Migraine

Diagnosis

Migraines are usually diagnosed by a specialist trained in treating headaches, most often a neurologist. The diagnosis is based on your medical history, reported symptoms, and a physical and neurological examination. There is no single test that confirms migraine, so careful evaluation of headache patterns and associated symptoms is essential.

If your symptoms are unusual, suddenly worsen, or are difficult to diagnose, your healthcare professional may order tests to rule out other causes of head pain.

• MRI scan
  Magnetic resonance imaging uses powerful magnets and radio waves to create detailed images of the brain and blood vessels. This test helps identify conditions such as brain tumors, strokes, bleeding, infections, or other disorders affecting the brain and nervous system.

• CT scan
  A computerized tomography scan uses a series of X-rays to create cross-sectional images of the brain. This test can help detect tumors, infections, brain injury, or bleeding that may cause headaches.

Treatment

Migraine treatment focuses on stopping symptoms during an attack and preventing future episodes. Treatment plans are individualized based on how often migraines occur, how severe they are, and whether they interfere with daily activities.

Medicines

Medicines used for migraines fall into two main categories.

• Pain-relieving medicines
  These medicines, also called acute or abortive treatments, are taken during a migraine attack to stop symptoms.

• Preventive medicines
  These medicines are taken regularly to reduce how often migraines occur and how severe they are.

Your healthcare professional considers factors such as headache frequency, pain severity, nausea or vomiting, disability caused by migraines, and other medical conditions when recommending treatment.

Pain-relieving medicines

Medicines for immediate relief work best when taken as soon as migraine symptoms begin.

• Pain relievers such as aspirin and ibuprofen, including combination medicines with caffeine, aspirin and acetaminophen, may help with mild migraine pain. Long-term or frequent use can lead to medication overuse headaches and gastrointestinal problems.

• Triptans relieve migraine symptoms by blocking pain pathways in the brain. They are available in several forms, including tablets, injections and nasal sprays.

• Dihydroergotamine may be helpful for migraines that last longer than 24 hours but is not recommended for people with certain heart, kidney or liver conditions.

• Lasmiditan is an oral medicine approved for migraines with or without aura. It may cause drowsiness and dizziness.

• Oral CGRP antagonists, also called gepants, can relieve migraine pain and related symptoms such as nausea and sensitivity to light and sound.

• Intranasal zavegepant is a nasal spray that can quickly relieve migraine pain and other symptoms.

• Antinausea medicines may be used alongside pain-relieving drugs when nausea and vomiting occur.

• Opioid and barbiturate medicines are rarely used and only when other treatments are ineffective, due to the risk of dependence and side effects.

Some migraine medicines are not safe during pregnancy, so it is important to discuss treatment choices with your healthcare professional.

Preventive medicines

Preventive treatment may be recommended if migraines are frequent, severe, or do not respond well to pain-relieving medicines.

• Blood pressure–lowering medicines such as beta blockers and calcium channel blockers

• Antidepressants, particularly tricyclic antidepressants and certain alternatives with fewer side effects

• Antiseizure medicines that can reduce migraine frequency and severity

• Botox injections given every 12 weeks for certain adults with chronic migraines

• CGRP monoclonal antibodies given by injection monthly or every three months

• Atogepant, a daily oral medicine used to prevent migraines

• Rimegepant, which is used both for migraine prevention and symptom relief

Not all preventive medicines are safe during pregnancy, so medical guidance is essential.

Neuromodulation therapy

Neuromodulation therapy uses noninvasive devices that stimulate specific nerves to reduce migraine frequency or pain intensity. These devices work by altering the brain’s response to pain signals.

Available options include therapies that stimulate the supraorbital nerve, vagus nerve, or peripheral nerves. Another option is single-pulse transcranial magnetic stimulation, which targets the brain directly to relieve migraine pain.