This informational guide, part of POPSUGAR's Condition Center [1], lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

If you've ever had one, you know: migraines are not just bad headaches. They're a neurological disease, and while symptoms vary between people, they're generally characterized by throbbing head pain that's so intense, it can be disabling. Unfortunately, however, many of those who experience migraines report feeling dismissed by people — including clinicians [2] — who don't grasp how serious and painful the condition is. And the stigma that migraines aren't "that bad" can keep people who experience them from getting the help they need. That's why it's essential to understand what migraines really are and how they can best be treated.

Understanding Migraines

What's actually going on in the brain to cause migraine symptoms still isn't fully understood. The most up-to-date thinking is that people who experience migraines may have excitable cells in certain parts of the brain [3] that cause blood vessels to narrow, leading to pain and other issues. Along with throbbing pain, often on one side of your head, migraine symptoms [4] may include nausea, vomiting, and sensitivity to light or sound and can last from four to 72 hours. Additionally, in the day or two before a migraine starts, you may notice subtle warning signs that an episode is coming, including moodiness, food cravings, neck stiffness, or frequent yawning. Some people also experience migraines with visual disturbances known as auras, which can look like zigzag lines or flashing lights and are a telltale sign that a migraine is imminent. In the day or two after an attack, you might feel drained or cognitively muddled.

There are different types of migraines [5]. Most can be considered episodic, which means they occur between zero to 14 days out of the month. Chronic migraines, on the other hand, occur 15 days or more per month and may require a different treatment plan.

Causes of Migraine Pain

While researchers are still narrowing in on the actual source of the neurological disorder, there's plenty of information [6] on the different factors that may set off symptoms.

• Most people with migraines have specific triggers that reliably set off an attack hours or days later. Common triggers [7] include stress, alcohol use, weather changes, a disrupted sleep routine, certain foods or food additives, intense physical activity, and certain medications. But these are individual; one person's triggers won't necessarily bother another.
• Fluctuations in hormone levels seem to play a significant role in migraine pain. For some people, the drop in the hormone estrogen (and peak in prostaglandins, which are fatty compounds with hormone-like qualities) that occurs at the beginning of their periods can trigger migraines, also known as menstrual migraines, says Chethan Rao, MD [8], associate professor of neurology and neurosurgery at Baylor College of Medicine. "Levels of [the brain chemical] serotonin increase when estrogen drops, and that plays a role in migraine attacks, too," he adds. The hormone connection may partially explain why cis women are up to three times as likely [9] as cis men to experience migraines and why some small studies indicate trans women taking hormone-replacement therapy can experience an increase in migraine frequency [10] as well.
• Gender-affirming surgery may also be associated with more migraines, though more research needs to be conducted before experts can say for sure. The American Migraine Foundation points out that immediately after hysterectomies and oophorectomies (surgeries that remove the uterus and ovaries, respectively), cisgender patients have reported an increase in the frequency of migraine attacks. Anna Pace, MD, director of the Transgender Headache Medicine Program at Mount Sinai, told the American Migraine Foundation [11] the same may be true for people who undergo the procedures as part of gender-affirming care. But, she added, migraine treatment should help counteract this issue.
• Having a family history of migraines or other medical conditions — such as depression, bipolar disorder, sleep disorders, or epilepsy — can make you more likely to experience migraines in your lifetime.

The Most Effective Migraine Treatments

When you feel a migraine coming on, you may be able to nip it in the bud by relaxing in a dark, quiet room (and napping, if possible); applying cold or hot compresses to your neck or head; and taking an over-the-counter pain reliever, such as acetaminophen or aspirin, with a small caffeinated beverage, which can enhance the effects of the medication. There are also a number of prescription meds you can take during an attack, including triptans, which diminish the effect of serotonin in the brain, Dr. Rao says. But you need to be careful not to use them too often, or they can cause a medication-overuse headache, sometimes called a rebound headache, Dr. Rao says.

That said, the best migraine treatment is prevention. "People who are prone to migraines can make lifestyle changes that may help prevent attacks," Dr. Rao says. One of the most effective steps migraineurs can take is to try to stick to a daily routine, aiming to wake up, eat meals [12], exercise [13], and go to bed at roughly the same time every day, he says. Inconsistent sleep and spikes in stress, in particular, are common triggers for migraines, so sticking to a regular schedule can go a long way in reducing the frequency of attacks.

People with migraines should also make it a priority to identify their specific triggers, Dr. Rao adds. To pinpoint what sets off your migraines, many doctors will suggest keeping a journal. Log your diet and general lifestyle habits daily, and when you have an attack, look back to see if anything pops out — had you been drinking alcohol in the few days before? Was there a thunderstorm? Did you spend time with a friend who's always drenched in perfume? Once you know what your triggers are, you can begin to avoid or plan around them.

Practicing mindfulness meditation, which bolsters your ability to cope with stress, can help, too. It can diminish the number of headaches, reduce pain and disability, and improve quality of life in people with migraines, according to a 2020 study published in the Journal of the American Medical Association [14].

If you have three or more severe migraines a month — ones that interfere with your ability to do your usual daily activities — you're a candidate for preventive medications, like blood-pressure medication, antiseizure drugs, monoclonal antibodies, and hormone therapy. Dr. Rao adds, "Migraines can be effectively managed, but if you have lots of them, it's best to work with a neurologist who has a thorough understanding of the condition."