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Migraine

Migraine is much more than a bad headache. Knowing your phases, your triggers and the newer treatment options helps — and a few warning signs, especially around aura, need emergency care.

Call 911 or go to the emergency room now if a headache comes with any of these:

Don’t drive yourself — call 911 so treatment can start on the way, and note when symptoms began (CDC).

Get urgent medical advice the same day if aura symptoms last longer than 1 hour (NHS), or your headaches get worse over days or weeks or change in pattern (NINDS). See your doctor soon if attacks are severe, getting worse, lasting longer than usual, happening more than once a week, or hard to control (NHS). If you are pregnant, see “Migraine and pregnancy” below.

Don’t wait for a chiropractic, acupuncture or massage appointment for any of these.

What migraine is

Migraine is more than a bad headache: attacks often bring moderate to severe throbbing pain, usually on one side, with nausea, vomiting and sensitivity to light, noise and smells (NINDS). Attacks usually last 4 hours to 3 days (NHS). Researchers believe migraine has a genetic cause, and most people with it have relatives who have it too (MedlinePlus). There is no cure yet, but treatment can help manage symptoms (NINDS).

For headaches in general — tension-type, cluster, “sinus” and neck-related — see our Headaches guide.

How common is migraine?

  • About 12% of Americans get migraines, and women are three times more likely than men to have them (MedlinePlus, NCCIH).
  • In a 2018 CDC national survey, 20.1% of women and 10.6% of men said they had a severe headache or migraine in the past 3 months. It was most common in younger adults: 25.5% of women and 12.3% of men aged 18–44, falling to 7.6% and 4.0% at age 75 and older (CDC).
  • Worldwide, migraine ranked third among causes of disability-adjusted life years in 2021, after stroke and a newborn brain condition (neonatal encephalopathy) (WHO).

How migraine is diagnosed

Diagnosis rests mainly on your story and an exam. A doctor reviews your health history, does a physical and neurological exam and asks when headaches start, how long they last, what they feel like, what triggers them and what other symptoms come with them. MRI or CT scans aren’t usually needed, but may be ordered if another condition is suspected (NINDS). Headaches are only considered migraine once the typical symptoms have happened at least five times (InformedHealth). A headache diary (see below) helps a lot.

Migraine and other conditions

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Pain relievers, triptans, gepants (ubrogepant, rimegepant, zavegepant) or lasmiditan for attacks; prevention with beta-blockers, topiramate, amitriptyline, CGRP antibodies, atogepant or rimegepant, and onabotulinumtoxinA for chronic migraine; FDA-cleared nerve-stimulation devices. Cost estimate being researched. Finding the right preventive may take several tries. Acute medicines work best taken early, and using them too often causes more headaches.
Chiropractic Spinal manipulation, usually of the neck and upper back, to reduce migraine days. About $55–$100 a follow-up visit and $90–$200 for a first visit without insurance. Medicare covers only spinal adjustment for subluxation (20% coinsurance). Reviews disagree: one found a small, preliminary benefit; a newer one called it unproven. Mild soreness is common; neck manipulation carries a rare, debated stroke risk.
Acupuncture A course of needle treatments to prevent episodic migraine, alongside usual attack treatment. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A Cochrane review found fewer migraine days, a small edge over sham needling and results similar to preventive drugs, with fewer side effects. Few complications.
Herbal medicine PA-free butterbur, feverfew, magnesium, riboflavin (vitamin B2) and coenzyme Q10 studied for prevention. Cost estimate being researched. Small amounts of evidence. Butterbur has liver concerns; feverfew isn’t for pregnancy; magnesium for migraine only under medical supervision. Check every supplement with a pharmacist.
Massage therapy Relaxing massage of the back, neck, shoulders and head, mainly for stress and sleep. One national chain’s membership runs about $70–$90 a month, including one 60-minute session. A few small studies found fewer migraines, but evidence is limited and inconsistent. Low risk with a trained therapist.
MBHA Wellness Coach A headache diary, regular sleep and meals, fluids, steady caffeine, gentle exercise, stress skills and tracking pain-reliever days. Cost estimate being researched. Supports — never replaces — medical care. Steady routines and a diary are often a big part of fewer attacks.

Approach 1 of 6

Conventional medicine (AMA)

Treatment aims to relieve attacks and prevent new ones (NINDS). You may need to try a combination before finding what works (NHS). We don’t list doses; ask your doctor or pharmacist what is right for you.

During an attack, rest in a quiet, dark room with a cool cloth on your forehead and drink plenty of fluid; a little caffeine early on may help (NINDS).

Medicines for attacks

Preventive treatment

Prevention is usually offered if attacks happen once a week or more, or are severe (NINDS).

In 2024 the American Headache Society said these CGRP-targeting medicines should be a first-line option for prevention, without first having to fail older medicines, and that serious side effects are rare (AHS position statement, 2024).

Devices

Some prescription nerve-stimulation devices are FDA-authorized for migraine in adults: Cefaly, an electrical nerve stimulator, to prevent episodic migraine (2014) (FDA); Nerivio Migra, worn on the upper arm, for attacks in people without chronic migraine (2019) (FDA); gammaCore Sapphire, a vagus nerve stimulator held to the side of the neck, to treat and prevent migraine (FDA); sTMS mini, a magnetic stimulator held to the back of the head, for attacks of migraine with aura (FDA); and Relivion, worn on the head, for attacks with or without aura (FDA). Ask your doctor whether one suits you and whether insurance pays.

What it costs

Doctor visits, prescription medicines, injections and devices: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Spinal manipulation — a controlled force applied to a spinal joint by hand or with a device — is often used for headaches, but it’s uncertain whether it helps because studies have had contradictory results (NCCIH).

What the research says about migraine

In short: the evidence for migraine is limited and disputed. If you try chiropractic care, use it alongside your medical plan, not instead of it.

Safety

Mild soreness, stiffness or headache are common and usually go away within 24 hours. Neck manipulation has been linked to rare tears in neck arteries that can cause a stroke; the risk appears low and experts disagree about whether manipulation causes them, but you should be told about it (NCCIH). Because migraine with aura already carries a higher stroke risk (see “Migraine with aura, stroke and birth control” below), discuss this with your doctor first, and get any new or unusual headache or aura checked medically before an adjustment.

Coverage and cost

Medicare Part B covers only spinal adjustments to correct a subluxation, and you pay 20% after the deductible (Medicare.gov). Without insurance a follow-up visit costs about $55–$100 and a first visit about $90–$200 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

What the research says

A 2016 Cochrane review of 22 trials (4,985 adults with episodic migraine) found (Linde et al., Cochrane review, 2016):

  • Added to usual attack treatment, acupuncture cut headache frequency: it was at least halved in 41% of people having acupuncture versus 17% without it.
  • Compared with sham (placebo) needling the edge was small: 50% versus 41% (moderate-quality evidence).
  • In three trials it worked at least as well as preventive drugs, and people having acupuncture were less likely to drop out because of side effects.
  • The authors concluded acupuncture can be considered for people willing to try it, but studies longer than a year are lacking.

NCCIH describes this as moderate-quality evidence that acupuncture may reduce migraine frequency (NCCIH), though much of its benefit for headache may come from expectation and placebo responses (NCCIH). Cochrane published a plan for an updated review in 2025; its results are not out yet (Cochrane protocol, 2025).

Safety and cost

Few complications have been reported; the FDA requires sterile, single-use needles, and most states license acupuncturists (NCCIH). Medicare covers acupuncture only for chronic low back pain, not migraine (Medicare.gov). Cash prices run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Many supplements are marketed for migraine but have not been thoroughly tested; talk with your doctor first, because some medicine-and-supplement combinations can be dangerous (NINDS). We don’t list doses.

Butterbur

A butterbur root extract may reduce how often migraines happen in adults and children. The American Academy of Neurology recommended it in 2012 but stopped in 2015 over safety concerns. The raw plant contains pyrrolizidine alkaloids (PAs) that can damage the liver and lungs; use only products processed to remove them and labeled or certified PA-free. Even PA-free products have rarely been linked to liver injury (NCCIH).

Feverfew

A 2020 review of 7 small studies (634 people) found inconsistent results. Feverfew may slow blood clotting (stop it at least 2 weeks before surgery), may interact with migraine medicines and should not be taken in pregnancy (NCCIH).

Magnesium, riboflavin and coenzyme Q10

  • Magnesium: a 2018 review of 5 studies found it possibly effective in reducing migraine frequency. The amounts used are above the safe limit for supplements, so use it only under a health care provider’s supervision; it interacts with some antibiotics, diuretics and osteoporosis drugs (NCCIH).
  • Riboflavin (vitamin B2): a 2017 review of 9 studies found some, but not all, showed benefit, more in adults than children; no harmful effects or drug interactions are known (NCCIH).
  • Coenzyme Q10: a 2021 review of 6 studies (371 people) suggested it may shorten migraines and make them less frequent, but not less severe; the evidence and effects were small. It may interact with the blood thinner warfarin and with insulin (NCCIH).

Check with your doctor or pharmacist before any supplement, especially if you take migraine medicines, a blood thinner or insulin, or are pregnant, breastfeeding, planning surgery or giving it to a child. Supplements can interact with medicines, and “natural” doesn’t always mean safe (NCCIH).

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

What the research says

  • Only a few small studies of massage for headache exist, and their results are not consistent. In a 2016 study of 64 people with migraine, two types of massage both reduced migraine frequency compared with a waiting list, but in a 2011 study of 83 people, adding hand massage made no difference (NCCIH).
  • In a 2006 trial of 47 people, weekly massage improved migraine frequency and sleep compared with no massage, and lowered anxiety and the stress hormone cortisol during sessions; the authors called this preliminary (Lawler and Cameron, 2006).

Massage may be most useful as a way to relax and sleep better — stress and poor sleep are common triggers (NINDS). Because many people with migraine are sensitive to light, noise and smells (NINDS), MBHA suggests booking between attacks and asking for a quiet, dim, unscented room.

Safety and cost

The risk of harm is low, though rare serious problems such as a blood clot or nerve injury have been reported, often with vigorous techniques (NCCIH). People with health conditions and pregnant women should check with their provider first (NCCIH). At one national chain a membership runs about $70–$90 a month and includes one 60-minute session (The Pricer). Medicare doesn’t cover massage therapy ordered by a chiropractor (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

For some people, changes to everyday habits can reduce or prevent migraine episodes (NINDS). An MBHA Wellness Coach can help you build them — alongside, never instead of, medical care.

Another approach

The four phases of a migraine attack

Not everyone goes through every phase each time (MedlinePlus).

  • Prodrome — a few hours to a few days before the headache: food cravings, unexplained mood changes, uncontrollable yawning, swelling or needing to urinate more (NINDS). Some people feel thirsty or very tired (NHS).
  • Aura — only in some people (see below).
  • Headache — usually starts slowly and builds, often on one side, with nausea, vomiting and sensitivity to light, smell and sound; it can last hours to days. Some people have a migraine without any headache (NINDS). Moving, coughing or sneezing can make the pain worse (MedlinePlus).
  • Postdrome — feeling exhausted, confused, dizzy or moody, or finding it hard to concentrate, for up to two days (NINDS).

Another approach

Aura and its types

Migraine without aura is the most common type (NINDS). An aura usually affects vision — dots, zigzags, sparks or flashing lights — but can also cause pins and needles, trouble speaking, muscle weakness or confusion. Auras appear about 10 minutes to an hour before the headache and usually last no more than an hour (NINDS). Aura lasting longer than 1 hour needs urgent medical advice (NHS).

  • Migraine with brainstem aura: at least two of vertigo, double vision, trouble with balance, slurred speech, ringing in the ears, hearing problems or fainting.
  • Hemiplegic migraine: rare and severe, with temporary paralysis on one side of the body that may last for days.
  • Retinal migraine: temporary vision problems or vision loss, usually in one eye.

(NINDS) Because these can look like a stroke, a first-ever aura of this kind, or one that is different from your usual pattern, needs emergency assessment — see the warning box above.

Another approach

Migraine with aura, stroke and birth control

A 2009 review of studies found migraine linked to about twice the risk of ischemic stroke (stroke caused by a blocked blood vessel), but only in people who have migraine with aura. The risk looked higher in women, and was further raised in people under 45, smokers and women using birth control pills (Schürks et al., 2009). This matters for some decisions:

  • Combined (estrogen-containing) birth control. CDC’s 2024 contraception guidance rates combined hormonal methods as an “unacceptable health risk” (category 4) for people with migraine with aura, and category 2 for migraine without aura (CDC, 2024). The NHS says the combined pill may not be suitable if you have ever had migraine with aura (NHS). CDC rates both copper and hormonal IUDs as category 1 (no restriction) for migraine with or without aura (CDC, 2024). If you have aura, tell whoever prescribes your contraception.
  • Other risk factors. Smoking further raised the risk in the 2009 review (Schürks et al., 2009), and CDC’s ratings assume no other stroke risk factors such as older age, high blood pressure or smoking (CDC, 2024). An MBHA Stroke guide is planned.

Another approach

Episodic and chronic migraine

Migraine is in most cases episodic — attacks that come and go (WHO). It is chronic when migraine headaches happen on at least 15 days a month for more than three months, with or without aura (NINDS). Fewer than 2 in 100 people with migraine have the chronic form (InformedHealth). The difference matters for treatment: onabotulinumtoxinA is approved only for chronic migraine (Botox label), rimegepant only for preventing episodic migraine (Nurtec ODT label), and the Nerivio device only for people without chronic migraine (FDA).

A rare complication, status migrainosus, lasts over 3 days and may need hospital care (NINDS).

Another approach

Menstrual migraine and hormones

Hormone changes with the menstrual cycle or pregnancy seem to be an important trigger, which is likely why migraine is more common in women (NINDS). Menstrual migraine starts on the first day of the period in at least two of three cycles; some people also have attacks at other times of the month (NINDS). These attacks are often longer and more severe than others (NHS).

For other period and hormone concerns, see our Female Problems guide.

Another approach

Migraine in children and teens

About 4 to 5 in 100 children have migraine, and in children boys and girls are affected equally (InformedHealth). Children’s attacks are usually shorter, with more stomach symptoms (WHO); some have nausea, vomiting or dizziness without a headache (InformedHealth). Very young children may not be able to describe it — they may refuse to watch TV or use a device, or stop playing to lie down in a dark room (NINDS).

  • Always talk with a doctor before giving a child headache medicine (NINDS), and never give aspirin to children under 16 (NHS).
  • Treatments that work in adults don’t always work in young people. In a large NIH-funded trial of 361 children and teens aged 8 to 17, amitriptyline and topiramate did no better than a placebo, and caused more side effects (CHAMP trial, 2017).
  • Biofeedback seemed helpful for children’s migraines in a small review, and cognitive behavioral therapy added to standard medicine has some of the best evidence in childhood migraine (NCCIH).
  • Get medical care quickly for a child’s headache after a head injury, or with a rash, fever or sleepiness (NINDS), or one that gets worse or wakes them at night (NHS).

Another approach

Migraine and pregnancy

Migraine sometimes improves in pregnancy (NHS), though for some people it first starts then (NINDS). If you are planning a pregnancy, review your medicines with your doctor first: topiramate may harm an unborn baby (MedlinePlus), feverfew should not be taken (NCCIH), and the safety of PA-free butterbur in pregnancy is unknown (NCCIH). Acetaminophen (paracetamol) is the first-choice pain reliever in pregnancy, for the shortest time needed; avoid NSAIDs such as ibuprofen and medicines with codeine unless prescribed. Call your maternity care provider right away for a severe headache, blurred vision or flashing lights, pain just below the ribs, vomiting or sudden swelling of the face, hands or feet — possible signs of pre-eclampsia (NHS). An MBHA Pregnancy guide is planned.

Another approach

Triggers and keeping a diary

Triggers differ from person to person (NINDS). Common ones include:

  • Emotional stress, too much or too little sleep, skipped meals or low blood sugar, physical strain, sudden weather changes, strong smells, loud noises, bright or flashing lights, motion sickness, tobacco, too much alcohol, hormone changes and some medicines (NINDS).
  • Caffeine or caffeine withdrawal, and overusing migraine medicine (MedlinePlus).
  • For some people, foods — especially combined with other triggers: alcohol, chocolate, aged cheeses, MSG, some fruits and nuts, fermented or pickled foods, yeast, and cured or processed meats (MedlinePlus).
  • Attacks can also come once stress lets up — on weekends or the first days of a vacation (InformedHealth).

Your diary. After each headache, note when it started, how strong it was and how long it lasted, what you were doing, medicines taken, last night’s sleep, stress, weather and food and drink in the previous 24 hours, plus period days (NINDS). A diary can also show whether avoiding a suspected trigger, such as red wine, really helps (InformedHealth).

Another approach

When pain relievers make it worse

Taking pain relievers or migraine medicines very often can itself cause more headaches. What counts is the number of days: pain relievers such as acetaminophen, aspirin or ibuprofen on 15 or more days a month, or triptans on 10 days a month, is overuse. It is most common in middle-aged women with migraine, and people often think their usual migraines have simply got worse (InformedHealth). The NHS suggests not taking painkillers on more than 2 days a week (NHS).

Treatment means a supervised break from the medicine, which can make headaches worse for a few days before they improve; preventive treatment can help, and relapse is common, so stay in touch with your doctor (InformedHealth). Our Headaches guide covers rebound headaches in more detail.

Member stories

Living with Migraine? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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