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What causes migraines? Diagnosis, prevention, and treatment

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Oct. 27, 2023  •  Published Mar. 28, 2023
Fact Checked
Migraines causes

Overview: What are migraines?

Migraine is a common headache disorder that is characterized by moderate or severe headaches, primarily affecting one side of the head. These headaches are also accompanied by other migraine symptoms, such as nausea, vomiting, light sensitivity, vision changes, and other problems. 

Like all headaches, migraines reduce quality of life. However, migraines can be so severe or last so long that they cause people to be disabled by them. Healthcare professionals consider migraine to be a complex neurological disorder that is partly genetic in origin. Fortunately, not only are there a host of medications that can treat or prevent migraines, but lifestyle changes can have a big impact on reducing their frequency and severity as well. 

RELATED: What is a migraine? Your guide to talking about the condition

Key takeaways:

  • Migraines are a common health condition that mostly affect women, but can affect anyone, regardless of age, sex, race, or ethnicity. Find updated migraines statistics here.

  • While the cause is not entirely understood, healthcare professionals believe that migraines are caused by disruptions in the nervous system that result in a cascade of problems, including nerve swelling and blood vessel constriction.

  • Risk factors for migraines include a family history of migraines, female gender, alcohol abuse, or middle age.  

  • Symptoms of migraines include moderate to severe head pain, usually on one side of the head, nausea, vomiting, and sensitivity to light, sound, or smell. Sometimes, migraines are preceded by sensory abnormalities, called “aura.”

  • Migraine usually requires a medical diagnosis.

  • Migraines generally require treatment. They typically improve with a variety of treatments designed to either relieve migraine attacks or prevent them from occurring.

  • Treatment of migraines may include medications that relieve migraine attacks, such as pain relievers, or medications that prevent migraines from happening. Lifestyle changes are a key component in reducing the severity and frequency of migraines. Read more about migraine treatments here.

  • Migraines are preventable by avoiding triggers, managing stress, changing lifestyle habits, making changes to the diet, and taking prescription medications that prevent migraines.

  • Use coupons for migraine treatments, such as Imitrex (sumatriptan), Topamax (topiramate), Aimovig (erenumab), Emgality, and Nurtec ODT (rimegepant), to save up to 80%.

What causes migraines?

The causes of migraines are not fully understood. The current thinking is that migraines are a neurological disorder primarily of the central nervous system (the brain and spine), but involve other nerves as well. Whatever the problem is, it’s usually inherited. The majority of people who get migraines have relatives that also get them. 

For people with migraines, the most important question is not what causes migraines, but what triggers a migraine episode. The answer varies from person to person. While some people will have only one or two migraine triggers, most people will have several. Some can have as many as 14 or 15 different things that trigger an attack. The most common triggers are:

  • Stress (80%)

  • Hormone changes due to the menstrual cycle, birth control, menopause, or estrogen hormone replacement therapy (65% of women)

  • Missed meals (57%)

  • Weather changes (53%)

  • Sleep problems (50%)

  • Strong smells like perfume (43%)

  • Neck pain (38%)

  • Flashing lights or bright lights (38%)

  • Drinking alcohol, such as red wine (38%)

  • Smoking (36%)

  • Oversleeping (32%)

  • Heat (30%)

  • Food (27%)

  • Exercise or physical fatigue (22%)

  • Sexual activity (5%)

  • Loud noises

Foods that commonly trigger migraines include chocolate, soft cheeses, aged cheeses, and anything that contains monosodium glutamate (MSG) or artificial sweeteners, such as aspartame.

Risk factors for migraines

The most predictive risk factor for migraines is having relatives with migraines. Other migraine risk factors include:

Are migraines serious?

Migraines are serious enough to significantly interfere with daily functioning, sometimes severely. That’s reason enough to see a doctor. First, migraine episodes may become more frequent and severe. Second, self-treating migraines with over-the-counter pain relievers might lead to medication overuse headaches—rebound headaches that occur when the medication wears off.

Should you go to an emergency room with a migraine? Many people do. According to the American Migraine Foundation, headaches are one of the most common reasons people go to the ER. With migraines, go to the ER if there are any neurological symptoms that haven’t been experienced before, such as vision changes, weakness on one side of the body, dizziness, or mental changes like confusion. They may be signs of a more serious problem.

RELATED: How long do migraines last?

How are migraines diagnosed?

Migraine is primarily diagnosed from the symptoms. According to the International Classification of Headache Disorders, the criteria for diagnosing migraine include:

  • At least five headache episodes that last four to 72 hours that have at least two of the following characteristics: moderate to severe pain, throbbing pain, unilateral location (on one side of the head), or headache worsened by physical activity

  • At least one other symptom, such as nausea, sound sensitivity, or light sensitivity

A diagnosis of migraine with aura is made when people experience migraines at least twice with aura symptoms preceding the headache. 

The doctor will then determine if the problem is episodic migraine (fewer than 14 episodes a month) or chronic migraine (15 or more episodes per month).

To prepare for a doctor’s visit, keep a headache diary that includes:

  • When each headache occurs

  • What you were doing before the episode

  • The symptoms experienced and their sequence

  • The pain level

  • How long the pain lasts

  • Medications that are taken to treat the headache

  • What seems to make the headache worse

  • What seems to make the headache better

  • What it feels like after the headache passes

If you can, try to think of any family members who experience migraine headaches and ask about their experience. 

Are migraines hereditary?

Migraines are strongly linked with genetics. About 80% of people with migraine have a first-degree relative—father, mother, sister, brother, or child—with the same problem. Many genes are involved, but one type, hemiplegic migraine, is thought to be due to a single gene.

Are migraines curable?

Migraines are not curable, but they are manageable. Most people will require some treatment, even if it involves nothing more than over-the-counter pain relievers, such as acetaminophen or ibuprofen. Some over-the-counter migraine pain relievers include caffeine, which can also help relieve symptoms.

Healthcare professionals typically prescribe NSAIDs, triptans, or combination drugs to treat migraine episodes. If these don’t work, backup drugs include ergot drugs, anticonvulsants, and opioids. 

To prevent migraines, healthcare providers usually prescribe regular dosing with beta blockers, antidepressants, or anticonvulsants. For more chronic or recalcitrant migraines, a doctor may prescribe more expensive CGRP inhibitors, which prevent blood vessels from tightening. CGRP inhibitors come in the form of either antibodies, such as Aimovig (erenumab), or small molecules, such as Ubrelvy (ubrogepant). Chronic migraine may be treated with Botox injections to deaden facial nerves.

RELATED: What you should know about migraine

How to prevent migraines

An essential part of migraine treatment involves lifestyle modifications. These include:

  • Keeping a headache diary to identify possible triggers

  • Avoiding known triggers

  • Not skipping meals

  • Eating a healthy diet

  • Avoiding hormonal birth control

  • Practicing good sleep hygiene to get a full night’s sleep

  • Practicing stress management daily through relaxation exercises, meditation, and yoga

  • Avoiding alcohol and caffeine

Most importantly, manage the triggers and risk factors

Migraines are not caused by triggers or risk factors, but they can be brought on by them. Some are unavoidable, like genetics, weather changes, or hormone disruptions. Most, however, are avoidable. The first step is to adopt healthy lifestyle habits, such as maintaining a healthy weight, sleeping well, eating well, managing stress, relaxing, and staying away from smoking and drinking. The second step is to avoid triggers. Keep a headache diary or calendar. Record what happens in the days before an attack, like missing a meal or feeling anxious. Once triggers are identified, avoid them. If handling stress and anxiety is difficult for you, then get medical advice from a cognitive behavioral therapist or a psychiatrist. 

RELATED: The best diet for migraine

FAQs about migraines causes

What causes ocular migraines?

An ocular migraine is a type of migraine that affects vision, usually causing blurred vision, blind spots, or flashing lights.  These vision changes can happen at any time during a migraine episode, from the early warning signs period to the headache itself. Healthcare professionals believe that ocular migraine symptoms are caused by blood vessel constriction or spasms interrupting blood flow to the eye and retina.

What causes chronic migraines?

While chronic migraine often develops in people who already have episodic migraines, healthcare professionals consider it to be a distinct illness. The exact cause is poorly understood. However, there are modifiable risk factors, such as excess weight, caffeine use, alcohol, pain reliever overuse, and stress. They don’t “cause” chronic migraine, but they do contribute to the problem.

RELATED: How I learned to manage my chronic migraines

What is the main cause of vestibular migraines?

Vestibular migraines affect the inner ear, so migraine symptoms can also include dizziness, loss of balance, and vertigo on top of other common migraine symptoms. In some vestibular migraine episodes, these inner ear symptoms may be the only migraine symptoms. Healthcare researchers are perplexed when it comes to the cause of vestibular migraines. Because vestibular migraines may be due to other causes, doctors are careful when diagnosing and monitoring this type of migraine.

Are migraines caused by stress?

Stress is the most common trigger of migraine episodes. The effect of stress is usually delayed. One study found that migraine episodes are closely linked to stressful events occurring at any time starting four days before the attack. Stress management, then, is a key component for preventing migraines. For people who have problems with stress or anxiety, the most workable solutions may be cognitive behavioral therapy, biofeedback, or anxiety medications.

What neurological conditions cause migraines?

Migraine is a neurological condition. It is, however, associated with other neurological disorders. In particular, there is a strong correlation between migraine and multiple sclerosis, another neurological problem characterized by nerve swelling. Migraines are frequently an early symptom of MS.

What’s next? Additional resources for people with migraines

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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