According to Dr. Ailani, there are many neuropeptides (chemical messengers in nerve cells) involved in migraine but most recently, researchers have focused on two that get released in the brain and cause migraine: calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide (PACAP). Research on CGRP is more advanced. In the last five years, several drugs that block CGRP receptors (known as CGRP antagonists) have been approved by the FDA, some of which are taken orally when a migraine strikes and some of which are self-injected monthly or quarterly to prevent migraine attacks from happening in the first place.“PACAP is the next molecule that’s closest to nearing the finish line in clinical trials,” says Dr. Ailani. “It’s the next big thing we have our eye on.” Danish researchers have found that the neuropeptide PACAP-38 is a key player in migraine pathophysiology: A clinical trial1 showed that an infusion of PACAP-38 increases plasma levels of the neuropeptide and leads to migraine attacks. In a small study published in Brain2, when the neuropeptide PACAP-38 was injected into people–12 with a history of migraine and 12 without–the majority of people experienced a migraine attack.Now, drug companies are trying to create antibodies that specifically target PACAP receptors. A 2020 clinical trial tested a drug that targets one receptor called PAC13. It, unfortunately, didn’t improve migraine compared to the placebo. Researchers suggest a number of explanations, among them, that the concentration of the drug wasn’t high enough to have an effect, or that perhaps a different PAC receptor needs to be targeted instead of or in addition to PAC1. The good news, according to Dr. Silberstein, is that trials like this teach us more and more about the chemistry of migraine, bringing us closer to finding answers.Once an effective PACAP inhibitor is found, people with migraine will have yet another drug to add to their arsenal of migraine treatments. “There are different pathways for migraine,” notes Dr. Silberstein. “One pathway is CGRP; another is PACAP. When we get a good PACAP drug, I suspect that nonresponders to the CGRP drug will respond to PACAP drugs.”Another promising area of research is the study of how oxytocin (the “love hormone”) may play a role in inhibiting migraine. In 2017, Stanford researchers4 showed that when given as a nasal spray, oxytocin can significantly decrease migraine pain. More research is needed but so far the data has been positive, notes Dr. Ailani.New Drug-Free Ways to Treat MigraineThe thing about targeted migraine medications is that they often cause unpleasant side effects, like tingling or prickling of the skin, dizziness, dry mouth, and nausea, among others. And if you’re pregnant or have a health condition like coronary artery disease, you may not be able to take certain migraine drugs. In these instances, non-drug treatment options are crucial—and fortunately, more and more are becoming available.“An exciting area in the field of migraine is the development of wearable devices that can treat and prevent migraine,” Dr. Silberstein says. In the last five years, the FDA has approved four migraine devices that are worn on different areas of the body: the forehead, neck, arm, or head. Each device works in a slightly different way but they all deliver electrical pulses to nerves that can cause migraine.
Courtney White was a 23-year-old med student the first time she experienced a migraine attack. “I didn’t panic because I knew exactly what it was,” the now 31-year-old, who is a neurologist and clinical assistant professor at Thomas Jefferson University Hospital in Philadelphia, tells SELF. Dr. White witnessed her mother living with the pain of migraine when she was growing up—and she eventually learned about the neurological condition in med school. “The next steps were very clear to me,” she says. “Go see a doctor and get treatment.”But her appointment didn’t go as expected. “I was very knowledgeable and knew what treatment I wanted but I wasn’t taken seriously,” Dr. White says. “It was like: ‘Oh here’s this little med student who thinks she knows everything.’” It wasn’t until Dr. White was 26—three years after her initial symptoms began—that she started a treatment plan that offered some degree of relief. At 31, she was finally diagnosed with chronic migraine and received treatment that’s helped her become nearly symptom-free. Ironically, it was the same treatment she asked for back when she was 23. “There I was, actually knowing a lot about migraine, and I was still being dismissed,” says Dr. White. “If I had to struggle, imagine someone who doesn’t even know what migraine is and what treatments are available.”Unfortunately, like many chronic conditions, migraine symptoms—which can range from debilitating head pain to nausea and dizziness—are often dismissed by general practitioners. Dr. White mainly chalks this up to a lack of education. “Med schools generally only spend four hours over the course of four years talking about migraine,” she says. “So most doctors don’t know how to appropriately diagnose and treat it.”When migraine has taken over your life and you’re desperate for help, it can be hard to drag yourself to the doctor, let alone determine if they’re the right fit for your needs. Here are some signs that your health care provider isn’t taking your migraine symptoms seriously enough:They downplay your symptoms.“I can’t tell you how many times I was told I was just being hysterical,” Karen Tartt, 34, a bartender based in San Francisco who has had vestibular migraine—a form of migraine characterized by dizziness and vertigo—since she was 11, tells SELF.Alicia Wolf, 36, who also deals with vestibular migraine and is a patient advocate with the nonprofit Miles for Migraine, had a similar experience. “Multiple doctors told me I was just anxious and depressed; they said it was all in my head and nothing was wrong,” the Dallas resident tells SELF. “They made me feel like I was going insane.”Having your symptoms dismissed—especially when it comes to pain—can be especially common for people of color. “There’s a long history in the medical world of Black and brown bodies being viewed as biologically and genetically different from white bodies,” explains Dr. White. The inaccurate thought process, which is rooted in racism and medical bias, included beliefs that Black and brown skin is “thicker,” which implied that people of color don’t feel as much pain—a symptom that Black Americans have systematically been undertreated for.They don’t listen to you.You’ve finally gotten an appointment to see a doctor, but you feel like they’re just talking at you (or over you) and not listening to what you’re saying. This happened to Wolf on many occasions so she started bringing her husband to her appointments. “I noticed when he was there, they took me more seriously,” she says. “But they would only talk to him, which was frustrating. I was like: I’m smart. I can understand. Why won’t you listen and talk to me?” If you feel like your doctor isn’t hearing what you’re saying, that could be a sign they aren’t taking your concerns seriously.They say “your tests are normal so there’s nothing wrong with you.”Unlike other health conditions in which something like a blood test can help your doctor make a diagnosis, there is no single test to determine if you have migraine. To diagnose the neurological condition, a doctor will ask about your symptoms and medical history, and they may do a physical examination, according to the Mayo Clinic. “Testing is only done to rule out other conditions,” explains Dr. White. For example, if your symptoms are unusual or suddenly become severe, your doctor may order an MRI or CT scan of your brain to make sure they aren’t being caused by a tumor or bleeding in the brain. If those tests come back normal, that’s a good thing. “Tests are supposed to be normal for migraine,” says Dr. White. “And there’s no test for pain so how could someone say you’re not feeling it?”They blame you for your migraines.If your doctor puts all the onus on you—saying things like, “You just need to learn how to manage your stress” or “You need to exercise more”—that’s a big red flag, says Dr. White. “Anxiety and depression can worsen migraine but they don’t cause it,” she explains. So while it’s true that making healthy lifestyle changes like decreasing stress, getting plenty of exercise, and staying hydrated can help you manage your migraine symptoms, it’s still a genetically-inherited disease, which means sometimes the attacks are simply outside of your control.They’re unwilling to keep trying new treatments.The thing about migraine is there’s no silver bullet solution—it can take a lot of trial and error to figure out what works for you. If, after trying a few treatments, your doctor tells you there’s nothing more they can do for you, that’s a bad sign. “There’s no running out of treatment options with migraine,” says Wolf. “There are so many new medications and devices coming out, plus natural things you can try. They may not work separately but together they can; it’s about finding the perfect mix.” Your doctor should be willing to fight for you and not stop until they get you at least some degree of relief.What can you do if your doctor isn’t taking your migraine symptoms seriously?In a perfect world, you would just find a new doctor, but that’s not always a possibility. As a career bartender, Tartt rarely had health insurance. “At one point, I did have it and I started treatment but then I lost it and had to stop because it was too expensive to pay out-of-pocket,” she says. Access to care can also be a big issue. Wolf had to drive 16 hours, paying for gas and hotels along the way, to finally see the specialist who diagnosed her with vestibular migraine. “I come from a privileged background where I could afford to do that but a lot of people don’t have that luxury,” she notes.
You might think the world is divided neatly into two groups—people with migraine and people without. Rarely are things that simple, though, and migraine is no exception. There are actually a number of different migraine types, and the two main ones are “migraine with aura” and “migraine without aura.”1 These two groups can further be divided into several subtypes, Nauman Tariq, MD, the director of the headache treatment program at Atrium Health Neurosciences Institute Charlotte, tells SELF.Aura is characterized by visual, sensory, and speech disturbances—and you can have migraine aura with or without a headache, migraine with brainstem aura, hemiplegic migraine, and retinal migraine, per the American Migraine Foundation. “We used to lump all of these migraines into ‘complex migraine’ but now they are further categorized based on the symptoms they cause,” Dr. Tariq explains.That’s good news for migraineurs since being diagnosed properly is the key to getting the right treatment. That said, the different types of “migraine with aura” can be a little confusing. Here’s everything you need to know, including the symptoms they cause and how to get relief.What is migraine with aura?First, it’s important to understand what migraine is in the first place. Migraine isn’t just a headache—it’s a neurological disease that affects about 12% of people in the U.S., the majority of whom are people assigned female at birth. Most people with migraine (around 80 to 85%) have migraine without aura, which is characterized as a throbbing or pulsing sensation, usually on one side of the head, that gets worse with physical activity, bright lights, loud sounds, and strong smells, according to the Cleveland Clinic.Migraine with aura is less common, affecting around 15 to 20% of people with migraine. In addition to head pain and sensitivity to light, sound, or smells, migraine with aura symptoms includes visual, sensory, motor, or speech symptoms that usually warn that a migraine attack is coming. Per the International Classification of Headache Disorders, migraine with aura can be further divided into the following subtypes:2Migraine with typical aura—with or without a headache: Typical aura includes visual, sensory, or speech symptoms but no motor (that means muscle) weakness. This type of migraine can come with or without head pain.Migraine with brainstem aura: This type of migraine has aura symptoms that originate from the base of the brain (brainstem) or both sides of the brain at the same time. It’s typically associated with pain at the back of the head on both sides, according to the National Center for Advancing Translational Sciences.Hemiplegic migraine: An extremely rare type of migraine, hemiplegic migraine is characterized by experiencing weakness on one side of the body (hemiplegia) along with typical migraine symptoms.Retinal migraine: Sometimes called ocular migraine, this type of migraine causes visual disturbances that occur in only one eye before head pain begins.Back to topWhat are the symptoms of migraine with aura?Migraine with aura can cause an array of symptoms, from visual disturbances like seeing zig-zags or stars to sensory changes such as numbness or tingling. The symptoms of each type of migraine with aura can overlap, but here are the typical signs of each one, according to the American Migraine Foundation:
If you deal with migraine, you know how important it is to be prepared when the pain strikes. Beyond putting an ice pack on your head and laying down in a dark room, for most people, treatment includes having an arsenal of migraine drugs at the ready so symptoms can be addressed right away—and potentially other medications that can prevent them from happening in the first place.While certain over-the-counter pain relievers (like NSAIDs) can provide some relief, many migraineurs rely on prescription drugs that are designed to stop migraine pain specifically. The good news is, there are more options than ever to stop a migraine. The bad news? Navigating the world of migraine drugs can be tricky—that’s why we created this simple guide to help you find relief ASAP.So, what is a migraine, exactly?It’s a common misconception that migraine is “just a headache.” The reality is migraine is a neurological disease that affects about 12% of people in the U.S.—most of whom are people assigned female at birth. Indeed, people with vaginas are approximately three times more likely than those without to have migraine, most likely because of the hormone estrogen.1You’ll know you have a migraine (rather than a run-of-the-mill headache) because it typically comes with debilitating symptoms, and not just head pain. Though severe head pain, often on one side of the head, is a major symptom. It may feel like a throbbing, pulsing, or stabbing sensation that gets worse with physical activity. You may also experience nausea, vomiting, and sensitivity to light, sounds, and smells.Another defining feature, that some, but not all, people with migraine experience is aura. This involves visual disturbances before the attack begins, such as flashes of light, sparklers, squiggly lines, blurred vision, or even vision loss that usually resolves within an hour.2Back to topWhat types of migraine medications can be used for treatment?When it comes to migraine treatment, there’s good news. “In the last 11 years, the U.S. Food and Drug Administration (FDA) approved at least 13 new treatments—that’s the highest number in any neurology subspecialty,” Nauman Tariq, MD, the director of the headache treatment program at Atrium Health Neurosciences Institute Charlotte, tells SELF. “There’s no shortage of options so rather than suffering, I highly suggest people seek help.”Migraine drugs are split into two categories: abortive medications, which stop a migraine that has already started, and preventative drugs that are taken on a regular basis (usually daily or monthly) to reduce the severity and frequency of migraine, according to the Mayo Clinic. “The decision to give patients abortive and preventative medication is based on the number of migraine attacks the person gets each month,” says Dr. Tariq. “There are different schools of thought, but I only give patients a preventative if they’re having eight or more days per month of migraine.”If you’re having fewer than eight days of migraine per month, but still think you would benefit from a preventative medication, talk with your doctor. The 2021 American Headache Society Consensus Statement actually recommends preventative treatment be offered if you’re getting migraine headache symptoms six days a month or more even with no degree of disability, four or more days a month with some disability, or three or more days a month with severe disability.3 Below is a breakdown of the most common abortive and preventative treatment options.Abortive migraine medicationsMedications for acute migraine relief fall into a couple of categories: over-the-counter (OTC) pain relievers and prescription meds. Here are the best options:
As if painful cramping and uncomfortable bloating weren’t enough to deal with when you get your period, there’s another not-so-fun side effect many people with vaginas get: a menstrual migraine. As the name implies, menstrual migraine is a migraine attack that occurs around the time of your period. You might think it’s normal to get a headache with your period—it’s even sometimes called a hormonal headache—but it’s important to understand that migraine is no ordinary headache. It’s actually a neurological disease that causes debilitating pain, usually on one side of the head. The pain may feel throbbing or stabbing and it can come with other symptoms like nausea, sensitivity to light and sound, and vomiting.Approximately 70% of people who get migraine attacks have vaginas—in fact, migraine is three times more common in people with vaginas than those with penises, according to the Cleveland Clinic. On top of that, of the people who regularly experience migraines, 60 to 70% of them report a connection between their periods and migraine attacks. That makes sense given that fluctuating hormones are a known migraine trigger. Think you might suffer from menstrual migraine? Here’s everything you need to know, including the symptoms to look out for, prevention, and treatment options.What is menstrual migraine?If, like clockwork, you get a migraine around the time of your period—and only during that time of the month—you may have menstrual migraine. “The migraine can start about three days before actual bleeding, can continue while you bleed, and may go on for three days after bleeding ends,” Jessica Ailani, MD, a board-certified neurologist at Medstar’s Georgetown University Hospital, tells SELF. “Pure menstrual migraine, when you only get it around your period and no other times of the month, is actually pretty rare. Most women have menstrually-related migraine, which means it happens around their period but also at other times of the month.”Pure menstrual migraine is more common in the teenage years and can progress from there, becoming menstrually-related migraine or even chronic migraine, where you have an attack 15 or more days per month. People going through perimenopause—when your body is transitioning to menopause—can also trigger menstrual migraines due to fluctuating estrogen levels.1 It’s important to note that menstrual migraine can occur in people who were born with a vagina or those who have transitioned, Dr. Ailani says.Back to topWhat are menstrual migraine symptoms?Menstrual migraine feels like any other form of migraine but it tends to last longer and may cause more nausea, Dr. Ailani says. According to a 2017 study published in the Journal of Headache Pain, menstrual migraine attacks may even be more painful than other types.2 Typical migraine symptoms include: 1Throbbing, pounding, or pulsating pain on one side of your head or around your eyes or cheeksHead pain that worsens with physical activityNausea and vomitingSensitivity to light, noise, and smellsHead pain that lasts for several hours and up to several daysHead pain that’s severe enough to make you miss your usual activitiesSome people also experience migraine with aura, which is usually characterized by visual disturbances such as flashes of light, dots or blind spots, blurred vision, and vision loss. These symptoms usually show up before the migraine attack and go away in an hour or less. However, according to a 2021 study published in the journal South Dakota Medicine, having a menstrual migraine with aura is not very common.3