Migraine
Migraine is diagnosed using ICHD-3 criteria (International Headache Society, 2018): at least 5 attacks lasting 4-72 hours with characteristic features. It affects about 12% of people, more often women, per a 2025 Global Burden of Disease analysis.
Symptoms
Throbbing, often one-sided head pain, typically with nausea, and light or sound sensitivity; some people also experience visual or sensory aura beforehand.
Causes and risk
Family history is the strongest risk factor. Common triggers include stress, poor sleep, certain foods, hormonal changes, and skipped meals, though triggers vary widely person to person.
How it is evaluated
Routine imaging is not needed for typical migraine, per the American Headache Society neuroimaging guideline. The SNNOOP10 red-flag framework identifies atypical features -- a new or different headache pattern, neurologic deficits, or a thunderclap onset -- that do warrant imaging.
Treatment
First-line acute therapy is NSAIDs or acetaminophen, stepping up to triptans, then gepants for inadequate relief; triptans are avoided in significant cardiovascular disease. Opioids and butalbital are avoided due to overuse and dependence risk. For prevention, the American Headache Society's 2024 position statement establishes CGRP-targeting therapies as first-line without requiring older medications to fail first, though many insurers still require step therapy in practice; the general threshold for starting preventive treatment is 4 or more migraine days per month.
When to seek care
A sudden, severe "thunderclap" headache, a headache with fever and neck stiffness, or any new neurologic deficit (weakness, vision loss, confusion) needs emergency evaluation to rule out a dangerous cause other than migraine.