Migraines are painful, throbbing headaches that last from 4 to 72 hours. They often occur on only one side of your head. But the pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Migraines may be so painful that you aren't able to do your daily activities.

When you have a migraine, you may also feel sick to your stomach and vomit. Activity, light, noise, or certain smells may make your migraine worse.

Some people have an aura before their migraine starts. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before your headache. But most people don't have auras.

Migraines run in families. But it's not clear why some people get them and others don't.

The cause of migraines is not well understood. But experts think that they may have something to do with the blood vessels in your brain, certain foods, alcohol, and stress.

If your migraine symptoms are mild to moderate, doctors recommend that you first try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription migraine medicines. They include:

• Acetaminophen (such as Tylenol).
• Aspirin (such as Bayer).
• Ibuprofen (such as Advil).
• Naproxen (such as Aleve).

Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine.

If these medicines don't help, your doctor may prescribe a medicine that can quickly stop a migraine after it has started. A group of drugs called triptans is most often tried first. But these can cause serious side effects, especially for people who have heart disease and high blood pressure.

If over-the-counter pain medicines or triptans don't work, and if you get bad migraines often, you may want to take a daily medicine to help prevent them.

There are several types of medicines that help prevent migraines. These medicines were first approved to treat other medical problems such as seizures, depression, high blood pressure, and heart disease. But they also help to prevent migraines.

These medicines are sorted into five groups:

• Anticonvulsants (antiseizure medicines), including valproate (such as Depakene)
• Antidepressants, including amitriptyline
• Beta-blockers, including propranolol (such as Inderal)
• Calcium channel blockers, including verapamil (such as Calan)
• Botulinum toxin, such as Botox.

Medicines to prevent migraines may not stop every migraine. But studies have shown that:¹

• The antiseizure medicines topiramate and valproate and the beta-blocker propranolol can reduce the number of migraines you get each month by more than half. This happened in about 50 out of 100 people who took one of these medicines.
• The antidepressant amitriptyline can greatly reduce how many migraines you get and the number of days that they last. It can also make your symptoms less severe.

Even though calcium channel blockers may be used to prevent migraines, the evidence for how well they work is not as strong as it is for these other medicines.¹

You'll need to take pills every day—even when you don't have a headache.

It could take up to 2 to 3 months for the medicine to work. If you don't see any improvement after several weeks, talk to your doctor. You may need to try several different medicines to find one that works for you.

Medicine that you take daily may not prevent all migraines, so there may be times when you need to take another medicine to stop a migraine after it has started.

Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more—the side effects of the medicine or your migraines.

Common side effects include:

• Sleep and memory problems.
• An upset stomach.
• Dry mouth.
• Constipation.
• Weight gain or loss.
• Fatigue.
• Dizziness.
• A fast heart rate.

What else can you do to prevent migraines?

There are other things you can try to prevent migraines. These work for some people:

• Acupuncture, which involves putting very thin needles into the skin at certain points on the body. Current evidence suggests that it can help prevent some headaches.²
• Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
• Butterbur, which is an herb that has been shown to help prevent migraines in some people.³
• Feverfew, which is an herb that has been studied a lot for migraine prevention. Some small studies show that it may help prevent migraines in some people. But most experts think the benefits are still unproven.⁴
• Magnesium, which some doctors recommend to help prevent migraines. Studies have found that some people with migraines have low levels of magnesium in the brain.⁵
• Menthol. There is some evidence that a menthol solution rubbed on the forehead can stop or reduce migraine headache pain.⁶
• Riboflavin (vitamin B2) and coenzyme Q10, which in small studies have both been shown to help prevent migraines.⁷

Here are some things you can do at home:

• Identify and avoid triggers, such as certain foods, alcohol, and smoking. It may help to keep a headache diary to track how often you have migraines, how painful they are, and what you think might be causing them.
• Practice relaxation and breathing exercises, such as meditation, guided imagery, tai chi, or qi gong, to help reduce stress and relax your mind and muscles.
• Exercise regularly, eat healthy foods, and get enough sleep.

Why might your doctor recommend medicine to prevent your migraines?

Your doctor may advise you to take medicine every day to prevent migraines if:

• You get bad migraines often.
• Your migraines are so painful that you're not able to do your daily activities.
• You use medicine more than twice a week to stop a migraine after it has started.
• You have tried medicines to stop a migraine, but they don't help.