Migraine is not just a headache. Migraine is a neurological condition that can cause intense, disabling head pain along with many other symptoms. On average, most people with migraine experience episodic attacks two to four times a month. Some people have attacks more frequently. About 2.5 percent of people progress to chronic migraine, meaning they experience symptoms at least 15 days out of every month.

Talking About Migraine

It can help to understand the terms associated with migraine. Although people commonly refer to migraine headaches as “migraines,” the medical world calls episodes of migraine symptoms “migraine attacks.” The singular word “migraine” is preferred over “migraines” and is used to talk about the disease as a whole.

People with migraine are sometimes referred to as migraineurs. Migraine is often treated by a neurologist — a specialist in disorders of the nervous system, including the brain and nerves. However, migraine is often diagnosed (and may be treated) by a general practitioner, family doctor, or other healthcare professional.

The History of Migraine

Migraine and headaches have been reported and studied during every period of history. Hippocrates wrote of migraine and visual auras in medical journals dating from 400 B.C.E. Hua T’o, a surgeon during the Han Dynasty in China, treated the emperor’s migraine attacks with acupuncture.

In the second century, the ancient Greek physician Galen distinguished migraine headaches from common headaches, calling them hemicrania, meaning “half skull.” Later, the word entered the French lexicon and was corrupted to “migraine.”

English clinician Thomas Willis introduced the term “neurology” in 1672. Willis is credited as the founder of modern brain anatomy and clinical neurology, and he categorized many causes of migraine attacks, including heredity, changes in season, and diet.

History of Migraine Treatment

Throughout history, theories about the cause of migraine have been based on superstition, and many painful, sometimes potentially fatal, migraine “cures” were used.

Anthropologists studying skulls from 9,000 years ago found evidence of trepanation (drilling holes into the skull). Sometimes called trephination, this procedure may have been performed to treat migraine, epilepsy, and mental illness. Some historians theorize that trepanation sought to release evil spirits believed to be trapped in the skull and causing the symptoms.

In the Middle Ages, migraine treatments included:

• Bloodletting with leeches
• Cauterization (using heat to seal a wound) with a hot iron
• Placement of garlic into fresh skin incisions

Later, attempted migraine treatments included oil in the ears, electric shocks, radiation therapy, and lumbar puncture — piercing the membrane surrounding the spinal cord to release cerebrospinal fluid.

The Emergence of Modern Treatment

In the 1930s, American doctors John R. Graham and Harold G. Wolff published the vascular theory of migraine. According to vascular theory, the brain’s blood vessels dilate (widen) during migraine and cause pain and other symptoms. They used ergotamine, an ergot alkaloid drug, to cause vasoconstriction (narrowing of blood vessels) in the brain during migraine. Although newer treatments have largely replaced them, some ergot alkaloids — particularly dihydroergotamine — are still used to treat migraine today.

Triptans, another class of vasoconstricting drugs, were developed in the 1990s. Triptans are used for the acute treatment of migraine attacks (also called abortive treatment).

The genetic theory of migraine gained support in 2012 when researchers showed that migraine is linked to specific genes. Current research indicates that inherited factors may account for as much as 30 percent to 60 percent of the risk of developing migraine.

Over the past 20 years, people with migraine began to report relief from their symptoms while taking medicines for unrelated conditions. To treat migraine, doctors used to prescribe drugs such as the following off-label (not for the approved purpose):

• Medications for epilepsy and depression
• Cosmetic onabotulinumtoxinA (Botox) injections
• Beta-blockers for heart conditions

Eventually, several of these “borrowed” drugs for migraine were approved by the U.S. Food and Drug Administration (FDA) to treat migraine.

Historical People Who Experienced Migraine

Notable historical and cultural figures who experienced migraine include:

• Napoleon Bonaparte
• Julius Caesar
• Lewis Carroll
• Charles Darwin
• Albert Einstein
• Sigmund Freud
• Ulysses S. Grant
• Thomas Jefferson
• John F. Kennedy
• Blaise Pascal
• Elvis Presley
• Elizabeth Taylor

The Dutch artist Vincent van Gogh, also a migraineur, painted auralike forms in some of his works.

How Common Is Migraine?

Across the globe, more than 1 billion people — over 10 percent of the population — live with migraine. These facts help illustrate just how common this condition is:

• Most people with migraine experience an average of two to four migraine attacks per month.
• About 2.5 percent of people with episodic migraine will progress to chronic migraine, experiencing symptoms 15 or more days out of a month.
• Anyone, including children, can develop migraine, but women are three times more likely to experience migraine than men, according to JAMA.
• Around 17 percent of women in the United States have symptoms of migraine, per JAMA.
• Migraine most often affects people between 20 and 50 years old.

Symptoms of Migraine

The most common migraine symptom is intense head pain. Migraine pain may be felt in different ways. Besides migraine headache, symptoms can include fatigue, nausea, vomiting, numbness, weakness, uncontrollable movements, depression, and mood swings.

Phases of Migraine

Most doctors describe migraine attacks as having four distinct phases. However, people living with migraine don’t necessarily experience all four phases with every migraine attack. Understanding the phases of migraine can help people better manage this condition by timing treatments for maximum effectiveness.

Causes of Migraine

Scientists don’t yet know what causes migraine, but it may involve changes in the brainstem — the lowest part of the brain, just above the spinal cord. Migraine also seems to be connected to altered levels of chemicals, known as neurotransmitters, that transfer electrical impulses between cells.

In many people, migraine triggers may include stress, bright lights, a missed meal, sleep disturbance, alcohol, certain foods, or hormone fluctuations in the menstrual cycle. People with a family history of migraine are much more likely to develop the condition.

Types of Migraine

The two most common types of migraine are defined by the presence or lack of an aura — an abnormal feeling, visual or auditory disturbance, or smell that occurs before or during a migraine headache. Most people experience migraine either with or without aura. It’s rare but possible to get a migraine aura without headache pain.

Other specific types of migraine may be classified by unique symptoms:

• Abdominal migraine — Pain is concentrated in the abdomen.
• Hemiplegic migraine — Numbness and weakness affect one side of the body.
• Menstrual migraine — This type tends to occur at regular times during the menstrual cycle.

It’s possible to get more than one type of migraine.

Diagnosis of Migraine

There’s no one conclusive test for diagnosing migraine. Migraine is typically diagnosed by a physician using a combination of a neurological and physical exam, a history of symptoms, and a family medical history. The doctor may also order blood tests, imaging tests such as CT or MRI scans, or a lumbar puncture (spinal tap) to rule out other potential causes of symptoms.

Treatment of Migraine

There are two main types of migraine treatment options. The first is preventive medication, taken regularly to help keep a migraine from starting. The second is abortive (symptomatic) treatment, taken when you’re experiencing a migraine attack.

Preventive Treatment

Treatments for migraine prevention come in many forms. Examples of preventive treatment include:

• Beta-blockers
• Antidepressants such as amitriptyline and venlafaxine
• Anticonvulsants (anti-seizure medications), such as topiramate and divalproex sodium
• Antihypertensives (blood pressure drugs)
• OnabotulinumtoxinA injections in people with chronic migraine
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies in people who haven’t responded to other treatments
• Nutritional and herbal supplements, such as riboflavin and magnesium oxide or magnesium citrate
• Lifestyle changes, such as avoiding known triggers

Abortive Treatment

Once a migraine attack has started, it may be treated with multiple types of abortive treatments, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Acetaminophen
• Ergots
• Triptans
• Antiemetic (anti-nausea) drugs in addition to pain medicine
• Neuromodulation (delivery of electrical or magnetic pulses to a specific location to reduce nerve activity)
• CGRP, which can be used in treatment as well as prevention

Abortive therapy is usually most effective when used right when a migraine attack begins.

Alternative Treatment

Some people with migraine participate in clinical trials or try complementary or alternative approaches, such as relaxation training or cognitive behavioral therapy.

Life Expectancy With Migraine

On average, people with migraine live a normal lifespan and die from the same conditions that cause death in most people, including cancer and cardiovascular disease.

According to a 2016 article in The BMJ, some studies have found an increased risk of stroke in women with migraine, especially those who get migraine with aura. The risk of stroke was highest in women with additional risk factors for stroke, such as smoking, taking oral birth control, or having high blood pressure. If you’re concerned about your risk of stroke, ask your doctor to evaluate your risk and help you take steps to lower it.

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 84,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you been diagnosed with migraine? What advice do you have for others living with this condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.