]] or premonitory symptoms occur in about 60% of those with migraine,<ref name="Amin2009">{{cite book |title=Clinical neurology |vauthors=Simon RP, Aminoff MJ, Greenberg DA |publisher=Lange Medical Books/McGraw-Hill |year=2009 |isbn=978-0-07-166433-2 |edition=7 |location=New York, N.Y |pages=85–88}}</ref><ref name=Five2004>{{cite book| vauthors = Lynn DJ, Newton HB, Rae-Grant A |title=The 5-minute neurology consult|year=2004|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-683-30723-8|page=26|url=https://books.google.com/books?id=Atuv8-rVXRoC&pg=PA26|url-status=live|archive-url=https://web.archive.org/web/20170313021724/https://books.google.com/books?id=Atuv8-rVXRoC&pg=PA26|archive-date=13 March 2017}}</ref> with an onset that can range from two hours to two days before the start of pain or the aura.<ref name=Buzzi2005>{{cite journal | vauthors = Buzzi MG, Cologno D, Formisano R, Rossi P | title = Prodromes and the early phase of the migraine attack: therapeutic relevance | journal = Functional Neurology | volume = 20 | issue = 4 | pages = 179–83 | date = October–December 2005 | pmid = 16483458 }}</ref> These symptoms may include a wide variety of phenomena,<ref>{{cite journal | vauthors = Rossi P, Ambrosini A, Buzzi MG | title = Prodromes and predictors of migraine attack | journal = Functional Neurology | volume = 20 | issue = 4 | pages = 185–91 | date = October–December 2005 | pmid = 16483459 }}</ref> including altered mood, irritability, [[Depression (mood)|depression]] or [[euphoria (emotion)|euphoria]], [[fatigue (physical)|fatigue]], craving for certain food(s), difficulty speaking or reading, yawning, stiff muscles (especially in the neck), constipation or [[diarrhea]], and sensitivity to smells or noise.<ref name=Five2004/><ref>{{cite web |url=https://americanmigrainefoundation.org/resource-library/migraine-prodrome-symptoms-prevention/ |title=MIGRAINE PRODROME: SYMPTOMS AND PREVENTION |date=17 March 2022 |publisher=American Migraine Foundation}}</ref> This may occur in those with either migraine with aura or migraine without aura.<ref name=Sam2009>{{cite book| vauthors = Ropper AH, Adams RD, Victor M, Samuels MA |title=Adams and Victor's principles of neurology|year=2009|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-149992-7|pages=Chapter 10|edition=9}}</ref> Neuroimaging indicates the [[limbic system]] and [[hypothalamus]] as the origin of prodromal symptoms in migraine.<ref>{{cite journal | vauthors = May A, Burstein R | title = Hypothalamic regulation of headache and migraine | journal = Cephalalgia | volume = 39 | issue = 13 | pages = 1710–1719 | date = November 2019 | pmid = 31466456 | pmc = 7164212 | doi = 10.1177/0333102419867280 }}</ref>

=== Aura phase ===
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|-
|[[Image:Fortifikation (Migräne).jpg|150px|Enhancements reminiscent of a zigzag fort structure]]||[[File:Negatives Skotom (Brandenburger Tor Blaue Stunde) 1.jpg|150px|Negative scotoma, loss of awareness of local structures]]
|-
|[[File:Positives Skotom (Brandenburger Tor Blaue Stunde) 1.jpg|150px|Positive scotoma, local perception of additional structures]]||[[File:Gesichtsfeldausfall (Brandenburger Tor Blaue Stunde) 1.jpg|150px|Mostly one-sided loss of perception]]
|}

[[aura (symptom)|Aura]] is a transient focal neurological phenomenon that occurs before or during the headache.<ref name=Amin2009/> Aura appears gradually over a number of minutes (usually occurring over 5–60 minutes) and generally lasts less than 60&nbsp;minutes.<ref name=Tint2010/><ref name="Ashina">{{cite journal | vauthors = Ashina M | title = Migraine | journal = The New England Journal of Medicine | volume = 383 | issue = 19 | pages = 1866–1876 | date = November 2020 | pmid = 33211930 | doi = 10.1056/NEJMra1915327 | s2cid = 227078662 }}</ref> Symptoms can be visual, sensory or motoric in nature, and many people experience more than one.<ref name = "Cutrer_2006" /> Visual effects occur most frequently: they occur in up to 99% of cases, and in more than 50% of cases are not accompanied by sensory or motor effects.<ref name = "Cutrer_2006" /> If any symptom remains after 60 minutes, the state is known as [[Persistent aura without infarction|persistent aura]].<ref>{{cite journal | vauthors = Viana M, Sances G, Linde M, Nappi G, Khaliq F, Goadsby PJ, Tassorelli C | title = Prolonged migraine aura: new insights from a prospective diary-aided study | journal = The Journal of Headache and Pain | volume = 19 | issue = 1 | article-number = 77 | date = August 2018 | pmid = 30171359 | pmc = 6119171 | doi = 10.1186/s10194-018-0910-y | doi-access = free | title-link = doi }}</ref>

Visual disturbances often consist of a [[scintillating scotoma]] (an area of partial alteration in the [[field of vision]], which flickers and may interfere with a person's ability to read or drive).<ref name=Amin2009/> These typically start near the center of vision and then spread out to the sides with zigzagging lines, which have been described as looking like fortifications or walls of a castle.<ref name = "Cutrer_2006" /> Usually, the lines are in black and white, but some people also see colored lines.<ref name = "Cutrer_2006" /> Some people lose part of their field of vision known as [[hemianopsia]] while others experience blurring.<ref name = "Cutrer_2006" />

Sensory auras are the second most common type; they occur in 30–40% of people with auras.<ref name = "Cutrer_2006" /> Often, a feeling of pins-and-needles begins on one side in the hand and arm and spreads to the nose–mouth area on the same side.<ref name = "Cutrer_2006" /> Numbness usually occurs after the tingling has passed with a loss of [[proprioceptive|position sense]].<ref name = "Cutrer_2006" /> Other symptoms of the aura phase can include speech or language disturbances, [[vertigo|world spinning]], and, less commonly, motor problems.<ref name = "Cutrer_2006" /> Motor symptoms indicate that this is a [[hemiplegic migraine]], and weakness often lasts longer than one hour unlike other auras.<ref name = "Cutrer_2006" /> [[Auditory hallucination]]s or [[delusion]]s have also been described.<ref>{{cite book|vauthors = Slap, GB|title=Adolescent medicine|date=2008|publisher=Mosby/Elsevier|location=Philadelphia, PA|isbn=978-0-323-04073-0|page=105|url=https://books.google.com/books?id=s4UGU7SQTQgC&pg=PA105|url-status=live|archive-url=https://web.archive.org/web/20170313025509/https://books.google.com/books?id=s4UGU7SQTQgC&pg=PA105|archive-date=13 March 2017}}</ref>

=== Pain phase ===
Classically the headache is unilateral, throbbing, and moderate to severe in intensity.<ref name=Tint2010>{{cite book | vauthors = Tintinalli JE |title=Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) |publisher=McGraw-Hill Companies |location=New York |year=2010 |pages=1116–1117 |isbn=978-0-07-148480-0 }}</ref> It usually comes on gradually<ref name=Tint2010/> and is aggravated by physical activity during a migraine attack.<ref name=ICHD2004/> However, the effects of physical activity on migraine are complex, and some researchers have concluded that, while exercise can trigger migraine attacks, regular exercise may have a [[prophylactic]] effect and decrease frequency of attacks.<ref name="Barber"/><ref name="The association between migraine an">{{cite journal |vauthors=Amin FM, Aristeidou S, Baraldi C, Czapinska-Ciepiela EK, Ariadni DD, Di Lenola D, Fenech C, Kampouris K, Karagiorgis G, Braschinsky M, Linde M |date=September 2018 |title=The association between migraine and physical exercise |journal=The Journal of Headache and Pain |volume=19 |issue=1 |article-number=83 |doi=10.1186/s10194-018-0902-y |pmc=6134860 |pmid=30203180 |doi-access=free }}</ref> The feeling of pulsating pain is not in phase with the [[pulse]].<ref name="pathos">{{cite journal | vauthors = Qubty W, Patniyot I | title = Migraine Pathophysiology | journal = Pediatric Neurology | volume = 107 | pages = 1–6 | date = June 2020 | pmid = 32192818 | doi = 10.1016/j.pediatrneurol.2019.12.014 | s2cid = 213191464 }}</ref> In more than 40% of cases, however, the pain may be bilateral (both sides of the head), and neck pain is commonly associated with it.<ref>{{cite book| vauthors = Tepper SJ, Tepper DE |title=The Cleveland Clinic manual of headache therapy|publisher=Springer|location=New York|isbn=978-1-4614-0178-0|page=6|url=https://books.google.com/books?id=uaG08nAKG_wC&pg=PA6|date=1 January 2011|url-status=live|archive-url=https://web.archive.org/web/20161222073613/https://books.google.com/books?id=uaG08nAKG_wC&pg=PA6|archive-date=22 December 2016}}</ref> Bilateral pain is particularly common in those who have migraine without aura.<ref name=Amin2009/> Less commonly pain may occur primarily in the back or top of the head.<ref name=Amin2009/> The pain usually lasts 4 to 72 hours in adults;<ref name=Tint2010/> however, in young children frequently lasts less than 1&nbsp;hour.<ref name=Bigal2010>{{cite journal | vauthors = Bigal ME, Arruda MA | title = Migraine in the pediatric population--evolving concepts | journal = Headache | volume = 50 | issue = 7 | pages = 1130–43 | date = July 2010 | pmid = 20572878 | doi = 10.1111/j.1526-4610.2010.01717.x | s2cid = 23256755 }}</ref> The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month.<ref name = "Rasmussen_2006">{{cite book| vauthors = Rasmussen BK | chapter = Epidemiology of Migraine | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=238–240| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|archive-date=13 March 2017}}</ref><ref>{{cite book| vauthors = Dalessio DJ |veditors = Silberstein SD, Lipton RB, Dalessio DJ|title=Wolff's headache and other head pain|year=2001|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-513518-3|page=122|url=https://books.google.com/books?id=aJRV199FZcoC&pg=PA122|edition=7}}</ref>

The pain is frequently accompanied by nausea, vomiting, [[photophobia|sensitivity to light]], [[Hyperacusis|sensitivity to sound]], [[osmophobia|sensitivity to smells]], fatigue, and irritability.<ref name=Amin2009/> Many thus seek a dark and quiet room.<ref name=Walton2009/> In a [[basilar artery|basilar migraine]], a migraine with neurological symptoms related to the [[brain stem]] or with neurological symptoms on both sides of the body,<ref name=Basil2009>{{cite journal | vauthors = Kaniecki RG | title = Basilar-type migraine | journal = Current Pain and Headache Reports | volume = 13 | issue = 3 | pages = 217–20 | date = June 2009 | pmid = 19457282 | doi = 10.1007/s11916-009-0036-7 | s2cid = 22242504 }}</ref> common effects include [[vertigo (medical)|a sense of the world spinning]], light-headedness, and confusion.<ref name=Amin2009/> [[Nausea]] occurs in almost 90% of people, and vomiting occurs in about one-third.<ref name=Walton2009>{{cite book| vauthors = Lisak RP, Truong DD, Carroll W, Bhidayasiri R |title=International neurology: a clinical approach|year=2009|publisher=Wiley-Blackwell|location=Chichester, UK|isbn=978-1-4051-5738-4|page=670|url=https://books.google.com/books?id=L6_L75yvaPQC&pg=PA670}}</ref> Other symptoms may include [[blurred vision]], nasal stuffiness, diarrhea, frequent urination, [[pallor]], or sweating.<ref name=Joel1999>{{cite book| vauthors = Glaser JS |title=Neuro-ophthalmology|year=1999|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-1729-8|page=555|url=https://books.google.com/books?id=eVU2CODGj98C&pg=PA555|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073802/https://books.google.com/books?id=eVU2CODGj98C&pg=PA555|archive-date=13 March 2017}}</ref> Swelling or tenderness of the scalp may occur as can neck stiffness.<ref name=Joel1999/> Associated symptoms are less common in the elderly.<ref name=ElderlyBook2008/>

==== Silent migraine ====
Sometimes, aura occurs without a subsequent headache.<ref name = "Cutrer_2006">{{cite book | vauthors = Cutrer FM, Olesen J | chapter = Migraines with Aura and Their Subforms | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=238–240| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238 |edition=3rd |url-status=live |archive-url= https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=238|archive-date=13 March 2017 }}</ref> This is known in modern classification as a [[acephalgic migraine|typical aura without headache]], or acephalgic migraine in previous classification, or commonly as a silent migraine.<ref name="americanmigrainefoundation.org-Robblee-2019-Silent-Guide">{{cite web |vauthors=Robblee J |title=Silent Migraine: A Guide |url=https://americanmigrainefoundation.org/resource-library/silent-migraine/ |website=American Migraine Foundation |access-date=22 January 2021 |date=21 August 2019 |archive-date=28 January 2021 |archive-url=https://web.archive.org/web/20210128132026/https://americanmigrainefoundation.org/resource-library/silent-migraine/ |url-status=live }}</ref><ref name="jmedicalcaserep-Yusheng-2015-aura-w/o-headache">{{cite journal | vauthors = He Y, Li Y, Nie Z | title = Typical aura without headache: a case report and review of the literature | journal = Journal of Medical Case Reports | volume = 9 | issue = 1 | article-number = 40 | date = February 2015 | pmid = 25884682 | pmc = 4344793 | doi = 10.1186/s13256-014-0510-7 | doi-access = free | title-link = doi }}</ref> However, silent migraine can still produce debilitating symptoms, with visual disturbance, vision loss in half of both eyes, alterations in color perception, and other sensory problems, like sensitivity to light, sound, and odors.<ref name="medicalnewstoday-Leonard-2018-Silent-migraine">{{cite web |vauthors=Leonard J |veditors=Han S |title=Silent migraine: Symptoms, causes, treatment, prevention |url=https://www.medicalnewstoday.com/articles/323011 |work=Medical News Today |access-date=22 January 2021 |date=7 September 2018 |archive-date=19 January 2021 |archive-url=https://web.archive.org/web/20210119184614/https://www.medicalnewstoday.com/articles/323011 |url-status=live }}</ref>

=== Postdrome ===
The migraine postdrome is the constellation of symptoms occurring once the acute headache has ceased.<ref>{{cite journal | vauthors = Bose P, Goadsby PJ | title = The migraine postdrome | journal = Current Opinion in Neurology | volume = 29 | issue = 3 | pages = 299–301 | date = June 2016 | pmid = 26886356 | doi = 10.1097/WCO.0000000000000310 | s2cid = 22445093 }}</ref> A study found reports of a sore feeling in the same area as the migraine;<ref name="pmid16426278" /> reports of impaired thinking for a few days after the headache passed;<ref name="pmid16426278" /> reports of tiredness, feeling "hungover", head pain, cognitive difficulties, gastrointestinal symptoms, weakness,<ref name="pmid16426278">{{cite journal | vauthors = Kelman L | title = The postdrome of the acute migraine attack | journal = Cephalalgia | volume = 26 | issue = 2 | pages = 214–20 | date = February 2006 | pmid = 16426278 | doi = 10.1111/j.1468-2982.2005.01026.x | s2cid = 21519111 }}</ref> body aches, and nausea.<ref name="Cleveland">{{cite web |url=https://my.clevelandclinic.org/health/diseases/migraine-hangover-postdrome |title=Migraine Hangover (Postdrome)}}</ref><ref>{{cite web | last1=Ruschel | first1=Marco A. Pescador | last2=Jesus | first2=Orlando De | title=Migraine Headache | publisher=StatPearls Publishing | date=5 July 2024 | pmid=32809622 | url=https://www.ncbi.nlm.nih.gov/books/NBK560787/ | access-date=8 November 2025}}</ref>

== Cause ==
Migraine is believed to result from a mix of genetic, environmental, and neurological factors.<ref name="Bentivegna"/> Migraine runs in families in about two-thirds of cases<ref name=Bart10/> but this rarely reflects a single gene defect.<ref name="Schurk2012"/> Rather, a variety of genetic factors may relate to neuronal, vascular and other systems, and create genetic susceptibility. Migraine has high comorbidity with  [[major depressive disorder|depression]], [[anxiety disorder|anxiety]], and [[bipolar disorder]], which often have a bidirectional relationship (either one can worsen the other). It is likely that shared genetic and neurobiological mechanisms contribute to risk factors that underlie multiple conditions.<ref>{{cite journal |last1=Duan |first1=S |last2=Ren |first2=Z |last3=Xia |first3=H |last4=Wang |first4=Z |last5=Zheng |first5=T |last6=Li |first6=G |last7=Liu |first7=L |last8=Liu |first8=Z |title=Associations between anxiety, depression with migraine, and migraine-related burdens. |journal=Frontiers in Neurology |date=2023 |volume=14 |article-number=1090878 |doi=10.3389/fneur.2023.1090878 |doi-access=free |pmid=37181566 |pmc=10166814 }}</ref><ref>{{cite journal |last1=Grangeon |first1=L |last2=Lange |first2=KS |last3=Waliszewska-Prosół |first3=M |last4=Onan |first4=D |last5=Marschollek |first5=K |last6=Wiels |first6=W |last7=Mikulenka |first7=P |last8=Farham |first8=F |last9=Gollion |first9=C |last10=Ducros |first10=A |last11=European Headache Federation School of Advanced Studies |first11=(EHF-SAS) |title=Genetics of migraine: where are we now? |journal=The Journal of Headache and Pain |date=20 February 2023 |volume=24 |issue=1 |page=12 |doi=10.1186/s10194-023-01547-8 |doi-access=free |pmid=36800925 |pmc=9940421 }}</ref>

[[File:Gray786.png|thumb|Intracranial [https://www.ncbi.nlm.nih.gov/books/NBK459244/ cavernous sinus]: a potential site where dilation of cerebral vessels can compress multiple cranial nerves.]]

Success of the surgical migraine treatment by [[Nerve decompression|decompression]] of extracranial sensory nerves adjacent to vessels<ref>{{cite journal | vauthors = Bink T, Duraku LS, Ter Louw RP, Zuidam JM, Mathijssen IM, Driessen C | title = The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache | journal = Plastic and Reconstructive Surgery | volume = 144 | issue = 6 | pages = 1431–1448 | date = December 2019 | pmid = 31764666 | doi = 10.1097/PRS.0000000000006270 | s2cid = 208273535 }}</ref> suggests that some people with migraine may have an anatomical predisposition for neurovascular compression<ref>{{cite journal | vauthors = Szmyd B, Sołek J, Błaszczyk M, Jankowski J, Liberski PP, Jaskólski DJ, Wysiadecki G, Karuga FF, Gabryelska A, Sochal M, Tubbs RS, Radek M | title = The Underlying Pathogenesis of Neurovascular Compression Syndromes: A Systematic Review | journal = Frontiers in Molecular Neuroscience | volume = 15 | article-number = 923089 | date = 4 July 2022 | pmid = 35860499 | pmc = 9289473 | doi = 10.3389/fnmol.2022.923089 | doi-access = free }}</ref> that may be caused by both intracranial and extracranial vasodilation due to migraine triggers.<ref>{{cite journal | vauthors = Macionis V | title = Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review | journal = Current Pain and Headache Reports | volume = 27 | issue = 11 | pages = 775–791 | date = November 2023 | pmid = 37837483 | doi = 10.1007/s11916-023-01174-7 }}</ref> This, along with the existence of numerous cranial neural interconnections,<ref>{{cite journal | vauthors = Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M | title = Electrical stimulation of cranial nerves in cognition and disease | journal = Brain Stimulation | volume = 13 | issue = 3 | pages = 717–750 | date = May 2020 | pmid = 32289703 | pmc = 7196013 | doi = 10.1016/j.brs.2020.02.019 }}</ref> may explain the multiple cranial nerve involvement and consequent diversity of migraine symptoms.<ref name=":7">{{cite journal | vauthors = Villar-Martinez MD, Goadsby PJ | title = Pathophysiology and Therapy of Associated Features of Migraine | journal = Cells | volume = 11 | issue = 17 | page = 2767 | date = September 2022 | pmid = 36078174 | pmc = 9455236 | doi = 10.3390/cells11172767 | doi-access = free }}</ref>

=== Genetics ===
{{Main|Genetics of migraine}}

Studies of twins indicate a 34–51% genetic influence on the likelihood of developing migraine.<ref name=Lulli2007>{{cite journal | vauthors = Piane M, Lulli P, Farinelli I, Simeoni S, De Filippis S, Patacchioli FR, Martelletti P | title = Genetics of migraine and pharmacogenomics: some considerations | journal = The Journal of Headache and Pain | volume = 8 | issue = 6 | pages = 334–339 | date = December 2007 | pmid = 18058067 | pmc = 2779399 | doi = 10.1007/s10194-007-0427-2 }}</ref> This genetic relationship is stronger for migraine with aura than for migraine without aura.<ref name="Olesen_2006" /> It is clear from family and populations studies that migraine is a complex disorder, where numerous [[single-nucleotide polymorphism|genetic risk variants]] exist, and where each variant increases the risk of migraine marginally.<ref>{{cite journal | vauthors = Gormley P, Kurki MI, Hiekkala ME, Veerapen K, Häppölä P, Mitchell AA, Lal D, Palta P, Surakka I, Kaunisto MA, Hämäläinen E, Vepsäläinen S, Havanka H, Harno H, Ilmavirta M, Nissilä M, Säkö E, Sumelahti ML, Liukkonen J, Sillanpää M, Metsähonkala L, Koskinen S, Lehtimäki T, Raitakari O, Männikkö M, Ran C, Belin AC, Jousilahti P, Anttila V, Salomaa V, Artto V, Färkkilä M, Runz H, Daly MJ, Neale BM, Ripatti S, Kallela M, Wessman M, Palotie A | title = Common Variant Burden Contributes to the Familial Aggregation of Migraine in 1,589 Families | journal = Neuron | volume = 98 | issue = 4 | pages = 743–753.e4 | date = May 2018 | pmid = 29731251 | pmc = 5967411 | doi = 10.1016/j.neuron.2018.04.014 }}</ref><ref>{{cite journal | vauthors = Harder AV, Terwindt GM, Nyholt DR, van den Maagdenberg AM | title = Migraine genetics: Status and road forward | journal = Cephalalgia | volume = 43 | issue = 2 | page = 3331024221145962 | date = February 2023 | article-number = 03331024221145962 | pmid = 36759319 | doi = 10.1177/03331024221145962 | doi-access = free }}</ref> It is also known that having several of these risk variants increases the risk by a small to moderate amount.<ref name="Schurk2012" />

[[Single gene disorder]]s that result in migraine are rare.<ref name=Schurk2012>{{cite journal | vauthors = Schürks M | title = Genetics of migraine in the age of genome-wide association studies | journal = The Journal of Headache and Pain | volume = 13 | issue = 1 | pages = 1–9 | date = January 2012 | pmid = 22072275 | pmc = 3253157 | doi = 10.1007/s10194-011-0399-0 }}</ref> One of these is known as [[familial hemiplegic migraine]], a type of migraine with aura, which is inherited in an [[autosomal dominant]] fashion.<ref>{{cite journal | vauthors = de Vries B, Frants RR, Ferrari MD, van den Maagdenberg AM | title = Molecular genetics of migraine | journal = Human Genetics | volume = 126 | issue = 1 | pages = 115–32 | date = July 2009 | pmid = 19455354 | doi = 10.1007/s00439-009-0684-z | s2cid = 20119237 }}</ref><ref>{{cite journal | vauthors = Montagna P | title = Migraine genetics | journal = Expert Review of Neurotherapeutics | volume = 8 | issue = 9 | pages = 1321–30 | date = September 2008 | pmid = 18759544 | doi = 10.1586/14737175.8.9.1321 | s2cid = 207195127 }}</ref> Four genes have been shown to be involved in familial hemiplegic migraine.<ref name=Ducros2013>{{cite journal | vauthors = Ducros A | title = [Genetics of migraine] | journal = Revue Neurologique | volume = 169 | issue = 5 | pages = 360–71 | date = May 2013 | pmid = 23618705 | doi = 10.1016/j.neurol.2012.11.010 }}</ref> Three of these genes are involved in [[ion transport]].<ref name=Ducros2013/> The fourth is the [[axon]]al protein [[PRRT2]], associated with the [[exocytosis]] complex.<ref name=Ducros2013/> Another genetic disorder associated with migraine is [[CADASIL syndrome]] or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.<ref name=Amin2009/> One meta-analysis found a protective effect from [[angiotensin converting enzyme]] polymorphisms on migraine.<ref>{{cite journal | vauthors = Wan D, Wang C, Zhang X, Tang W, Chen M, Dong Z, Yu S | title = Association between angiotensin-converting enzyme insertion/deletion polymorphism and migraine: a meta-analysis | journal = The International Journal of Neuroscience | volume = 126 | issue = 5 | pages = 393–9 | date =January 2016 | pmid = 26000817 | doi = 10.3109/00207454.2015.1025395 | s2cid = 34902092 }}</ref> The ''[[TRPM8]]'' gene, which codes for a [[Ion channel|cation channel]], has been linked to migraine.<ref>{{cite journal | vauthors = Dussor G, Cao YQ | title = TRPM8 and Migraine | journal = Headache | volume = 56 | issue = 9 | pages = 1406–1417 | date = October 2016 | pmid = 27634619 | pmc = 5335856 | doi = 10.1111/head.12948 }}</ref>

The common forms of migraine are [[Polygenic trait|polygenetic]], where common variants of numerous genes contribute to the predisposition for migraine. These genes can be placed in three categories, increasing the risk of migraine in general, specifically migraine with aura, or migraine without aura.<ref>{{cite journal | vauthors = Bjornsdottir G, Chalmer MA, Stefansdottir L, Skuladottir AT, Einarsson G, Andresdottir M, Beyter D, Ferkingstad E, Gretarsdottir S, Halldorsson BV, Halldorsson GH, Helgadottir A, Helgason H, Hjorleifsson Eldjarn G, Jonasdottir A, Jonasdottir A, Jonsdottir I, Knowlton KU, Nadauld LD, Lund SH, Magnusson OT, Melsted P, Moore KH, Oddsson A, Olason PI, Sigurdsson A, Stefansson OA, Saemundsdottir J, Sveinbjornsson G, Tragante V, Unnsteinsdottir U, Walters GB, Zink F, Rødevand L, Andreassen OA, Igland J, Lie RT, Haavik J, Banasik K, Brunak S, Didriksen M, T Bruun M, Erikstrup C, Kogelman LJ, Nielsen KR, Sørensen E, Pedersen OB, Ullum H, Masson G, Thorsteinsdottir U, Olesen J, Ludvigsson P, Thorarensen O, Bjornsdottir A, Sigurdardottir GR, Sveinsson OA, Ostrowski SR, Holm H, Gudbjartsson DF, Thorleifsson G, Sulem P, Stefansson H, Thorgeirsson TE, Hansen TF, Stefansson K | title = Rare variants with large effects provide functional insights into the pathology of migraine subtypes, with and without aura | journal = Nature Genetics | volume = 55 | issue = 11 | pages = 1843–1853 | date = November 2023 | pmid = 37884687 | pmc = 10632135 | doi = 10.1038/s41588-023-01538-0 }}</ref><ref>{{cite journal | vauthors = Hautakangas H, Winsvold BS, Ruotsalainen SE, Bjornsdottir G, Harder AV, Kogelman LJ, Thomas LF, Noordam R, Benner C, Gormley P, Artto V, Banasik K, Bjornsdottir A, Boomsma DI, Brumpton BM, Burgdorf KS, Buring JE, Chalmer MA, de Boer I, Dichgans M, Erikstrup C, Färkkilä M, Garbrielsen ME, Ghanbari M, Hagen K, Häppölä P, Hottenga JJ, Hrafnsdottir MG, Hveem K, Johnsen MB, Kähönen M, Kristoffersen ES, Kurth T, Lehtimäki T, Lighart L, Magnusson SH, Malik R, Pedersen OB, Pelzer N, Penninx BW, Ran C, Ridker PM, Rosendaal FR, Sigurdardottir GR, Skogholt AH, Sveinsson OA, Thorgeirsson TE, Ullum H, Vijfhuizen LS, Widén E, van Dijk KW, Aromaa A, Belin AC, Freilinger T, Ikram MA, Järvelin MR, Raitakari OT, Terwindt GM, Kallela M, Wessman M, Olesen J, Chasman DI, Nyholt DR, Stefánsson H, Stefansson K, van den Maagdenberg AM, Hansen TF, Ripatti S, Zwart JA, Palotie A, Pirinen M | title = Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles | journal = Nature Genetics | volume = 54 | issue = 2 | pages = 152–160 | date = February 2022 | pmid = 35115687 | doi = 10.1038/s41588-021-00990-0 | pmc = 8837554 }}</ref> Three of these genes, ''[[CALCA]]'', ''[[CALCB]]'', and ''[[HTR1F]]'' are already target for migraine specific treatments. Five genes are specific risk to migraine with aura, ''[[PALM|PALMD]]'', ''[[ABO blood group system|ABO]]'', ''[[LRRK2]], [[CACNA1A]]'' and ''PRRT2'', and 13 genes are specific to migraine without aura. Using the accumulated genetic risk of the common variations, into a so-called [[Polygenic score|polygenetic risk]], it is possible to assess e.g. the treatment response to triptans.<ref>{{Cite journal | vauthors = Mikol DD, Picard H, Klatt J, Wang A, Peng C, Stefansson K |date=April 2020 |title=Migraine Polygenic Risk Score Is Associated with Severity of Migraine – Analysis of Genotypic Data from Four Placebo-controlled Trials of Erenumab (1214) |journal=Neurology |volume=94 |issue=15_supplement |article-number=1214 |doi=10.1212/WNL.94.15_supplement.1214 }}</ref><ref>{{cite journal | vauthors = Kogelman LJ, Esserlind AL, Francke Christensen A, Awasthi S, Ripke S, Ingason A, Davidsson OB, Erikstrup C, Hjalgrim H, Ullum H, Olesen J, Folkmann Hansen T | title = Migraine polygenic risk score associates with efficacy of migraine-specific drugs | journal = Neurology. Genetics | volume = 5 | issue = 6 | article-number = e364 | date = December 2019 | pmid = 31872049 | pmc = 6878840 | doi = 10.1212/NXG.0000000000000364 }}</ref>

=== Triggers ===
Categories of hypothesized migraine triggers include emotion, nutrition, sleep disturbance, hormones, weather, sensory overstimulation and strenuous exercise.<ref>{{Cite web |date=2024-06-28 |title=Migraine Triggers: Avoid or Cope? |url=https://migrainecanada.org/migraine-triggers-avoid-or-cope/ |access-date=2025-11-11 |website=Migraine Canada |language=en-US}}</ref>  A migraine trigger reduces the threshold at which a migraine attack occurs in someone who is predisposed to migraine. Migraine triggers may be classified as internal, modifying the body's homeostasis (e.g. hormonal variability, stress, sleep disturbance, fasting) or external, originating outside the body and influencing the perception of sensory signals (e.g. temperature fluctuations, noises, and odors). In some cases, factors reported as triggers (e.g. sensory sensitivities, food cravings and mood change) may be more appropriately considered as premonitory symptoms resulting from changes in brain activity during the prodromal phase of migraine.<ref name="Sebastianelli">{{cite journal |last1=Sebastianelli |first1=G |last2=Atalar |first2=AÇ |last3=Cetta |first3=I |last4=Farham |first4=F |last5=Fitzek |first5=M |last6=Karatas-Kursun |first6=H |last7=Kholodova |first7=M |last8=Kukumägi |first8=KH |last9=Montisano |first9=DA |last10=Onan |first10=D |last11=Pantovic |first11=A |last12=Skarlet |first12=J |last13=Sotnikov |first13=D |last14=Caronna |first14=E |last15=Pozo-Rosich |first15=P |last16=International Headache Academy of the International Headache Society |first16=(IHS-iHEAD) |title=Insights from triggers and prodromal symptoms on how migraine attacks start: The threshold hypothesis. |journal=Cephalalgia : An International Journal of Headache |date=October 2024 |volume=44 |issue=10 |article-number=3331024241287224 |doi=10.1177/03331024241287224 |pmid=39380339}}</ref><ref name="Zobdeh" /><ref name=":6">{{cite journal |last1=Kesserwani |first1=H |title=Migraine Triggers: An Overview of the Pharmacology, Biochemistry, Atmospherics, and Their Effects on Neural Networks. |journal=Cureus |date=1 April 2021 |volume=13 |issue=4 |article-number=e14243 |doi=10.7759/cureus.14243 |doi-access=free |pmid=33954064 |pmc=8088284 }}</ref><ref>{{cite journal |last1=Karsan |first1=N |last2=Bose |first2=P |last3=Newman |first3=J |last4=Goadsby |first4=PJ |title=Are some patient-perceived migraine triggers simply early manifestations of the attack? |journal=Journal of Neurology |date=May 2021 |volume=268 |issue=5 |pages=1885–1893 |doi=10.1007/s00415-020-10344-1 |pmid=33399964 |pmc=8068686 }}</ref> Determining whether and when something acts as a true causal trigger, and when it is a symptom of already-occurring changes, is an ongoing area of study.<ref name="Sebastianelli" /> 

Studies of the brain's structure and function indicate that brain activity changes during the 48 (or even 72) hours before the pain phase of migraine.  During this initial phase of a migraine attack, people may report prodromal/premonitory symptoms (PSs) such as fatigue, yawning, difficulty concentrating, mood changes, dizziness, neck pain, light sensitivity, food cravings, and nausea. Such symptoms may continue into the pain phase and postdrome.<ref name="Sebastianelli" /> Some studies suggest that PSs may be linked to activity in particular neuroanatomical pathways and areas of the brain. Yawning, food cravings, homeostatic regulation, and sleep disturbance may be linked to activation in the hypothalamus. Other PSs, such as neck pain and nausea, may be related to activity in the brainstem.<ref name="Sebastianelli" /> The stimuli that are found disturbing vary from person to person.<ref name="Smith"/> Those experiencing PSs can sometimes correctly predict an oncoming attack.<ref name="Sebastianelli" /> 

The extent to which a possible trigger has an actual causal connection with headache onset is uncertain in most cases, and some relationships may be bidirectional.<ref name="Trigger09">{{cite journal |vauthors=Levy D, Strassman AM, Burstein R |date=June 2009 |title=A critical view on the role of migraine triggers in the genesis of migraine pain |journal=Headache |volume=49 |issue=6 |pages=953–7 |doi=10.1111/j.1526-4610.2009.01444.x |pmid=19545256 |s2cid=31707887}}</ref><ref>{{cite journal |vauthors=Martin PR |date=June 2010 |title=Behavioral management of migraine headache triggers: learning to cope with triggers |journal=Current Pain and Headache Reports |volume=14 |issue=3 |pages=221–7 |doi=10.1007/s11916-010-0112-z |pmid=20425190 |s2cid=5511782}}</ref> However, there are strong associations between migraine and hormonal changes, stress, quality of sleep, and fasting. It has been theorized that these "catalyst triggers" may act by increasing activity in the hypothalamus or trigeminal system and exceeding the brain's migraine threshold.<ref name="Sebastianelli" /> Lifestyle changes that help to maintain bodily homeostasis, such as regular sleep, managing of stress, and eating regularly, can be helpful interventions.<ref name=":1" /> Regardless of whether a possible trigger is a cause or an early symptom, it may help to manage exposure to sensory stimuli such as smells, lights, sound or touch.<ref name="Smith">{{cite web |last1=Smith |first1=Lisa |title=Osmophobia and Migraine |url=https://www.migrainedisorders.org/osmophobia/ |website=Association of Migraine Disorders |access-date=17 November 2025 |date=6 February 2025}}</ref>

==== Hormonal changes ====
From puberty onwards, women experience migraine attacks at greater rates than men. Incidence of attacks is related to hormonal changes in [[estrogen]], which varies monthly and across a woman's lifespan.<ref>{{cite journal |last1=Pavlović |first1=JM |title=The impact of midlife on migraine in women: summary of current views. |journal=Women's Midlife Health |date=2020 |volume=6 |article-number=11 |doi=10.1186/s40695-020-00059-8 |doi-access=free |pmid=33042563 |pmc=7542111 }}</ref> Migraine episodes are more likely to occur around [[menstruation]], possibly due to the drop in estrogen levels before the menstrual period.<ref name="Rad2013">{{cite journal |vauthors=Radat F |date=May 2013 |title=[Stress and migraine] |journal=Revue Neurologique |volume=169 |issue=5 |pages=406–12 |doi=10.1016/j.neurol.2012.11.008 |pmid=23608071}}</ref>  Hormonal changes may also affect incidence and occurrence of migraines in relation to [[menarche]], [[oral contraceptive]] use, [[pregnancy]], perimenopause, and [[menopause]].<ref name=Chai2014>{{cite journal | vauthors = Chai NC, Peterlin BL, Calhoun AH | title = Migraine and estrogen | journal = Current Opinion in Neurology | volume = 27 | issue = 3 | pages = 315–24 | date = June 2014 | pmid = 24792340 | pmc = 4102139 | doi = 10.1097/WCO.0000000000000091 }}</ref> Attacks may worsen during perimenopause due to fluctuating estrogen levels.<ref name="Ferrari2022" />  Migraine episodes typically do not occur during the [[second trimester|second]] and [[third trimester]]s of pregnancy, and may rapidly decline following menopause.<ref name=Amin2009/>  Women are more likely to have migraine without aura.<ref name="Rasmussen_2006" />

==== Stress ====
The headache trigger that people are most aware of is stress, ranking first in reports for men, and second to hormonal factors for women.<ref name=":6" /><ref name="Stubberud" /> Best practices for psychologically addressing stress as a possible migraine trigger include [[relaxation therapy]], [[biofeedback]], and [[cognitive behavioral therapy]] (CBT). Activities such as relaxation therapy are more likely to be effective when used as a routine part of daily life or to address incidents of stress as a risk factor, rather than during the pain phase of a migraine attack.<ref name="Sturgeon">{{cite journal |last1=Sturgeon |first1=JA |last2=Ehde |first2=DM |last3=Darnall |first3=BD |last4=Barad |first4=MJ |last5=Clauw |first5=DJ |last6=Jensen |first6=MP |title=Psychological Approaches for Migraine Management. |journal=Anesthesiology Clinics |date=June 2023 |volume=41 |issue=2 |pages=341–355 |doi=10.1016/j.anclin.2023.02.002 |pmid=37245946 |pmc=10513739 }}</ref>

==== Sleep====
Migraineurs report a variety of sleep-related issues as possible triggers. These include undersleeping, irregular sleep, frequent night-time waking, and oversleeping. Those who experience chronic migraine may be less likely to maintain consistent sleep habits than those who experience episodic migraines.<ref name="Elmazny"/> Jet-lag, shift work, and other disruptions of [[circadian rhythms]] may increase migraines.<ref name="Woldeamanuel">{{cite journal |last1=Woldeamanuel |first1=YW |last2=Rahman |first2=A |last3=Hyimanot |first3=ET |last4=Chirravuri |first4=R |last5=Fani |first5=M |last6=Javaheri |first6=ED |last7=Welch |first7=M |last8=Zhuang |first8=J |last9=Mun |first9=CJ |date=1 August 2025 |title=Disrupting the Clock: Meta-Analysis of Irregular Night Shifts and Migraine, Proposing Shift Work Migraine Disorder with Chronobiology Strategies. |journal=medRxiv : The Preprint Server for Health Sciences |doi=10.1101/2025.07.31.25332540 |pmid=40766149 |pmc=12324640 }}</ref><ref name="Stanyer">{{cite journal |last1=Stanyer |first1=EC |last2=Brookes |first2=J |last3=Pang |first3=JR |last4=Urani |first4=A |last5=Holland |first5=PR |last6=Hoffmann |first6=J |title=Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach. |journal=The Journal of Headache and Pain |date=8 September 2023 |volume=24 |issue=1 |page=123 |doi=10.1186/s10194-023-01638-6 |doi-access=free |pmid=37679693 |pmc=10486047 }}</ref><ref name="Leso">{{cite journal |last1=Leso |first1=V |last2=Gervetti |first2=P |last3=Mauro |first3=S |last4=Macrini |first4=MC |last5=Ercolano |first5=ML |last6=Iavicoli |first6=I |title=Shift work and migraine: A systematic review. |journal=Journal of Occupational Health |date=January 2020 |volume=62 |issue=1 |article-number=e12116 |doi=10.1002/1348-9585.12116 |pmid=32515906 |pmc=7154593 }}</ref>
Sleep hygiene improvements and maintaining a consistent sleep schedule are among the most frequently recommended migraine management techniques.<ref name="Robblee">{{cite journal |last1=Robblee |first1=J |last2=Starling |first2=AJ |title=SEEDS for success: Lifestyle management in migraine. |journal=Cleveland Clinic Journal of Medicine |date=November 2019 |volume=86 |issue=11 |pages=741–749 |doi=10.3949/ccjm.86a.19009 |pmid=31710587}}</ref>
<ref name=":2" /><ref name=":4" /><ref name=":5" />

==== Diet ====
[[Fasting]] or missed meals are a commonly perceived trigger for migraines, and dietary modifications are a frequent management technique.<ref name="Elmazny"/>  Missing meals like breakfast can reduce brain glucose levels, leading to [[hypoglycemia]] and triggering the release of stress hormones like [[cortisol]] and [[adrenaline]], which can affect migraines.  Irregular meals are particularly strong predictors of attacks for those experiencing chronic migraines. Eating balanced meals at consistent times and hydrating well can help to prevent migraines and lessen migraine symptoms.<ref name="Legesse">{{cite journal |last1=Legesse |first1=SM |last2=Addila |first2=AE |last3=Jena |first3=BH |last4=Jikamo |first4=B |last5=Abdissa |first5=ZD |last6=Hailemarim |first6=T |title=Irregular meal and migraine headache: a scoping review. |journal=BMC Nutrition |date=26 March 2025 |volume=11 |issue=1 |pages=60 |doi=10.1186/s40795-025-01048-8 |doi-access=free |pmid=40140884 |pmc=11938733 }}</ref>

A wide variety of specific foods and drinks have been reported as possible triggers, including alcohol, coffee, chocolate, cheese, nuts, citrus fruits, fatty foods, processed meats, monosodium glutamate, and [[aspartame]].<ref name="Legesse"/> Mechanisms of action have been proposed for some of the commonly reported foods and drinks, such as red and white wine, hot dogs, and chocolate.<ref name=":6"/> [[Tyramine]], which is naturally present in alcoholic beverages, most cheeses, processed meats, and other foods may trigger migraine symptoms in some individuals.<ref>{{cite journal |vauthors=Özturan A, Şanlıer N, Coşkun Ö |title=The Relationship Between Migraine and Nutrition |journal=Turk J Neurol |year=2016 |volume=22 |issue=2 |pages=44–50 |doi=10.4274/tnd.37132 }}</ref><ref>{{cite journal |last1=Fayed |first1=AI |last2=Emam |first2=H |last3=Abdel-Fattah |first3=AN |last4=Shamloul |first4=RM |last5=Elkholy |first5=TA |last6=Yassen |first6=EM |last7=Hamdy |first7=E |last8=Mohamed |first8=MT |last9=Seddeek |first9=MI |last10=Abed |first10=E |title=The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt). |journal=Scientific Reports |date=20 February 2024 |volume=14 |issue=1 |pages=4150 |doi=10.1038/s41598-024-54339-8 |pmid=38378909 |pmc=10879089 |bibcode=2024NatSR..14.4150F }}</ref>  Tyramine is also present at low levels in chocolate.<ref>{{cite journal |last1=Deus |first1=VL |last2=Bispo |first2=ES. |last3=Franca |first3=AS |last4=Gloria |first4=MBA |title=Influence of cocoa clones on the quality and functional properties of chocolate – Nitrogenous compounds |journal=LWT |date=1 December 2020 |volume=134 |article-number=110202 |doi=10.1016/j.lwt.2020.110202 |hdl=1843/41303 |url=https://doi.org/10.1016/j.lwt.2020.110202 |access-date=18 November 2025 |issn=0023-6438}}</ref> [[Monosodium glutamate]] (MSG) has been reported as a trigger for migraine in some individuals, but whether or not there is a causative relationship continues to be debated.<ref name="Ahdoot">{{cite journal |last1=Ahdoot |first1=E |last2=Cohen |first2=F |title=Unraveling the MSG-Headache Controversy: an Updated Literature Review. |journal=Current Pain and Headache Reports |date=March 2024 |volume=28 |issue=3 |pages=119–124 |doi=10.1007/s11916-023-01198-z |pmid=38079074}}</ref> 

People may experience food cravings as a result of changes in brain activity during the prodromal phase of migraine.  Reports that foods such as chocolate are triggers may actually reflect a increased desire for such foods as an early symptom of migraine attacks.<ref name="Lisicki">{{cite journal |last1=Lisicki |first1=M |last2=Schoenen |first2=J |title=Old Habits Die Hard: Dietary Habits of Migraine Patients Challenge our Understanding of Dietary Triggers. |journal=Frontiers in Neurology |date=2021 |volume=12 |article-number=748419 |doi=10.3389/fneur.2021.748419 |doi-access=free |pmid=34867734 |pmc=8636453 }}</ref><ref name="Sebastianelli" />

==== Sensory sensitivity ====
Sensitivity to light ([[photophobia]]), sensitivity to sound ([[phonophobia]]), and sensitivity to smells ([[osmophobia]]) are often reported as migraine triggers.  Some migraineurs may also report sensitivity to touch ([[allodynia]]).<ref name="Aguilar-Shea" /><ref name=":7" /> Neuroimaging and neurophysiological studies show changes in sensory thresholds relating to sensitivity to light, sound and smell and to pain perception.<ref name="Sebastianelli"/> Patient reports of sensitivity triggers may be early symptoms in the premonitory phase of a migraine attack.<ref name="Imai"/> People often deal with migraine attacks by avoiding sensory stimulation including movement, light, sounds, touch or smells.<ref name=":7" />  

=====Light=====
Sensitivity to light is a common symptom in migraine. Discomfort is associated with four categories of stimulation: bright light, flickering light, pattern, and color.  While retinal mechanisms also may be involved, cortical mechanisms are increasingly seen as explaining discomfort from all four types of visual stimulation.<ref name="Wilkins" />

People have been shown to have different thresholds for discomfort from stimuli. During migraine, stimulation can provoke a hyper-excitable cortical response involving specific subsets of neurons. Thresholds at which a response occurs and the size of the response that occurs  may both be involved. For example, those with a more sensitive discomfort glare threshold have been shown to display greater activity in the cunei, lingual gyri and superior parietal lobules in response to peripheral lights. Photophobia may reflect individual differences in homeostatic response to stimuli, in which cortical hyper-excitability is further aggravated by visual stimulation.<ref name="Wilkins" />  Those who are less sensitive to light may better reduce discomfort and avoid over-stimulation.<ref>{{cite journal |last1=Salvati |first1=V |last2=Otani |first2=S |last3=Tartaglia |first3=EM |title=Neural signatures of extreme sensitivities to light: cortical markers in hypersensitive and hyposensitive individuals via EEG. |journal=Frontiers in Neuroscience |date=2025 |volume=19 |article-number=1542154 |doi=10.3389/fnins.2025.1542154 |doi-access=free |pmid=40129722 |pmc=11931066 }}</ref><ref name="Wilkins">{{cite journal |last1=Wilkins |first1=AJ |last2=Haigh |first2=SM |last3=Mahroo |first3=OA |last4=Plant |first4=GT |title=Photophobia in migraine: A symptom cluster? |journal=Cephalalgia : An International Journal of Headache |date=October 2021 |volume=41 |issue=11–12 |pages=1240–1248 |doi=10.1177/03331024211014633 |pmid=33990148 |pmc=8497413 }}</ref> It has been suggested that migraineurs may experience dysfunction in inhibitory mechanisms, have difficulty habituating to ongoing stimuli, and even become sensitized to such stimuli.<ref>{{cite journal |last1=Fong |first1=CY |last2=Law |first2=WHC |last3=Fahrenfort |first3=JJ |last4=Braithwaite |first4=JJ |last5=Mazaheri |first5=A |title=Attenuated alpha oscillation and hyperresponsiveness reveals impaired perceptual learning in migraineurs. |journal=The Journal of Headache and Pain |date=5 April 2022 |volume=23 |issue=1 |pages=44 |doi=10.1186/s10194-022-01410-2 |doi-access=free |pmid=35382735 |pmc=8981672 }}</ref>

=====Sound=====
Migraineurs frequently report hypersensitivity to auditory stimuli. Research indicates that they may have lower hearing thresholds<ref name="Kalita"/> and lower thresholds of discomfort for sounds than non-migraineurs generally, not just during migraine attacks.<ref>{{cite journal |last1=Mourgela |first1=A |last2=Vikelis |first2=M |last3=Reiss |first3=JD |title=Investigation of Frequency-Specific Loudness Discomfort Levels in Listeners With Migraine: A Case-Control Study. |journal=Ear and Hearing |date=1 September 2023 |volume=44 |issue=5 |pages=1007–1013 |doi=10.1097/AUD.0000000000001339 |pmid=36790444 |pmc=10426780 }}</ref> Migraineurs also have lower hearing thresholds than usual while they are experiencing headaches. Lower hearing threshold correlates with headache frequency, and with frequency of auditory, visual, and tactile triggers. Phonophobia in migraineurs correlates with higher brainstem neuronal excitability.<ref name="Kalita">{{cite journal |last1=Kalita |first1=J |last2=Misra |first2=UK |last3=Bansal |first3=R |title=Phonophobia and brainstem excitability in migraine. |journal=The European Journal of Neuroscience |date=March 2021 |volume=53 |issue=6 |pages=1988–1997 |doi=10.1111/ejn.15078 |pmid=33305448}}</ref><ref>{{cite journal |last1=Kalita |first1=J |last2=Bansal |first2=R |last3=Mahajan |first3=R |last4=Jha |first4=V |title=Effect of High-Rate Repetitive Transcranial Magnetic Stimulation on Phonophobia and Brainstem Auditory Evoked Potential in Migraine. |journal=Molecular Neurobiology |date=November 2025 |volume=62 |issue=11 |pages=14079–14088 |doi=10.1007/s12035-025-05190-z |pmid=40660010}}</ref> Therer is some evidence suggesting that migraineurs experience an increase or potentiation in response to blocks of sound, rather than habituation.<ref name=":7" />

=====Smell=====
Osmophobia is a possible diagnostic marker of migraine, distinguishing it from other types of headaches.<ref>{{cite journal |last1=Delussi |first1=M |last2=Laporta |first2=A |last3=Fraccalvieri |first3=I |last4=de Tommaso |first4=M |title=Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. |journal=The Journal of Headache and Pain |date=18 September 2021 |volume=22 |issue=1 |pages=109 |doi=10.1186/s10194-021-01327-2 |doi-access=free |pmid=34537019 |pmc=8449918 }}</ref>
Migraineurs may report increased aversion to a smell that would not be unpleasant normally, heightened awareness of a smell, or other olfaction-related symptoms.<ref>{{cite journal |last1=Fornazieri |first1=MA |last2=Neto |first2=AR |last3=de Rezende Pinna |first3=F |last4=Gobbi Porto |first4=FH |last5=de Lima Navarro |first5=P |last6=Voegels |first6=RL |last7=Doty |first7=RL |date=November 2016 |title=Olfactory symptoms reported by migraineurs with and without auras. |journal=Headache |volume=56 |issue=10 |pages=1608–1616 |doi=10.1111/head.12973 |pmid=27779326}}</ref><ref name="Smith" /> Osmophobia is more often observed in people with a longer history of migraines and greater migraine-related impairment. This may suggest that sensitivity to stimuli increases over time.<ref>{{cite journal |last1=Gossrau |first1=G |last2=Frost |first2=M |last3=Klimova |first3=A |last4=Koch |first4=T |last5=Sabatowski |first5=R |last6=Mignot |first6=C |last7=Haehner |first7=A |date=15 July 2022 |title=Interictal osmophobia is associated with longer migraine disease duration. |journal=The Journal of Headache and Pain |volume=23 |issue=1 |pages=81 |doi=10.1186/s10194-022-01451-7 |doi-access=free |pmid=35840888 |pmc=9284850 }}</ref> Migraineurs who experience scent-related symptoms are more likely to experience insomnia, depression, fatigue and neuropathic pain, and to report lower quality of life than those without osmophobia.<ref>{{cite journal |last1=Meşe Pekdemir |first1=E |last2=Tanik |first2=N |date=October 2023 |title=Clinical significance of osmophobia and its effect on quality of life in people with migraine. |journal=Acta Neurologica Belgica |volume=123 |issue=5 |pages=1747–1755 |doi=10.1007/s13760-022-02030-y |pmid=35864435}}</ref>  

The brain processes odorous stimuli through the olfactory, trigeminal, and pheromone systems. There is evidence that different odors may activate different brain regions. Reported trigger smells have been grouped into six general categories of products: oil derivatives and others; fetid odor;  cooking products; shampoos and conditioners; cleaning products; and perfumes, insecticides, and rose.<ref name="Imai"/> Perfumes were the smells most frequently reported in connection with migraine attacks.<ref name="Imai"/><ref>{{cite journal |last1=Kazemi |first1=Z |last2=Aboutaleb |first2=E |last3=Shahsavani |first3=A |last4=Kermani |first4=M |last5=Kazemi |first5=Z |title=Evaluation of pollutants in perfumes, colognes and health effects on the consumer: a systematic review. |journal=Journal of Environmental Health Science & Engineering |date=June 2022 |volume=20 |issue=1 |pages=589–598 |doi=10.1007/s40201-021-00783-x |pmid=35669814 |pmc=9163252 |bibcode=2022JEHSE..20..589K }}</ref><ref>{{cite journal |last1=Rádis-Baptista |first1=G |title=Do Synthetic Fragrances in Personal Care and Household Products Impact Indoor Air Quality and Pose Health Risks? |journal=Journal of Xenobiotics |date=1 March 2023 |volume=13 |issue=1 |pages=121–131 |doi=10.3390/jox13010010 |doi-access=free |pmid=36976159 |pmc=10051690 }}</ref>  There is evidence that those with chronic migraines are more likely than those with episodic migraines to be sensitive to floral scents in various types of products. Strategies for reducing scent exposure include using fragrance-free products, improving ventilation and air quality, wearing masks, and using air cleaners.<ref name="Imai">{{cite journal |last1=Imai |first1=N |last2=Osanai |first2=A |last3=Moriya |first3=A |last4=Katsuki |first4=M |last5=Kitamura |first5=E |title=Classification of odors associated with migraine attacks: a cross-sectional study. |journal=Scientific Reports |date=25 May 2023 |volume=13 |issue=1 |pages=8469 |doi=10.1038/s41598-023-35211-7 |pmid=37230996 |pmc=10213061 |bibcode=2023NatSR..13.8469I }}</ref><ref name="Smith" />

==== Weather ====
Migraines have been reported to be triggered by changes in weather conditions such as temperature, [[ambient pressure]], and humidity, but studies have shown mixed results.<ref name="Li">{{cite journal |last1=Li |first1=S |last2=Liu |first2=Q |last3=Ma |first3=M |last4=Fang |first4=J |last5=He |first5=L |title=Association between weather conditions and migraine: a systematic review and meta-analysis. |journal=Journal of Neurology |date=17 April 2025 |volume=272 |issue=5 |pages=346 |doi=10.1007/s00415-025-13078-0 |pmid=40246758}}</ref><ref>{{cite journal |last1=Denney |first1=DE |last2=Lee |first2=J |last3=Joshi |first3=S |title=Whether Weather Matters with Migraine. |journal=Current Pain and Headache Reports |date=April 2024 |volume=28 |issue=4 |pages=181–187 |doi=10.1007/s11916-024-01216-8 |pmid=38358443 |pmc=10940451 }}</ref><ref>{{cite journal |last1=Cioffi |first1=I. |last2=Farella |first2=M. |last3=Chiodini |first3=P. |last4=Ammendola |first4=L. |last5=Capuozzo |first5=R. |last6=Klain |first6=C. |last7=Vollaro |first7=S. |last8=Michelotti |first8=A. |title=Effect of weather on temporal pain patterns in patients with temporomandibular disorders and migraine |journal=Journal of Oral Rehabilitation |pages=333–339 |doi=10.1111/joor.12498 |date=May 2017|volume=44 |issue=5 |pmid=28244179 }}</ref><ref name=":6"/>

== Pathophysiology ==
[[File:Cortical spreading depression.gif|thumb|Animation of [[cortical spreading depression]]]]
Migraine is believed to be primarily a neurological disorder,<ref>{{cite journal | vauthors = Andreou AP, Edvinsson L | title = Mechanisms of migraine as a chronic evolutive condition | journal = The Journal of Headache and Pain | volume = 20 | issue = 1 | article-number = 117 | date = December 2019 | pmid = 31870279 | pmc = 6929435 | doi = 10.1186/s10194-019-1066-0 | doi-access = free | title-link = doi }}</ref><ref>{{cite web | title=Migraine | website=National Institute of Neurological Disorders and Stroke | date=11 July 2023 | url=https://www.ninds.nih.gov/health-information/disorders/migraine | access-date=25 August 2023}}</ref> while others{{who?|date=November 2025}} believe it to be a neurovascular disorder with blood vessels playing the key role, although evidence does not support this completely.<ref>{{cite journal | vauthors = Hoffmann J, Baca SM, Akerman S | title = Neurovascular mechanisms of migraine and cluster headache | journal = Journal of Cerebral Blood Flow and Metabolism | volume = 39 | issue = 4 | pages = 573–594 | date = April 2019 | pmid = 28948863 | pmc = 6446418 | doi = 10.1177/0271678x17733655 }}</ref><ref>{{cite journal | vauthors = Brennan KC, Charles A | title = An update on the blood vessel in migraine | journal = Current Opinion in Neurology | volume = 23 | issue = 3 | pages = 266–74 | date = June 2010 | pmid = 20216215 | pmc = 5500293 | doi = 10.1097/WCO.0b013e32833821c1 }}</ref><ref>{{cite journal| vauthors = Spiri D, Titomanlio L, Pogliani L, Zuccotti G |date= January 2012|title=Pathophysiology of migraine: The neurovascular theory|url=https://www.researchgate.net/publication/288611640|journal=Headaches: Causes, Treatment and Prevention|pages=51–64}}</ref><ref>{{cite journal | vauthors = Goadsby PJ | title = The vascular theory of migraine--a great story wrecked by the facts | journal = Brain | volume = 132 | issue = Pt 1 | pages = 6–7 | date = January 2009 | pmid = 19098031 | doi = 10.1093/brain/awn321 | doi-access = free | title-link = doi }}</ref> Others{{who?|date=November 2025}} believe both are likely important.<ref>{{cite journal | vauthors = Dodick DW | title = Examining the essence of migraine--is it the blood vessel or the brain? A debate | journal = Headache | volume = 48 | issue = 4 | pages = 661–7 | date = April 2008 | pmid = 18377395 | doi = 10.1111/j.1526-4610.2008.01079.x | s2cid = 6272233 }}</ref><ref>{{cite journal | vauthors = Chen D, Willis-Parker M, Lundberg GP | title = Migraine headache: Is it only a neurological disorder? Links between migraine and cardiovascular disorders | journal = Trends in Cardiovascular Medicine | volume = 30 | issue = 7 | pages = 424–430 | date = October 2020 | pmid = 31679956 | doi = 10.1016/j.tcm.2019.10.005 | doi-access = free | title-link = doi }}</ref><ref name="Neurovascular contributions to migr">{{cite journal | vauthors = Jacobs B, Dussor G | title = Neurovascular contributions to migraine: Moving beyond vasodilation | journal = Neuroscience | volume = 338 | pages = 130–144 | date = December 2016 | pmid = 27312704 | pmc = 5083225 | doi = 10.1016/j.neuroscience.2016.06.012 }}</ref><ref>{{cite journal | vauthors = Mason BN, Russo AF | title = Vascular Contributions to Migraine: Time to Revisit? | journal = Frontiers in Cellular Neuroscience | volume = 12 | article-number = 233 |year = 2018 | pmid = 30127722 | pmc = 6088188 | doi = 10.3389/fncel.2018.00233 | doi-access = free | title-link = doi }}</ref> One theory is related to increased excitability of the [[cerebral cortex]] and abnormal control of pain [[neurons]] in the [[trigeminal nucleus]] of the [[brainstem]].<ref>{{cite journal | vauthors = Dodick DW, Gargus JJ | title = Why migraines strike | journal = Scientific American | volume = 299 | issue = 2 | pages = 56–63 | date = August 2008 | pmid = 18666680 | doi = 10.1038/scientificamerican0808-56 | bibcode = 2008SciAm.299b..56D }}</ref>

Sensitization of trigeminal pathways is a key pathophysiological phenomenon in migraine. It is debatable whether sensitization starts in the periphery or in the brain.<ref>{{cite journal | vauthors = Edvinsson L, Haanes KA |date=May 2020 |title=Views on migraine pathophysiology: Where does it start? |journal=Neurology and Clinical Neuroscience |volume=8 |issue=3 |pages=120–127 |doi=10.1111/ncn3.12356 |s2cid=214320892 |issn=2049-4173}}</ref><ref>{{cite journal | vauthors = Do TP, Hougaard A, Dussor G, Brennan KC, Amin FM | title = Migraine attacks are of peripheral origin: the debate goes on | journal = The Journal of Headache and Pain | volume = 24 | issue = 1 | article-number = 3 | date = January 2023 | pmid = 36627561 | pmc = 9830833 | doi = 10.1186/s10194-022-01538-1 | doi-access = free }}</ref>

=== Aura ===
[[Cortical spreading depression]], or ''spreading depression'' according to [[Aristides Leão|Leão]], is a burst of neuronal activity followed by a period of inactivity, which is seen in those with migraine with aura.<ref name=HA28>''The Headaches'', Chp. 28, pp. 269–72</ref> There are several explanations for its occurrence, including activation of [[NMDA receptor]]s leading to calcium entering the cell.<ref name=HA28/> After the burst of activity, the blood flow to the cerebral cortex in the affected area is decreased for two to six hours.<ref name=HA28/> It is believed that when depolarization travels down the underside of the brain, nerves that sense pain in the head and neck are triggered.<ref name=HA28/>

=== Pain ===
The exact mechanism of the head pain that occurs during a migraine episode is unknown.<ref name=Olesen2009>{{cite journal | vauthors = Olesen J, Burstein R, Ashina M, Tfelt-Hansen P | title = Origin of pain in migraine: evidence for peripheral sensitisation | journal = The Lancet. Neurology | volume = 8 | issue = 7 | pages = 679–90 | date = July 2009 | pmid = 19539239 | doi = 10.1016/S1474-4422(09)70090-0 | s2cid = 20452008 }}</ref> Some evidence supports a primary role for [[central nervous system]] structures (such as the [[brainstem]] and [[diencephalon]]),<ref>{{cite journal | vauthors = Akerman S, Holland PR, Goadsby PJ | title = Diencephalic and brainstem mechanisms in migraine | journal = Nature Reviews. Neuroscience | volume = 12 | issue = 10 | pages = 570–84 | date = September 2011 | pmid = 21931334 | doi = 10.1038/nrn3057 | s2cid = 8472711 }}</ref> while other data support the role of peripheral activation (such as via the [[sensory nerve]]s that surround [[blood vessel]]s of the head and neck).<ref name=Olesen2009/> The potential candidate vessels include [[dura mater|dural arteries]], [[Pia mater|pial arteries]] and extracranial arteries such as those of the scalp.<ref name=Olesen2009/> The role of vasodilatation of the extracranial arteries, in particular, is believed to be significant.<ref>{{cite journal | vauthors = Shevel E | title = The extracranial vascular theory of migraine--a great story confirmed by the facts | journal = Headache | volume = 51 | issue = 3 | pages = 409–417 | date = March 2011 | pmid = 21352215 | doi = 10.1111/j.1526-4610.2011.01844.x | s2cid = 6939786 }}</ref>

=== Neuromodulators ===
[[Adenosine]], a [[neuromodulator]], may be involved.<ref name=Burn2015/> Released after the progressive cleavage of [[adenosine triphosphate]] (ATP), adenosine acts on [[adenosine receptors]] to put the body and brain in a low activity state by dilating blood vessels and slowing the heart rate, such as before and during the early stages of sleep. Adenosine levels are high during migraine attacks.<ref name=Burn2015>{{cite book | vauthors = Burnstock G | title = Pharmacological Mechanisms and the Modulation of Pain | chapter = Purinergic Mechanisms and Pain | series = Advances in Pharmacology | volume = 75 | pages = 91–137 | date = January 2016 | pmid = 26920010 | doi = 10.1016/bs.apha.2015.09.001 | isbn = 978-0-12-803883-3 | veditors = Barrett JE }}</ref><ref>{{cite book |vauthors=Davidoff R |url=https://books.google.com/books?id=PAdn6xC3KlAC&q=migraine+adenosine&pg=PA223 |title=Migraine: Manifestations, Pathogenesis, and Management |date=14 February 2002 |publisher=Oxford University Press |isbn=978-0-19-803135-2 |access-date=12 November 2020 |archive-date=23 August 2023 |archive-url=https://web.archive.org/web/20230823051112/https://books.google.com/books?id=PAdn6xC3KlAC&q=migraine+adenosine&pg=PA223 |url-status=live }}</ref> Caffeine's role as an inhibitor of adenosine may explain its effect in reducing migraine.<ref>{{cite journal | vauthors = Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K | title = Caffeine in the management of patients with headache | journal = The Journal of Headache and Pain | volume = 18 | issue = 1 | article-number = 107 | date = October 2017 | pmid = 29067618 | pmc = 5655397 | doi = 10.1186/s10194-017-0806-2 | doi-access = free | title-link = doi }}</ref> Low levels of the neurotransmitter [[serotonin]], also known as 5-hydroxytryptamine (5-HT), are also believed to be involved.<ref>{{cite journal |vauthors=Hamel E |date=November 2007 |title=Serotonin and migraine: biology and clinical implications |journal=Cephalalgia |volume=27 |issue=11 |pages=1293–300 |doi=10.1111/j.1468-2982.2007.01476.x |pmid=17970989 |s2cid=26543041 |doi-access=free}}</ref>

[[Calcitonin gene-related peptide]] is a [[neuropeptide]] implicated in the [[pathophysiology]] of migraines. It is predominantly found in the [[trigeminal ganglion]] and central nervous system pathways associated with migraine mechanisms.<ref>{{cite journal | vauthors = Wattiez AS, Sowers LP, Russo AF | title = Calcitonin gene-related peptide (CGRP): role in migraine pathophysiology and therapeutic targeting | journal = Expert Opinion on Therapeutic Targets | volume = 24 | issue = 2 | pages = 91–100 | date = February 2020 | pmid = 32003253 | pmc = 7050542 | doi = 10.1080/14728222.2020.1724285 }}</ref> During migraine attacks, elevated levels of CGRP are detected.<ref name=Gilmore2011/><ref name=pathos/> These elevated levels lead to vasodilation of cerebral and dural blood vessels and the release of inflammatory mediators from mast cells. These actions contribute to the transmission of nociceptive signals, culminating in migraine pain.<ref>{{cite journal |last1=Tanaka |first1=M |last2=Szabó |first2=A |last3=Körtési |first3=T |last4=Szok |first4=D |last5=Tajti |first5=J |last6=Vécsei |first6=L |title=From CGRP to PACAP, VIP, and Beyond: Unraveling the Next Chapters in Migraine Treatment |journal=Cells |date=November 2023 |volume=12 |issue=22 |page=2649 |doi=10.3390/cells12222649 |doi-access=free |pmid=37998384 |pmc=10670698 }}</ref><ref name="Gawde">{{cite journal |last1=Gawde |first1=P |last2=Shah |first2=H |last3=Patel |first3=H |last4=Bharathi |first4=KS |last5=Patel |first5=N |last6=Sethi |first6=Y |last7=Kaka |first7=N |title=Revisiting Migraine: The Evolving Pathophysiology and the Expanding Management Armamentarium |journal=Cureus |date=February 2023 |volume=2 |issue=15 |article-number=e34553 |doi=10.7759/cureus.34553 |doi-access=free |pmid=36879707 |pmc=9985459 }}</ref><ref name="Levy">{{cite journal |last1=Levy |first1=D |last2=Moskowitz |first2=MA |title=Meningeal Mechanisms and the Migraine Connection |journal=Annual Review of Neuroscience |date=July 2023 |volume=46 |pages=39–58 |doi=10.1146/annurev-neuro-080422-105509 |pmid=36913712 |pmc=11412714 |issn=0147-006X}}</ref>

== Diagnosis ==
The diagnosis of a migraine is based on signs and symptoms.<ref name=Bart10/> A headache calendar is a useful diagnostic tool for tracking the date, duration, and symptoms of headaches. Migraine can be classified according to whether the patient experiences an aura (MA) or not (MO) and frequency of headaches (episodic or chronic).<ref name="Aguilar-Shea" /> [[Neuroimaging]] tests are not necessary to diagnose migraine, but may be used to find other causes of headaches in those whose examination and history do not confirm a migraine diagnosis.<ref name="AHSfive">
* {{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}
* {{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}
* {{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }}</ref> It is believed that a substantial number of people with the condition remain undiagnosed.<ref name=Bart10/>

The diagnosis of migraine without aura, according to the [[International Headache Society]], can be made according to the "5, 4, 3, 2, 1 criteria", which is as follows:<ref name=ICHD2004/>
* Five or more attacks&nbsp;– for migraine ''with'' aura, two attacks are sufficient for diagnosis.
* Four hours to three days in duration
* Two or more of the following:
** Unilateral (affecting one side of the head)
** Pulsating
** Moderate or severe pain intensity
** Worsened by or causing avoidance of routine physical activity
* One or more of the following:
** Nausea and/or vomiting
** Sensitivity to both light ([[photophobia]]) and sound ([[Hyperacusis|phonophobia]])

If someone experiences two of the following: photophobia, nausea, or inability to work or study for a day, the diagnosis is more likely.<ref>{{cite journal | vauthors = Cousins G, Hijazze S, Van de Laar FA, Fahey T | title = Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis | journal = Headache | volume = 51 | issue = 7 | pages = 1140–8 | date = Jul–Aug 2011 | pmid = 21649653 | doi = 10.1111/j.1526-4610.2011.01916.x | s2cid = 205684294 }}</ref> In those with four out of five of the following: pulsating headache, duration of 4–72 hours, pain on one side of the head, nausea, or symptoms that interfere with the person's life, the probability that this is a migraine attack is 92%.<ref name=Gilmore2011/> In those with fewer than three of these symptoms, the probability is 17%.<ref name=Gilmore2011/>

=== Classification ===
{{Main|ICHD classification and diagnosis of migraine}}

<!-- Refractory migraine management missing (maybe include https://doi.org/10.1016/j.ebiom.2023.104943) -->
Migraine was first comprehensively classified in 1988.<ref name="Olesen_2006">{{cite book| vauthors = Olesen J, Goadsby PJ | chapter = The Migraines: Introduction | veditors = Olesen J |title=The Headaches|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-5400-2|pages=232–233| chapter-url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA232|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170313073938/https://books.google.com/books?id=F5VMlANd9iYC&pg=PA238|archive-date=13 March 2017}}</ref>

The [[International Headache Society]] updated its classification of headaches in 2004.<ref name=ICHD2004/> A third version was published in 2018.<ref>{{cite journal | vauthors = | title = Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition | journal = Cephalalgia | volume = 38 | issue = 1 | pages = 1–211 | date = January 2018 | pmid = 29368949 | doi = 10.1177/0333102417738202 | doi-access = free | title-link = doi }}</ref> According to this classification, migraine is a primary headache disorder along with [[tension-type headache]]s and [[cluster headache]]s, among others.<ref>{{cite journal | vauthors = Nappi G | title = Introduction to the new International Classification of Headache Disorders | journal = The Journal of Headache and Pain | volume = 6 | issue = 4 | pages = 203–4 | date = September 2005 | pmid = 16362664 | pmc = 3452009 | doi = 10.1007/s10194-005-0185-y }}</ref>

Migraine is divided into six subclasses (some of which include further subdivisions):<ref>{{Cite journal |date=January 2018 |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |doi=10.1177/0333102417738202 |pmid=29368949 |issn=0333-1024}}</ref>
* ''Migraine without aura'', or "common migraine", involves migraine headaches that are not accompanied by aura.
* ''Migraine with aura'', or "classic migraine", usually involves migraine headaches accompanied by aura. Less commonly, aura can occur without a headache or with a nonmigraine headache.
** Subtype of migraine with aura: [[familial hemiplegic migraine|hemiplegic migraine]] and [[sporadic hemiplegic migraine]], in which a person has migraine with aura and with accompanying motor weakness. If a close relative has had the same condition, it is called "familial"; otherwise, it is called "sporadic".
** Subtype of migraine with aura: basilar-type migraine, where a headache and aura are accompanied by [[dysarthria|difficulty speaking]], [[Vertigo (medical)|world spinning]], [[tinnitus|ringing in ears]], or several other brainstem-related symptoms, but not motor weakness. This type was initially believed to be due to spasms of the [[basilar artery]], the artery that supplies the brainstem. Now that this mechanism is not believed to be primary, the symptomatic term [[ICHD classification and diagnosis of migraine#Migraine with brainstem aura|migraine with brainstem aura (MBA)]] is preferred.<ref name=Basil2009/> [[Retinal migraine]] (which is distinct from visual or optical migraine) involves migraine headaches accompanied by visual disturbances or even temporary blindness in one eye.
* Childhood periodic syndromes that are commonly precursors of migraine include [[cyclical vomiting syndrome|cyclical vomiting]] (occasional intense periods of vomiting), [[abdominal migraine]] (abdominal pain, usually accompanied by nausea), and [[benign paroxysmal vertigo of childhood]] (occasional attacks of vertigo).
* ''Complications of migraine'' describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.
* ''Probable migraine'' describes conditions that have some characteristics of migraine, but where there is not enough evidence to diagnose it as migraine with certainty (in the presence of concurrent medication overuse).
* ''Chronic migraine'' is a complication of migraine, and is a headache that fulfills diagnostic criteria for ''migraine headache'' and occurs for a greater time interval. Specifically, greater than or equal to 15 days/month for longer than 3 months.<ref>{{cite journal | vauthors = Negro A, Rocchietti-March M, Fiorillo M, Martelletti P | title = Chronic migraine: current concepts and ongoing treatments | journal = European Review for Medical and Pharmacological Sciences | volume = 15 | issue = 12 | pages = 1401–20 | date = December 2011 | pmid = 22288302 }}</ref>

=== Abdominal migraine ===
The diagnosis of [[abdominal migraine]] is controversial.<ref name=Abdo2002>{{cite book| vauthors = Davidoff RA |title=Migraine: manifestations, pathogenesis, and management|year=2002|publisher=Oxford Univ. Press|location=Oxford [u.a.]|isbn=978-0-19-513705-7|page=81|url=https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|edition=2|url-status=live|archive-url=https://web.archive.org/web/20161222063436/https://books.google.com/books?id=PAdn6xC3KlAC&pg=PA81|archive-date=22 December 2016}}</ref> Some evidence indicates that recurrent episodes of abdominal pain in the absence of a headache may be a type of migraine<ref name=Abdo2002/><ref>{{cite journal | vauthors = Russell G, Abu-Arafeh I, Symon DN | title = Abdominal migraine: evidence for existence and treatment options | journal = Paediatric Drugs | volume = 4 | issue = 1 | pages = 1–8 | year = 2002 | pmid = 11817981 | doi = 10.2165/00128072-200204010-00001 | s2cid = 12289726 }}</ref> or are at least a precursor to migraine attacks.<ref name = "Olesen_2006" /> These episodes of pain may or may not follow a migraine-like prodrome and typically last minutes to hours.<ref name=Abdo2002/> They often occur in those with either a personal or family history of typical migraine.<ref name=Abdo2002/> Other syndromes that are believed to be precursors include [[cyclical vomiting syndrome]] and [[benign paroxysmal vertigo of childhood]].<ref name = "Olesen_2006" />

=== Differential diagnosis ===
Other conditions that can cause similar symptoms to a migraine headache include [[temporal arteritis]], [[cluster headache]]s, [[acute glaucoma]], [[meningitis]] and [[subarachnoid hemorrhage]].<ref name=Gilmore2011/> Temporal arteritis typically occurs in people over 50 years old and presents with tenderness over the temple. Cluster headache presents with one-sided nose stuffiness, tears and severe pain around the orbits. Acute glaucoma is associated with vision problems. Meningitis associated with fever. Subarachnoid hemorrhage is associated with a very fast onset.<ref name=Gilmore2011/> [[Tension headaches]] typically occur on both sides, are not pounding, and are less disabling.<ref name=Gilmore2011/>

Those with stable headaches that meet criteria for migraine should not receive [[neuroimaging]] to look for other intracranial disease.<ref>{{cite journal | vauthors = Lewis DW, Dorbad D | title = The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations | journal = Headache | volume = 40 | issue = 8 | pages = 629–32 | date = September 2000 | pmid = 10971658 | doi = 10.1046/j.1526-4610.2000.040008629.x | s2cid = 14443890 }}</ref><ref>{{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | author = Medical Advisory Secretariat | title = Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis | journal = Ontario Health Technology Assessment Series | volume = 10 | issue = 26 | pages = 1–57 | year = 2010 | pmid = 23074404 | pmc = 3377587 }}</ref>

== Management ==
{{Main|Management of migraine}}

Management of migraine includes both [[prevention of migraine attacks]] and [[Management of migraine#Rescue treatment|rescue treatment]]. There are three main aspects of treatment: preventive (prophylactic) control, trigger avoidance, and acute (abortive).<ref>{{Cite journal | vauthors = Chawla J, Lutsep HL |date=13 June 2023 |title=Migraine Headache Treatment & Management |url=https://emedicine.medscape.com/article/1142556-treatment?form=fpf |journal=[[Medscape]] |access-date=3 May 2024}}</ref>

Managing possible triggers and addressing comorbidities are the first step of treatment.  Recommended lifestyle modifications promote maintaining a consistent lifestyle, through regular sleep patterns, regular eating, staying hydrated, managing stress, engaging in moderate exercise, and maintaining a healthy body weight.  Avoiding dietary triggers and caffeine overuse may also be recommended lifestyle modifications.<ref name=":1">Jenkins, B. Migraine management. Australian Prescriber. 2020; 43(5):148–151. https://doi.org/10.18773/austprescr.2020.047</ref> Data suggests that sleep modification may be particularly helpful in reducing migraine frequency for adults with chronic migraines.<ref name="Treadwell_2024" />

Behavioral techniques that have been utilized in the treatment of migraines include Cognitive Behavioral Therapy (CBT), relaxation training, biofeedback, Acceptance and Commitment Therapy (ACT), as well as mindfulness-based therapies.<ref name="Treadwell_2024" /> A 2024 systematic literature review and meta analysis found evidence that treatments such as CBT, relaxation training, ACT, and mindfulness-based therapies can reduce migraine frequency both on their own and in combination with other treatment options.<ref name="Treadwell_2024">{{cite report | vauthors = Treadwell JR, Tsou AY, Rouse B, Ivlev I, Fricke J, Buse D, Powers SW, Minen M, Szperka CL, Mull NK | title = Behavioral Interventions for Migraine Prevention | date = 2024 | pmid = 39471258 | doi = 10.23970/ahrqepccer270 | publisher = Agency for Healthcare Research and Quality (AHRQ) }}</ref> In addition, it was found that relaxation therapy aided in the lessening of migraine frequency when compared to education by itself.<ref name="Treadwell_2024" /> Similarly, for children and adolescents, CBT and biofeedback strategies are effective in decreasing of frequency and intensity of migraines. These techniques often include relaxation methods and promotion of long-term management without medication side effects, which is emphasized for younger individuals.<ref name="Treadwell_2024" /> 

A variety of possible diets have been proposed, including [[ketogenic diet]],<ref>{{cite journal | vauthors = Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M | title = Ketogenic diet in migraine: rationale, findings and perspectives | journal = Neurological Sciences | volume = 38 | issue = Suppl 1 | pages = 111–115 | date = May 2017 | pmid = 28527061 | doi = 10.1007/s10072-017-2889-6 | type = Review | s2cid = 3805337 }}</ref><ref>{{cite journal | vauthors = Gross EC, Klement RJ, Schoenen J, D'Agostino DP, Fischer D | title = Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention | journal = Nutrients | volume = 11 | issue = 4 | page = 811 | date = April 2019 | pmid = 30974836 | pmc = 6520671 | doi = 10.3390/nu11040811 | doi-access = free | title-link = doi }}</ref> [[Mediterranean diet]], [[DASH diet]], and high intakes of fruits, vegetables, legumes, and oil seeds<ref>{{cite journal |last1=Bakırhan |first1=Hande |last2=Yıldıran |first2=Hilal |last3=Uyar Cankay |first3=Tugba |title=Associations between diet quality, DASH and Mediterranean dietary patterns and migraine characteristics |journal=Nutritional Neuroscience |date=November 2022 |volume=25 |issue=11 |pages=2324–2334 |doi=10.1080/1028415x.2021.1963065 |pmid=34379573}}</ref>. Further research is needed to examine whether and when dietary interventions are beneficial to migraineurs.<ref name="Gazerani"/> [[Transcranial magnetic stimulation]] shows promise as a prevention mechanism,<ref name="Gilmore2011" /><ref>{{cite journal | vauthors = Magis D, Jensen R, Schoenen J | title = Neurostimulation therapies for primary headache disorders: present and future | journal = Current Opinion in Neurology | volume = 25 | issue = 3 | pages = 269–76 | date = June 2012 | pmid = 22543428 | doi = 10.1097/WCO.0b013e3283532023 }}</ref> as does [[transcutaneous supraorbital nerve stimulation]].<ref>{{cite journal | vauthors = Jürgens TP, Leone M | title = Pearls and pitfalls: neurostimulation in headache | journal = Cephalalgia | volume = 33 | issue = 8 | pages = 512–25 | date = June 2013 | pmid = 23671249 | doi = 10.1177/0333102413483933 | s2cid = 42537455 }}</ref> 

Acute treatments, including NSAIDs and triptans, are most effective when administered early in an attack, while preventive medications are recommended for those experiencing frequent or severe migraines. Proven preventive options include beta blockers, topiramate, and calcitonin gene related peptides (CGRP) inhibitors like erenumab and galcanezumab, which have demonstrated significant efficacy in clinical studies.<ref name="pmid32802591">{{cite journal | vauthors = Mohanty D, Lippmann S | title = CGRP Inhibitors for Migraine | journal = Innovations in Clinical Neuroscience | volume = 17 | issue = 4–6 | pages = 39–40 | date = April 2020 | pmid = 32802591 | pmc = 7413335 | doi = }}</ref> Other medications, such as gepants and ditans, are used as third-line treatment options. Prokinetic antiemetics are used as [[adjuvant therapy|adjunctives]] for patients with nausea and/or vomiting.<ref name="pmid34145431">{{cite journal | vauthors = Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M | title = Diagnosis and management of migraine in ten steps | journal = Nature Reviews. Neurology | volume = 17 | issue = 8 | pages = 501–514 | date = August 2021 | pmid = 34145431 | pmc = 8321897 | doi = 10.1038/s41582-021-00509-5 }}</ref> Corticosteroids are also used to treat migraine, and most benefited patients with status migrainosus, severe baseline disability, or refractory or recurrent headaches.<ref>{{cite journal |last1=Woldeamanuel |first1=Y.W. |last2=Rapoport |first2=A.M. |last3=Cowan |first3=R.P. |title=What is the evidence for the use of corticosteroids in migraine? |journal=Current Pain and Headache Reports |year=2014 |volume=18 |issue=12 |article-number=464 |doi=10.1007/s11916-014-0464-x |pmid=25373608 }}</ref>

A 2024 [[systematic review]] and [[Meta-analysis|network meta analysis]] compared the effectiveness of medications for acute migraine attacks in adults. It found that triptans were the most effective class of drugs, followed by non-steroidal anti-inflammatories. [[Gepants]] were less effective than non-steroidal anti-inflammatory drugs.<ref>{{Cite journal |last1=Karlsson |first1=William K. |last2=Ostinelli |first2=Edoardo G. |last3=Zhuang |first3=Zixuan A. |last4=Kokoti |first4=Lili |last5=Christensen |first5=Rune H. |last6=Al-Khazali |first6=Haidar M. |last7=Deligianni |first7=Christina I. |last8=Tomlinson |first8=Anneka |last9=Ashina |first9=Håkan |last10=Torre |first10=Elena Ruiz de la |last11=Diener |first11=Hans-Christoph |last12=Cipriani |first12=Andrea |last13=Ashina |first13=Messoud |date=18 September 2024 |title=Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis |journal=BMJ |volume=386 |article-number=e080107 |doi=10.1136/bmj-2024-080107 |issn=1756-1833 |pmid=39293828|pmc=11409395 }}</ref><ref>{{Cite journal |date=4 March 2025 |title=Which drugs are best for migraine attacks? |url=https://evidence.nihr.ac.uk/alert/which-drugs-are-best-for-migraine-attacks/ |journal=NIHR Evidence}}</ref>

== Prognosis ==
"Migraine exists on a continuum of different attack frequencies and associated levels of disability."<ref>{{cite journal | vauthors = Silberstein SD, Lee L, Gandhi K, Fitzgerald T, Bell J, Cohen JM | title = Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine | journal = Headache | volume = 58 | issue = 10 | pages = 1579–1592 | date = November 2018 | pmid = 30375650 | doi = 10.1111/head.13421 | s2cid = 53114546 }}</ref> For those with occasional, episodic migraine, a "proper combination of drugs for prevention and treatment of migraine attacks" can limit the disease's impact on patients' personal and professional lives.<ref name="NINDS">{{cite web | url = https://www.ninds.nih.gov/health-information/disorders/migraine | title = Migraine Information Page: Prognosis | archive-url = https://web.archive.org/web/20200610010837/https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page | archive-date=10 June 2020 | work = National Institute for Neurological Disorders and Stroke (NINDS) | url-status = live | publisher = National Institutes of Health (US) }}</ref> Fewer than half of people with migraine seek medical care.<ref>{{cite web|title=Key facts and figures about migraine|year=2017|url=https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-url=https://web.archive.org/web/20170312001659/https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/|archive-date=12 March 2017|website=The Migraine Trust|access-date=13 June 2021}}</ref> Severe migraine ranks in the highest category of disability, according to the World Health Organization, which uses metrics to determine disability burden,<ref>{{cite web | publisher = World Health Organization | date = 2008 | quote = Disability classes for the Global Burden of Disease study (table 8) | url = https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | title = The Global Burden of Disease: 2004 Update | archive-url = https://web.archive.org/web/20210613232410/https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf | archive-date = 13 June 2021 | page = 33}}</ref> and the bulk of disability burden is due to chronic (as opposed to episodic) migraine.<ref name="Brennan_2018" />

Repeated experiences of pain, including migraine pain, cause functional and structural changes in the brain<ref name="Brennan_2018">{{cite journal | vauthors = Brennan KC, Pietrobon D | title = A Systems Neuroscience Approach to Migraine | journal = Neuron | volume = 97 | issue = 5 | pages = 1004–1021 | date = March 2018 | pmid = 29518355 | pmc = 6402597 | doi = 10.1016/j.neuron.2018.01.029 }}</ref> It is possible for migraine to progress from an occasional inconvenience to a life-changing, chronic disorder. This "chronification" affects 3% of migraineurs in a given year, such that 8% of migraineurs have chronic migraine in any given year. Brain imagery reveals that the electrophysiological changes seen during an attack become permanent in people with chronic migraine; "thus, from an electrophysiological point of view, chronic migraine indeed resembles a never-ending migraine attack."<ref name="Brennan_2018" />

Migraine with aura appears to be a risk factor for [[ischemic stroke]]<ref name=Stroke2009>{{cite journal | vauthors = Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T | title = Migraine and cardiovascular disease: systematic review and meta-analysis | journal = BMJ | volume = 339 | article-number = b3914 | date = October 2009 | pmid = 19861375 | pmc = 2768778 | doi = 10.1136/bmj.b3914 }}</ref> doubling the risk.<ref>{{cite journal | vauthors = Kurth T, Chabriat H, Bousser MG | title = Migraine and stroke: a complex association with clinical implications | journal = The Lancet. Neurology | volume = 11 | issue = 1 | pages = 92–100 | date = January 2012 | pmid = 22172624 | doi = 10.1016/S1474-4422(11)70266-6 | s2cid = 31939284 }}</ref> Being a young adult, being female, using [[hormonal birth control]], and smoking further increases this risk.<ref name=Stroke2009/> There also appears to be an association with [[Vertebral artery dissection|cervical artery dissection]].<ref>{{cite journal | vauthors = Rist PM, Diener HC, Kurth T, Schürks M | title = Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis | journal = Cephalalgia | volume = 31 | issue = 8 | pages = 886–96 | date = June 2011 | pmid = 21511950 | pmc = 3303220 | doi = 10.1177/0333102411401634 }}</ref> Migraine without aura does not appear to be a factor.<ref name=Kurth2010>{{cite journal | vauthors = Kurth T | title = The association of migraine with ischemic stroke | journal = Current Neurology and Neuroscience Reports | volume = 10 | issue = 2 | pages = 133–9 | date = March 2010 | pmid = 20425238 | doi = 10.1007/s11910-010-0098-2 | s2cid = 27227332 }}</ref> The relationship with heart problems is inconclusive with a single study supporting an association.<ref name=Stroke2009/> Migraine does not appear to increase the risk of death from stroke or heart disease.<ref name="Death2011">{{cite journal|vauthors=Schürks M, Rist PM, Shapiro RE, Kurth T|date=September 2011|title=Migraine and mortality: a systematic review and meta-analysis|journal=Cephalalgia|volume=31|issue=12|pages=1301–14|doi=10.1177/0333102411415879|pmc=3175288|pmid=21803936}}</ref> Preventative therapy of migraine in those with migraine with aura may prevent associated strokes.<ref>{{cite journal | vauthors = Weinberger J | title = Stroke and migraine | journal = Current Cardiology Reports | volume = 9 | issue = 1 | pages = 13–9 | date = March 2007 | pmid = 17362679 | doi = 10.1007/s11886-007-0004-y | s2cid = 46681674 }}</ref> People with migraine, particularly women, may develop higher than average numbers of [[white matter]] brain lesions of unclear significance.<ref>{{cite journal | vauthors = Hougaard A, Amin FM, Ashina M | title = Migraine and structural abnormalities in the brain | journal = Current Opinion in Neurology | volume = 27 | issue = 3 | pages = 309–14 | date = June 2014 | pmid = 24751961 | doi = 10.1097/wco.0000000000000086 }}</ref>

== Epidemiology ==
[[File:Chalmer 2023.jpg|thumb|Percent of women and men who have experienced migraine with or without aura within the last 3 months]]
Migraine is common, with around 33% of women and 18% of men affected at some point in their lifetime.<ref name=Ferrari2022>{{cite journal | vauthors = Ferrari MD, Goadsby PJ, Burstein R, Kurth T, Ayata C, Charles A, Ashina M, van den Maagdenberg AM, Dodick DW | title = Migraine | journal = Nature Reviews. Disease Primers | volume = 8 | issue = 1 | article-number = 2 | date = January 2022 | pmid = 35027572 | doi = 10.1038/s41572-021-00328-4 | s2cid = 245883895 }}</ref> Onset can be at any age, but prevalence rises sharply around [[puberty]], and remains high until declining after age 50.<ref name=Ferrari2022/> Before puberty, boys and girls are equally impacted, with around 5% of children experiencing migraine attacks. From puberty onwards, women experience migraine attacks at greater rates than men. From age 30 to 50, up to 4 times as many women experience migraine attacks as men;<ref name=Ferrari2022/> this is most pronounced in migraine without aura.<ref>{{cite journal | vauthors = Chalmer MA, Kogelman LJ, Callesen I, Christensen CG, Techlo TR, Møller PL, Davidsson OB, Olofsson IA, Schwinn M, Mikkelsen S, Dinh KM, Nielsen K, Topholm M, Erikstrup C, Ostrowski SR, Pedersen OB, Hjalgrim H, Banasik K, Burgdorf KS, Nyegaard M, Olesen J, Hansen TF | title = Sex differences in clinical characteristics of migraine and its burden: a population-based study | journal = European Journal of Neurology | volume = 30 | issue = 6 | pages = 1774–1784 | date = June 2023 | pmid = 36905094 | doi = 10.1111/ene.15778 }}</ref>

Worldwide, migraine affects nearly 15% or approximately one billion people.<ref name=LancetEpi2012/> In the United States, about 6% of men and 18% of women experience a migraine attack in a given year, with a lifetime risk of about 18% and 43%, respectively.<ref name=Bart10/> In Europe, migraine affects 12–28% of people at some point in their lives, with about 6–15% of adult men and 14–35% of adult women getting at least one attack yearly.<ref name="Stovner2007">{{cite journal |vauthors=Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J |date=April 2006 |title=Epidemiology of headache in Europe |journal=European Journal of Neurology |volume=13 |issue=4 |pages=333–45 |doi=10.1111/j.1468-1331.2006.01184.x |pmid=16643310 |s2cid=7490176 |doi-access=free}}</ref> Rates of migraine are slightly lower in Asia and Africa than in Western countries.<ref name = "Rasmussen_2006" /><ref name=AsiaEpi2003>{{cite journal | vauthors = Wang SJ | title = Epidemiology of migraine and other types of headache in Asia | journal = Current Neurology and Neuroscience Reports | volume = 3 | issue = 2 | pages = 104–8 | date = March 2003 | pmid = 12583837 | doi = 10.1007/s11910-003-0060-7 | s2cid = 24939546 }}</ref> Chronic migraine occurs in approximately 1.4–2.2% of the population.<ref>{{cite journal | vauthors = Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, Lipton RB | title = Global prevalence of chronic migraine: a systematic review | journal = Cephalalgia | volume = 30 | issue = 5 | pages = 599–609 | date = May 2010 | pmid = 19614702 | doi = 10.1111/j.1468-2982.2009.01941.x | s2cid = 5328642 }}</ref>

During [[perimenopause]] symptoms often get worse before decreasing in severity.<ref name="Pol2009">{{cite journal | vauthors = Nappi RE, Sances G, Detaddei S, Ornati A, Chiovato L, Polatti F | title = Hormonal management of migraine at menopause | journal = Menopause International | volume = 15 | issue = 2 | pages = 82–6 | date = June 2009 | pmid = 19465675 | doi = 10.1258/mi.2009.009022 | s2cid = 23204921 }}</ref> While symptoms resolve in about two-thirds of the elderly, in 3–10% they persist.<ref name="ElderlyBook2008">{{cite book| vauthors = Dodick DW, Capobianco DJ | chapter = Chapter 14: Headaches | chapter-url=https://books.google.com/books?id=c1tL8C9ryMQC&pg=PA197 | veditors = Sirven JI, Malamut BL |title=Clinical neurology of the older adult |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-6947-1|edition=2nd |location=Philadelphia|page=197 |archive-url=https://web.archive.org/web/20170312231334/https://books.google.com/books?id=c1tL8C9ryMQC&pg=PA197|archive-date=12 March 2017|url-status=live}}</ref>

== History ==
[[Image:Cruikshank - The Head Ache.png|thumb|''The Head Ache'', George Cruikshank (1819)]]
An early description consistent with migraine is contained in the [[Ebers Papyrus]], written around 1500&nbsp;BCE in ancient Egypt.<ref name=Miller2005>{{cite book| vauthors = Miller N |title=Walsh and Hoyt's clinical neuro-ophthalmology |year=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=978-0-7817-4811-7|page=1275|url=https://books.google.com/books?id=9RA2ZOPRuhgC&pg=PA1275|edition=6|url-status=live|archive-url=https://web.archive.org/web/20170312232704/https://books.google.com/books?id=9RA2ZOPRuhgC&pg=PA1275|archive-date=12 March 2017}}</ref>

The word ''migraine'' is from the [[Greek language|Greek]] ἡμικρᾱνίᾱ (''hēmikrāníā''), 'pain in half of the head',<ref>{{cite web | vauthors = Liddell HG, Scott R |title=ἡμικρανία |work=A Greek-English Lexicon |url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dh%28mikrani%2Fa |url-status=live |archive-url=https://web.archive.org/web/20131108145951/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dh%28mikrani%2Fa |archive-date=8 November 2013 }} on Perseus</ref> from ἡμι- (''hēmi-''), 'half' and κρᾱνίον (''krāníon''), 'skull'.<ref>{{cite book | vauthors = Anderson K, Anderson LE, Glanze WD |title=Mosby's Medical, Nursing & Allied Health Dictionary |year=1994 |publisher=Mosby |isbn=978-0-8151-6111-0 |page=998 |edition=4|title-link=Mosby's Medical, Nursing & Allied Health Dictionary }}</ref>
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In 200 BCE, writings from the [[Hippocrates|Hippocratic school of medicine]] described the visual aura that can precede the headache and a partial relief occurring through vomiting.<ref name=Borsook2012>{{cite book| vauthors = Borsook D |title=The migraine brain: imaging, structure, and function|year=2012|publisher=Oxford University Press|location=New York|isbn=978-0-19-975456-4|pages=3–11|url=https://books.google.com/books?id=5GVVJS_fCAkC&pg=PA3|url-status=live|archive-url=https://web.archive.org/web/20170313014706/https://books.google.com/books?id=5GVVJS_fCAkC&pg=PA3|archive-date=13 March 2017}}</ref>

A second-century description by [[Aretaeus of Cappadocia]] divided headaches into three types: cephalalgia, cephalea, and heterocrania.<ref name=Waldman2011>{{cite book|vauthors=Waldman SD|title=Pain management|year=2011|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=978-1-4377-3603-8|pages=2122–2124|url=https://books.google.com/books?id=O6AojTbeXoEC&pg=PT2122|edition=2|access-date=24 September 2016|archive-date=23 August 2023|archive-url=https://web.archive.org/web/20230823052214/https://books.google.com/books?id=O6AojTbeXoEC&pg=PT2122|url-status=live}}</ref> [[Galen|Galen of Pergamon]] used the term hemicrania (half-head), from which the word migraine was eventually derived.<ref name=Waldman2011/> Galen also proposed that the pain arose from the meninges and blood vessels of the head.<ref name=Borsook2012/> Migraine was first divided into the two now used types&nbsp;– migraine with aura (''migraine ophthalmique'') and migraine without aura (''migraine vulgaire'') in 1887 by Louis Hyacinthe Thomas, a French librarian.<ref name=Borsook2012/> The mystical visions of [[Hildegard von Bingen]], which she described as "reflections of the living light", are consistent with the visual aura experienced during migraine attacks.<ref name="Distillations">{{cite web |title= Sex(ism), Drugs, and Migraines |date= 15 January 2019 |url= https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |website= Distillations |publisher= [[Science History Institute]] |access-date= 6 February 2020 |archive-date= 14 March 2021 |archive-url= https://web.archive.org/web/20210314045616/https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines |url-status= live }}</ref>

[[Image:Trepanated skull of a woman-P4140363-black.jpg|thumb|right|A [[trepanning|trepanated]] skull, from the [[Neolithic]]. The perimeter of the hole in the skull is rounded off by ingrowth of new bony tissue, indicating that the person survived the operation.]]
[[Trepanation]], the deliberate drilling of holes into a skull, was practiced as early as 7,000&nbsp;BCE.<ref name=Miller2005/> While sometimes people survived, many would have died from the procedure due to infection.<ref>{{cite book| vauthors = Margaret C, Simon M |title=Human osteology: in archaeology and forensic science|year=2002|publisher=Cambridge University Press|location=Cambridge [etc.]|isbn=978-0-521-69146-8|page=345|url=https://books.google.com/books?id=-UqAnk-n7wgC&pg=PA345|edition=Repr.|url-status=live|archive-url=https://web.archive.org/web/20130617062401/http://books.google.com/books?id=-UqAnk-n7wgC|archive-date=17 June 2013}}</ref> It was believed to work via "letting evil spirits escape".<ref>{{cite book| vauthors = Colen C |title=Neurosurgery|year=2008|publisher=Colen Publishing|isbn=978-1-935345-03-9|page=1|url=https://books.google.com/books?id=zHg53Gw0JrAC&pg=PA1}}</ref> [[William Harvey]] recommended trepanation as a treatment for migraine in the 17th century.<ref>{{cite book| vauthors = Daniel BT |title=Migraine|year=2010|publisher=AuthorHouse|location=Bloomington, IN|isbn=978-1-4490-6962-9|page=101|url=https://books.google.com/books?id=YSoSECeCudIC&pg=PA101|url-status=live|archive-url=https://web.archive.org/web/20170313073818/https://books.google.com/books?id=YSoSECeCudIC&pg=PA101|archive-date=13 March 2017}}</ref> The association between trepanation and headaches in ancient history may simply be a myth or unfounded speculation that originated several centuries later. In 1913, the world-famous American physician William Osler misinterpreted the French anthropologist and physician Paul Broca's words about a set of children's skulls from the Neolithic age that he found during the 1870s. These skulls presented no evident signs of fractures that could justify this complex surgery for mere medical reasons. Trepanation was probably born of superstitions, to remove "confined demons" inside the head, or to create healing or fortune talismans with the bone fragments removed from the skulls of the patients. However, Osler wanted to make Broca's theory more palatable to his modern audiences, and explained that trepanation procedures were used for mild conditions such as "infantile convulsions headache and various cerebral diseases believed to be caused by confined demons."<ref>{{cite book |vauthors=Butticè C |url=https://www.abc-clio.com/products/a6280c/ |title=What you need to know about headaches |publisher=Bloomsbury |date=April 2022 |isbn=978-1-4408-7531-1 |location=Santa Barbara, California |pages=29–30 |oclc=1259297708 |access-date=2 November 2022 |archive-date=28 November 2022 |archive-url=https://web.archive.org/web/20221128083152/https://www.abc-clio.com/products/a6280c/ |url-status=live }}</ref>

While many treatments for migraine have been attempted, it was not until 1868 that use of a substance that eventually turned out to be effective began.<ref name=Borsook2012/> This substance was the fungus [[ergot]] from which ergotamine was isolated in 1918<ref name=Hanson2011>{{cite journal | vauthors = Tfelt-Hansen PC, Koehler PJ | title = One hundred years of migraine research: major clinical and scientific observations from 1910 to 2010 | journal = Headache | volume = 51 | issue = 5 | pages = 752–78 | date = May 2011 | pmid = 21521208 | doi = 10.1111/j.1526-4610.2011.01892.x | s2cid = 31940152 }}</ref> and first used to treat migraine in 1925.<ref>{{cite journal | doi=10.1111/j.1468-2982.2008.01578.x | title=History of the Use of Ergotamine and Dihydroergotamine in Migraine from 1906 and Onward | date=2008 | journal=Cephalalgia | volume=28 | issue=8 | pages=877–886 | pmid=18460007 | vauthors = Tfelt-Hansen P, Koehler P }}</ref> [[Methysergide]] was developed in 1959 and the first triptan, [[sumatriptan]], was developed in 1988.<ref name=Hanson2011/> During the 20th century, with better study design, effective preventive measures were found and confirmed.<ref name=Borsook2012/>

== Society and culture ==
Migraine is a significant source of both medical costs and lost productivity. It has been estimated that migraine is the most costly neurological disorder in the European Community, costing more than {{Currency|27 billion|EUR|passthrough=yes}} per year.<ref name=EU2008>{{cite journal | vauthors = Stovner LJ, Andrée C | title = Impact of headache in Europe: a review for the Eurolight project | journal = The Journal of Headache and Pain | volume = 9 | issue = 3 | pages = 139–46 | date = June 2008 | pmid = 18418547 | pmc = 2386850 | doi = 10.1007/s10194-008-0038-6 }}</ref> In the United States, direct costs have been estimated at {{Currency|17 billion|USD|passthrough=yes}}, while indirect costs&nbsp;– such as missed or decreased ability to work&nbsp;– is estimated at {{Currency|15 billion|USD|linked=no|passthrough=yes}}.<ref name=EcoUSA2008>{{cite journal | vauthors = Mennini FS, Gitto L, Martelletti P | title = Improving care through health economics analyses: cost of illness and headache | journal = The Journal of Headache and Pain | volume = 9 | issue = 4 | pages = 199–206 | date = August 2008 | pmid = 18604472 | pmc = 3451939 | doi = 10.1007/s10194-008-0051-9 }}</ref> Nearly a tenth of the direct cost is due to the cost of [[triptans]].<ref name=EcoUSA2008/> In those who do attend work during a migraine attack, effectiveness is decreased by around a third.<ref name=EU2008/> Negative effects also frequently occur for a person's family.<ref name=EU2008/>

== Demographics ==
Statistical data indicates that women are more prone to having migraine, showing migraine incidence three times higher among women than men.<ref>{{cite journal | vauthors = Artero-Morales M, González-Rodríguez S, Ferrer-Montiel A | title = TRP Channels as Potential Targets for Sex-Related Differences in Migraine Pain | journal = Frontiers in Molecular Biosciences | volume = 5 | article-number = 73 |year = 2018 | pmid = 30155469 | pmc = 6102492 | doi = 10.3389/fmolb.2018.00073 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Stewart WF, Lipton RB, Celentano DD, Reed ML | title = Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors | journal = JAMA | volume = 267 | issue = 1 | pages = 64–69 | date = January 1992 | pmid = 1727198 | doi = 10.1001/jama.1992.03480010072027 }}</ref> The [[Society for Women's Health Research]] has also mentioned hormonal influences, mainly estrogen, as having a considerable role in provoking migraine pain. Studies and research related to the sex dependencies of migraine are ongoing, and conclusions have yet to be achieved.<ref>{{cite web|date=28 August 2018|title=Speeding Progress in Migraine Requires Unraveling Sex Differences|url=https://swhr.org/speeding-progress-in-migraine-requires-unraveling-sex-differences/|access-date=17 March 2021|publisher=Society for Women's Health Research|archive-date=18 June 2020|archive-url=https://web.archive.org/web/20200618070625/https://swhr.org/speeding-progress-in-migraine-requires-unraveling-sex-differences/|url-status=live}}</ref>
{{Clear}}

== See also ==
* [[List of investigational headache and migraine drugs]]

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite journal | vauthors = Ashina M | title = Migraine | journal = The New England Journal of Medicine | volume = 383 | issue = 19 | pages = 1866–1876 | date = November 2020 | pmid = 33211930 | doi = 10.1056/nejmra1915327 | s2cid = 227078662 | veditors = Ropper AH }}
* {{cite journal | vauthors = Oskoui M, Pringsheim T, Billinghurst L, Potrebic S, Gersz EM, Gloss D, Holler-Managan Y, Leininger E, Licking N, Mack K, Powers SW, Sowell M, Victorio MC, Yonker M, Zanitsch H, Hershey AD | title = Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society | journal = Neurology | volume = 93 | issue = 11 | pages = 500–509 | date = September 2019 | pmid = 31413170 | pmc = 6746206 | doi = 10.1212/WNL.0000000000008105 }}
* {{cite journal | vauthors = Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, Hershey AD, Licking N, Sowell M, Victorio MC, Gersz EM, Leininger E, Zanitsch H, Yonker M, Mack K | title = Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society | journal = Neurology | volume = 93 | issue = 11 | pages = 487–499 | date = September 2019 | pmid = 31413171 | doi = 10.1212/WNL.0000000000008095| s2cid = 199662718 | doi-access = free | title-link = doi }}
{{refend}}

== External links ==
{{offline|med}}
{{external media | width = 210px | headerimage= | audio1 = [https://www.sciencehistory.org/distillations/podcast/sexism-drugs-and-migraines Sex(ism), Drugs, and Migraines], ''Distillations'' Podcast, [[Science History Institute]], 15 January 2019}}

{{Medical condition classification and resources
 |DiseasesDB     = 8207  <!-- note that the formatting in this parameter and in DiseasesDB_mult is done as such to allow the word "Migraine" to appear next to the first entry! -->
 |DiseasesDB_mult = {{DiseasesDB2|31876}} {{DiseasesDB2|4693}}
 |ICD11          = {{ICD11|8A80}}
 |ICD10          = {{ICD10|G43}}
 |ICD9           = {{ICD9|346}}
 |OMIM           = 157300
 |MedlinePlus    = 000709
 |eMedicineSubj  = neuro
 |eMedicineTopic = 218
 |eMedicine_mult = {{eMedicine2|neuro|517}} {{eMedicine2|emerg|230}} {{eMedicine2|neuro|529}}
 | MeshID        = D008881
 |}}

{{Diseases of the nervous system}}
{{Headache}}
{{Antimigraine preparations}}
{{Portal bar | Medicine}}
{{Authority control}}

[[Category:Migraine| ]]
[[Category:Wikipedia medicine articles ready to translate (full)]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Ailments of unknown cause]] <!-- per the first sentence in the section "Causes" -->