What Should You Do When a Migraine Strikes?
Take acute medication as early as possible — ideally within the first 30 minutes of symptom onset. Rest in a quiet, dark room. Apply a cold compress to your forehead or neck. Stay hydrated and avoid known triggers. If you experience migraines frequently, talk to your doctor about preventive treatment options.
Early treatment is the single most important factor in effectively managing an acute migraine attack. Research published in Headache journal shows that taking triptans or other acute medications during the mild pain phase results in significantly better outcomes than waiting until pain becomes severe. If you have a prescription triptan like sumatriptan (Imitrex), rizatriptan (Maxalt), or eletriptan (Relpax), take it at the first sign of migraine pain. For mild attacks, over-the-counter options including ibuprofen (400 to 600 mg), naproxen sodium (500 mg), or aspirin (900 to 1,000 mg) with caffeine can be effective.
Environmental modifications provide important supportive relief. Retreat to a dark, quiet room since light and sound sensitivity are hallmark migraine features. Apply a cold pack to your forehead, temples, or the back of your neck for 15 to 20 minutes at a time. Drink water, as dehydration can worsen migraine symptoms. Caffeine in small amounts (about 100 mg, roughly one cup of coffee) can enhance the effectiveness of pain relievers, which is why it is included in some combination medications like Excedrin Migraine. However, regular caffeine use can lead to rebound headaches.
What Are Migraines and What Causes Them?
Migraines are a complex neurological condition involving abnormal brain activity, neurotransmitter changes, and activation of the trigeminovascular system. They are not simply bad headaches. Genetics play a major role, with about 70 to 80 percent of migraine sufferers having a family history of the condition.
Modern neuroscience has revealed that migraines involve a cascade of neurological events. The process begins with cortical spreading depression, a wave of electrical activity that sweeps across the brain cortex. This activates the trigeminovascular system, which releases calcitonin gene-related peptide (CGRP) and other neuropeptides that cause inflammation and dilation of blood vessels in the meninges, producing the characteristic throbbing pain. This understanding of CGRP's role led to the development of an entirely new class of preventive and acute migraine medications.
Migraine triggers are factors that can initiate this cascade in susceptible individuals. The most commonly reported triggers include emotional stress (reported by about 70 percent of migraineurs), hormonal changes in women (especially estrogen fluctuations around menstruation), irregular sleep patterns, skipping meals, weather changes (particularly barometric pressure drops), bright or flickering lights, strong odors, and certain foods and beverages. The American Migraine Foundation emphasizes that triggers are cumulative — a single trigger may not cause a migraine, but several triggers occurring together can push past the threshold.
Research shows about 70 to 80 percent of people with migraines have a first-degree relative with the condition
What Are the Symptoms of a Migraine?
Migraines typically cause moderate to severe throbbing pain on one side of the head lasting 4 to 72 hours, accompanied by nausea, vomiting, and sensitivity to light and sound. About 25 to 30 percent of people experience an aura — visual disturbances, tingling, or speech changes — before the headache begins.
A migraine attack progresses through up to four phases, though not everyone experiences all phases. The prodrome phase occurs hours to days before the headache and may include mood changes, food cravings, neck stiffness, increased yawning, frequent urination, or constipation. The aura phase, present in 25 to 30 percent of migraineurs, involves reversible neurological symptoms that develop over 5 to 20 minutes and last less than 60 minutes. Visual auras are most common, appearing as zigzag lines, blind spots, flashing lights, or shimmering spots. Sensory auras cause tingling or numbness, typically starting in the hand and spreading up the arm to the face.
The headache phase is characterized by moderate to severe throbbing or pulsating pain, usually unilateral though it can be bilateral. Pain is typically worsened by physical activity and accompanied by nausea (present in up to 80 percent of attacks), vomiting, photophobia (light sensitivity), and phonophobia (sound sensitivity). Some people also experience osmophobia (sensitivity to smells) and allodynia (pain from normally non-painful stimuli like brushing hair). The postdrome phase follows the headache and can last 24 to 48 hours, with fatigue, difficulty concentrating, and mood changes often described as a migraine hangover.
What Are the Treatment Options for Migraines?
Migraine treatment includes acute medications to stop attacks in progress and preventive medications to reduce attack frequency. Triptans are the first-line acute treatment. For prevention, beta-blockers, antidepressants, anticonvulsants, and the newer CGRP inhibitors are evidence-based options.
Acute treatment aims to abort a migraine attack quickly and completely. Triptans — including sumatriptan, rizatriptan, eletriptan, and zolmitriptan — are selective serotonin receptor agonists that constrict dilated blood vessels and block pain pathways. They are effective in 60 to 70 percent of patients when taken early. Newer acute options include CGRP receptor antagonists (gepants) such as ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT), which work without the vasoconstriction of triptans, making them suitable for patients with cardiovascular risk factors. Lasmiditan (Reyvow), a serotonin 1F receptor agonist, is another non-vasoconstrictive option.
Preventive treatment is recommended for patients experiencing four or more migraine days per month, when acute medications are not sufficiently effective, or when migraines significantly impair quality of life. Traditional preventive medications include beta-blockers (propranolol, metoprolol), antidepressants (amitriptyline, venlafaxine), and anticonvulsants (topiramate, valproate). The CGRP monoclonal antibodies — erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti) — represent a major advancement as the first medications specifically developed for migraine prevention. Clinical trials show they reduce monthly migraine days by 50 percent or more in a substantial proportion of patients.
Phase 3 trials of CGRP monoclonal antibodies demonstrated a 50 percent or greater reduction in monthly migraine days
How Can You Prevent Migraines?
Migraine prevention combines lifestyle modifications with preventive medications when needed. Maintaining regular sleep schedules, managing stress, staying hydrated, exercising regularly, and avoiding identified triggers can significantly reduce migraine frequency without medication.
Lifestyle modifications are the foundation of migraine prevention. The American Headache Society recommends maintaining consistent sleep and wake times, including on weekends, since both too little and too much sleep can trigger migraines. Regular aerobic exercise of at least 150 minutes per week has been shown to reduce migraine frequency comparably to topiramate in randomized trials. Stress management through cognitive behavioral therapy, biofeedback, or mindfulness meditation has strong evidence for migraine prevention. Staying well-hydrated and not skipping meals helps maintain metabolic stability.
Keeping a migraine diary is essential for identifying personal triggers and assessing treatment effectiveness. Record the date, time, duration, and severity of each attack, along with potential triggers, medications taken, and their effectiveness. Many smartphone apps like Migraine Buddy can simplify this process. After several months, patterns often emerge that guide targeted prevention strategies. The American Migraine Foundation recommends sharing your diary with your healthcare provider at each visit to optimize your treatment plan.
When Should You See a Doctor for Headaches?
See a doctor if headaches are increasing in frequency or severity, if over-the-counter medications no longer provide relief, if headaches interfere with work or daily life, or if you use acute headache medications more than two days per week. Seek emergency care for sudden severe headaches or headaches with neurological symptoms.
While many people manage occasional migraines independently, professional evaluation is important when the pattern changes. A new headache type in someone over 50, progressively worsening headaches over weeks, or headaches that wake you from sleep deserve medical attention. Using acute pain medications more than 10 to 15 days per month can paradoxically cause medication overuse headache, a vicious cycle that requires medical intervention to break. Your primary care provider can manage most migraine cases, but referral to a headache specialist or neurologist is appropriate for complex or treatment-resistant cases.
Certain headache features are red flags requiring immediate emergency evaluation. A sudden thunderclap headache reaching maximum intensity within seconds could signal a subarachnoid hemorrhage. Headache with fever and neck stiffness may indicate meningitis. Headache following head trauma could indicate intracranial bleeding. New headache with confusion, vision changes, weakness, or numbness on one side warrants urgent evaluation to rule out stroke. The mnemonic SNOOP helps remember red flags: Systemic symptoms, Neurological signs, Onset sudden, Older age of onset, and Pattern change.
