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Migraine

2025-11-23T22:53:36Z

Chuck23:added additional sources and citations

[[File:Migraine-art.jpg|left|thumb|320px|Source: [https://www.flickr.com/photos/tudedude/14019222689 Migraine by Tudor Barker]]] 
'''Migraine''' is believed to be highly comorbid in people with [[ME/CFS]]<ref>{{Cite news|url=https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/|title=Migraine and ME/CFS|last=Petrarca|first=Kylie|date=2022-05-12|work=Association of Migraine Disorders|access-date=2025-11-23|language=en-US}}</ref>. As many as 85% of people with ME/CFS may also have migraine disease.

Migraine is a spectrum neurobiological disease with a genetic predisposition. It is the dysfunction of the central and peripheral nervous systems. There are many different types & subtypes of migraine. If not properly managed, migraine can be a progressive, ongoing disease.

In a 2011 study by Ravindran, et al, migraine were found in 84%, and [[tension-type headache]]s in 81% of a cohort of [[chronic fatigue syndrome]] patients.<ref name="Ravindran2011" /> This compared to 5% and 45%, respectively, in a cohort of healthy controls.<ref name="Ravindran2011" /> Receiving a migraine diagnosis and appropriately treating the disease may reduce overall symptoms and stress that could trigger post-exertional malaise.

==Symptoms==
<ref name="NHS-overall" />

Migraine symptoms include mild to moderate unilateral and/or throbbing or pulsating headache that may get worse with or lead to the avoidance of physicial activity (such as doing laundry, etc). Migraine pain is described as moderate to severe, but some types of migraine have little to no head pain.

According to diagnostic criteria, other symptoms include light and/or sound sensitivity, as well as nausea and/or vomiting. The majority of migraine patients will experience allodynia during their attack.

Migraine makes one incredibly sensitive to sensory & environmental stimuli that many call triggers. Triggers do not cause migraine disease; migraine disease makes one sensitive to triggers.
==Phases==
Migraine has 4-5 phases: prodromal, aura (for 30% of migraine patients), acute, postdrome, and interictal (between attacks). Many with chronic migraine experience ongoing migrainous symptoms between attacks.
;Prodromal (pre-headache) stage
:4-42 hours before the aura or acute phase. Symptoms include phantom smells, heightened sensory sensitivity (smells, sounds, visual stimuli), food cravings, neck pain, increased urination, increased energy, etc.
:Recent research shows that many prodromal symptoms may be confused for migraine attack triggers.
;Aura phase (~30% of migraine population)
:5-60 minutes before the acute phase. Outside of migraine with brainstem aura, auras typically are experienced sequentially, fully reversing before transitioning to the next aura. This is due to how cortical spreading depression works by slowly traveling across various cortexes of the brain.
:The majority of people with migraine with aura experience visual aura: flashes of light (scintillations), blind spots (scotoma), perceiving objects to be much larger or smaller than in reality, shimmering, flickering, tunnel vision, and blurred/distorted vision.
:Other auras include somatosensory (tingling, pins & needles, numbness, feeling like a limb is disconnected), dysphasic (mixing up words, difficulty thinking of words, slurred speech, stutter, difficulty understanding speech), vestibular (dizziness, vertigo, spacial disorientation), and motor (motor weakness, facial droop, dexterity issues, sensation of dead weight).
:Anecdotally, people have reported olfactory & taste-related auras but those are not acknowledged by the International Classification of Headache Disorders, Third Edition (ICHD-3).
;Acute phase
:Typically a moderate or severe pulsating or throbbing head pain on one side of the head (but can be on both sides), often accompanied by [[nausea]], [[vomiting]] or [[photophobia|extreme light sensitivity]] and extreme sensitivity to loud sounds, which last from 4 hours to 3 days without acute medication.
:For the majority of people with migraine, allodynia (a sign of central sensitization) begins during the acute phase.
:For those with vestibular migraine, the acute phase consists of moderate to severe dizziness, in addition to the more traditional head pain, nausea, vomiting, and severe sensory sensitivities (particularly motion & screens).
;Postdromal stage
:Often referred to the hangover phase, the postdrome is when acute and other symptoms gradually fade, but there may be [[fatigue|tiredness]] & exhaustion for few days after<ref name="NHS-symptoms">{{Cite web|url=https://www.nhs.uk/conditions/migraine/symptoms/ | title = Migraine - Symptoms | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref><ref name="Khan2021" /><ref name="NHS-overall" /> Not every migraine patient experiences the postdrome.
:Additional symptoms may include brain fog, mood changes, sensory sensitivities, dull head pain, GI & urinary issues, temperature dysregulation, allodynia, and more.
:'''Interictal Phase'''
:Otherwise known as the phase between migraine attacks. For many, the interictal phase will be symptom-free, but for most with chronic migraine, vestibular migraine, or migraine with unilateral motor symptoms (MUMS), the interictal phase may include ongoing symptoms including dull headache, sensory sensitivities (light, sound, temperature, motion, etc), and other neurological symptoms. <ref>{{Cite journal|title=The not so hidden impact of interictal burden in migraine: A narrative review|date=2022-11-03|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC9669578/|journal=Frontiers in Neurology|volume=13|last=Vincent|first=Maurice|last2=Viktrup|first2=Lars|last3=Nicholson|first3=Robert A.|last4=Ossipov|first4=Michael H.|last5=Vargas|first5=Bert B.|language=en|doi=10.3389/fneur.2022.1032103|pmc=9669578|issn=1664-2295}}</ref>Those with chronic vestibular migraine typically experience ongoing baseline dizziness, and those with chronic MUMS may experience ongoing baseline unilateral weakness, tingling, & dysfunctioning proprioception.<ref>{{Cite journal|title=Association Between Interictal Sensory Hypersensitivities and Vestibular Symptoms in Migraine: A Cross‐Sectional Study|date=2025-10|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC12537835/|journal=Brain and Behavior|volume=15|issue=10|last=Jaimes|first=Alex|last2=Rodríguez‐Vico|first2=Jaime|last3=Pajares|first3=Olga|last4=Gómez|first4=Andrea|last5=Porta‐Etessam|first5=Jesús|language=en|doi=10.1002/brb3.70874|pmc=12537835|issn=2162-3279}}</ref>
[[File:Migraine-phases.jpg|left|thumb|600px|Migraine phases. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Khan et. al. (2021). Biomedicine & Pharmacotherapy, 139, 111557.]<ref name="Khan2021"/>]] 

==Types ==
===Migraine without aura===
'''Migraine without aura''' is defined by the following diagnostic criteria outlined in ''The International Classification Of Headache Disorders, 3rd edition''<ref>{{Cite web|url=https://ichd-3.org/1-migraine/|title=1. Migraine - ICHD-3|website=ichd-3.org|access-date=2025-11-23}}</ref>:

====Migraine without aura diagnostic criteria====
<ol style="list-style-type:upper-alpha"><li> At least '''five''' headache attacks that</li>
<li> Last 4–72 hours without successful treatment</li>
<li> Headaches have at least '''two''' of the following four characteristics:</li>
<ol><li> unilateral location;</li>
<li> pulsating quality;</li>
<li> moderate to severe pain intensity; and</li>
<li> aggravation by or causing avoidance of routine physical activity.</li></ol>
<li> During the headaches at least '''one''' of the following:</li>
<ol><li> [[nausea]] and/or vomiting</li>
<li> [[photophobia]] and phonophobia (avoidance of loud noises)</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.</li>
</ol>

:Migraines without aura may also be called '''common migraine'' or '''hemicrania simplex'''.<ref name="ICHD-3">{{Cite journal | last = Headache Classification Committee of the International Headache Society | date = 2018 | title = The International Classification of Headache Disorders|edition=3rd | url =https://doi.org/10.1177/0333102417738202|journal=Cephalalgia|language=en|volume=38|issue=1|pages=1–211|doi=10.1177/0333102417738202|issn=0333-1024}}</ref>

===Migraine with aura===
====Migraine with aura diagnostic criteria====

:Visual, sensory and central nervous system symptom in beginning shortly before a migraine headache are known as an '''aura''', although migraine with aura without migraine headaches are also recognized.

<ol style="list-style-type:upper-alpha"><li> At least '''two''' migraine attacks fulfilling criteria B and C</li>
<li>'''One''' or more of the following fully reversible aura symptoms</li>
<ol><li> visual </li>
<li> sensory </li>
<li> speech and/or language </li>
<li> motor </li>
<li> brainstem </li>
<li> retinal </li></ol>
<li> At least '''three''' of the following characteristics:</li>
<ol><li> at least '''one''' aura symptom spreads gradually over five minutes or longer</li>
<li> '''two''' or more aura symptoms occur in succession</li>
<li> each individual aura symptom lasts 5 to 60 minutes </li>
<li> at least one aura symptom is '''unilateral''' (one sided)</li>
<li> at least one aura symptom is '''positive''' </li>
<li> the aura is accompanied, or followed within 60 minutes, by headache</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.<ref name="ICHD-3" /></li></ol>

The recognized types of migraine with aura are:
*Typical aura with headache
*Typical aura without headache
*Migraine with brainstem aura
*Hemiplegic migraine, including familial hemiplegic migraine (FHM) type 1, type 2, type 3 and with other loci
* Sporadic hemiplegic migraine (SHM)
* Retinal migraine

Migraines without aura may also be called '''Classic or classical migraine''', '''ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine''', or '''complicated migraine'''.<ref name="ICHD-3" />

'''Note: Ocular and complex migraine are not official terms'''. Ocular migraine is used interchangeably with retinal migraine and migraine with (visual) aura. Retinal migraine is a very specific type of migraine where the aura appears in one eye only and is believed to be due to excitement in the retina. Migraine with visual aura is due to cortical spreading depression taking place in the brain, specifically the visual cortex.

[https://headaches.org/wp-content/uploads/2024/07/Complex-Migraine-Transcript.pdf Complex migraine is a catch-all term for migraine with atypical aura, migraine with brainstem aura, migraine with unilateral motor symptoms (MUMS), hemiplegic migraine, and vestibular migraine. Neurologists who use this term may not be well-versed in the specific mechanisms involved in each migraine type, which may lead to inappropriate treatment]. <ref>{{Cite web|url=https://headaches.org/what-is-complex-migraine/|title=What is Complex Migraine? {{!}} National Headache Foundation|website=headaches.org|access-date=2025-11-23}}</ref>

[https://www.milesformigraine.org/fighting-for-migraine-with-words/#:~:text=Here%20are%20some%20tips%20for%20using%20language,subtly%20blames%20the%20person%20who%20has%20it. Other outdated or inaccurate terms may include: classical migraine, cluster migraine, optical migraine, visual migraine, migraine headache, migraines, rebound headache, medication overuse headache]

===Epidosic vs Chronic migraine<ref>{{Cite journal|title=High-frequency episodic migraine: Time for its recognition as a migraine subtype?|date=October 22, 2024|url=https://journals.sagepub.com/doi/10.1177/03331024241291578|journal=Cephalalgia|volume=44|issue=10|pages=23|last=Cammarota|first=Francescantonio|author-link=https://journals.sagepub.com/reader/content/1951600cf8d/10.1177/03331024241291578/format/epub/EPUB/xhtml/index.xhtml?hmac=1763925246-mXuWtxp1NXr5RG41jihGsNVFQC2I1yUuSakdFIFA9Q8%3D#aff1-03331024241291578|last2=de Icco|first2=Roberto|author-link2=https://journals.sagepub.com/doi/10.1177/03331024241291578#con2|last3=Goadsby|first3=Peter|author-link3=https://orcid.org/0000-0003-3260-5904|last4=Vaghi|first4=Gloria|author-link4=https://journals.sagepub.com/authored-by/Vaghi/Gloria|last5=Corrado|first5=Michael|author-link5=https://journals.sagepub.com/authored-by/Corrado/Michele|doi=10.1177/03331024241291578|quote=Multiple features differentiate subjects with HFEM from low-frequency episodic migraine and from chronic migraine: education, employment rates, quality of life, disability and psychiatric comorbidities load. Some evidence also suggests that HFEM bears a specific profile of activation of cortical and spinal pain-related pathways, possibly related to maladaptive plasticity.|via=Sage Journals Home}}</ref> ===

* '''Very low frequency episodic migraine''' - 0-3 migraine and/or headache days/month
* '''Low frequency episodic migraine -''' 4-7 migraine and/or headache days/month
* '''High frequency episodic migraine -''' 8-14 migraine and/or headache days/month
* '''Chronic migraine -''' 15 headache days where at least 8 days have migrainous features (light/sound sensitivity, Nausea/vomiting, exacerbation by activity, etc)

Migrainous features can include sensory sensitivity (light, sound, smell, motion), nausea and/or vomiting, exacerbation by activity, neck pain, allodynia, etc. One does not have to have a stereotypical ''migraine attack'' to log a migrainous feature day; they can have a dull headache with light sensitivity, tinnitus, and allodynia, and that would count toward a migraine day, [https://journals.sagepub.com/doi/10.1177/03331024251393986 although the exact definition of a "migraine day" is still unstandardized by the headache community.]

Research does show a significant shift in quality of life as the person transitions from very low frequency episodic migraine to high frequency episodic migraine, which is why preventive treatment is now encouraged to begin when the person experiences 4 migraine and/or headache days in a month.

Note: '''as migraine progresses,''' it's symptoms typically become more persistent and neurological and less dominated by pain<ref>{{Cite journal|title=Neurobiology of migraine progression|date=2022-08|url=https://doi.org/10.1016/j.ynpai.2022.100094|journal=Neurobiology of Pain|volume=12|pages=100094|last=Rattanawong|first=Wanakorn|last2=Rapoport|first2=Alan|last3=Srikiatkhachorn|first3=Anan|doi=10.1016/j.ynpai.2022.100094|pmc=PMC9204797|issn=2452-073X}}</ref>. This happens because the brain undergoes changes in how it processes pain and sensory information over time. With repeated migraine attacks, the nervous system becomes sensitized and more reactive—not just to pain but to non-painful sensory inputs. Patients are more likely to develop vestibular migraine <ref>{{Cite journal|title=Vestibular migraine: an update|date=April 15, 2024|url=https://journals.lww.com/co-neurology/fulltext/2024/06000/vestibular_migraine__an_update.9.aspx|journal=Current Opinion on Neurology|volume=37|issue=3|pages=12|last=Goadsby|first=Peter|last2=Villar-Martinez|first2=Maria|doi=10.1097/WCO.0000000000001257|pmc=PMC11064914|pmid=38619053|quote=Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).}}</ref>and MUMS (or both) during this time.

This can lead to:

* A reduction in the intensity of headache pain but an increase in unusual sensory symptoms (like visual disturbances, dizziness, or sensory sensitivities).
* A “normalization” or habituation effect where the brain adapts to frequent pain signals, leading to less intense pain but more complex neurological symptoms.
* Alterations in brain networks related to sensory integration, emotional regulation, and pain modulation, changing the migraine experience qualitatively.
* Changes in neurotransmitter systems and cortical excitability reduce pain perception but increase aura complexity, sensory disturbances, or fatigue.

===Migraine with Aura without Head Pain (silent or acephalgic migraine) ===
Migraine symptoms that do not result in a headache are known as migraine with aura without head pain, e.g. migraine aura symptoms without head pain.migraine aura without headache – where an aura or other migraine symptoms are experienced, but a headache does not develop.<ref name="NHS-overall">{{Cite web|url=https://www.nhs.uk/conditions/migraine/ | title = Migraine | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref>

===Abdominal migraine ===
Most often occurring in children, <ref name="ICHD-3" /> the person must have had at least five recurrent episodes of moderate to severe pain in the abdomen usually around the midsection or belly button. The person must also have at least two of the following: nausea, vomiting, paleness, or loss of appetite. A headache may or may not be present. An aura may occur before the abdominal symptoms.<ref>{{Cite web|url=https://www.migrainedisorders.org/video/abdominal-migraine/|title=Chapter 1, Episode 10: What is Abdominal Migraine? - Association of Migraine Disorders|website=www.migrainedisorders.org|access-date=2025-11-23}}</ref>

== Other Migraine Types & complications ==
''(either recognized in the ICHD-3 appendix or gathering international headache research support)''

* Menstrual migraine or menstrual-related migraine
* Vestibular migraine
* Migraine with Unilateral Motor Symptoms (MUMS)<ref>{{Cite journal|title=Migraine with unilateral motor symptoms: a case-control study|date=2007-06-01|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC2077953/|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=78|issue=6|pages=600–604|last=Young|first=W. B|last2=Gangal|first2=K. S|last3=Aponte|first3=R. J|last4=Kaiser|first4=R. S|language=en|doi=10.1136/jnnp.2006.100214|pmc=2077953|issn=0022-3050}}</ref>
* Multi-sensory migraine subtypes
* Prolonged aura without infarction
* Persistent migraine aura

==Triggers ==
[[File:Migraine_triggers.jpg|left|600px|Migraine triggers. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Biomedicine & Pharmacotherapy, 139, 111557]<ref name="Khan2021"/>]] ''Migraine is a neurological disease with an inherent sensitivity to a wide and ever-changing range of triggers, many of which are unavoidable normal daily environmental or lifestyle factors that become problematic when experienced irregularly or unpredictably.''
People with migraine are sensitive to stress, environmental factors, various sensory stimuli, some food, and various changes (hormonals, biochemical) that are called triggers. Research is beginning to support that the [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841237#250653113 brain's altered processing creates a varied vulnerability to varied and unpredictable triggers]<ref>{{Cite web|url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841237|title=Information-Theoretic Trigger Surprisal and Future Headache Activity|last=Turner, PhD|first=Dana P|authorlink=Https://www.ncbi.nlm.nih.gov/pubmed/31784989|last2=Patel, MD|first2=Twinkle|authorlink2=Https://health.usnews.com/doctors/twinkle-patel-116495|date=November 11, 2025|website=JAMA Network Open|archive-url=https://archive.is/wip/wSPeI|archive-date=November 23, 2025|url-status=live}}</ref> rather than the previously presented singular trigger cause + effect theory. [https://www.neurologylive.com/view/helping-your-patients-avoid-the-migraine-trigger-trap Migraine management is slowly transitioning away from strict trigger avoidance and toward dynamic trigger management via treatments and lifestyle measures]<ref>{{Cite journal|title=Triggers, Protectors, and Predictors in Episodic Migraine|date=2018-10-05|url=https://pubmed.ncbi.nlm.nih.gov/30291562/|journal=Current Pain and Headache Reports|volume=22|issue=12|last=Marmura|first=Michael J.|language=en|doi=10.1007/s11916-018-0734-0|issn=1531-3433}}</ref>.

==Migraine & ME/CFS==
Migraines is one of several illnesses or conditions common in people with [[ME/CFS]].<ref name="ammes">{{Cite web|url=https://ammes.org/overlapping-conditions/ | title = Overlapping Conditions – American ME and CFS Society|website=ammes.org|language=en-US|access-date=2018-08-12}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17= Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012
| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref>

The [[Canadian Consensus Criteria]] recognizes migraines in the [[:Category:Neurological signs and symptoms|possible neurological symptoms]] of [[ME/CFS]], and the [[International Consensus Criteria]] recognizes [[headache]] conditions including [[migraine]] and [[tension-type headache]] in the diagnostic criteria for [[myalgic encephalomyelitis]].<ref name="ICC2011primer" /> Though it is important to note that migraine is not a symptom of ME/CFS but instead is a comorbidity that requires its own standalone treatment. <blockquote>
=== T[https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/ he Relationship and Commonalities Between ME/CFS and Migraine]<ref>{{Cite news|url=https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/|title=Migraine and ME/CFS|last=Petrarca|first=Kylie|date=2022-05-12|work=Association of Migraine Disorders|access-date=2025-11-23|language=en-US}}</ref> ===
It is believed central sensitization plays a key role in the connection between ME/CFS and migraine. Central sensitization is also known as hypersensitivity of the nervous system (brain and spinal cord) and causes allodynia and hyperalgesia. Allodynia occurs when someone experiences pain from something not normally painful. Some examples of allodynia are pain from touching cold water, brushing hair or moving the bed sheets across the skin. Hyperalgesia is when someone experiences an ''increased'' sensitivity to pain. Hyperalgesia can occur after injury to an area of the body or from opioid usage. Allodynia and hyperalgesia are common symptoms of migraine and ME/CFS which suggests central sensitization may be a key component underlying the physiology between both conditions.

'''''Other commonalities between migraine and ME/CFS include:'''''

* ME/CFS and migraine affect females more than males, although men can develop both diseases.
* Although both diseases have their own criteria for diagnosis, the diagnosis is made based on symptoms and elimination of other causes.
* Many people with ME/CFS or migraine are impacted by exercise, stress or sensitivity to sensory stimulation or changes in barometric pressure.
* They share many comorbidities such as fibromyalgia, irritable bowel syndrome, interstitial cystitis, temporomandibular joint disorder, chronic pelvic pain, depression, anxiety and more.

* Chronic pain, chronic migraine and ME/CFS are much more common in people with a history of abuse and PTSD.
</blockquote>'''Additional resources:'''

Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine<ref>{{Cite web|url=https://www.s4me.info/threads/fatigue-cfs-and-migraine-intersecting-the-lines-through-a-cross-sectional-study-in-patients-with-episodic-and-chronic-migraine-2023-kumar.35210/|title=Trial Report - Fatigue, CFS and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine, 2023, Kumar {{!}} Science for ME|website=www.s4me.info|access-date=2025-11-23}}</ref><ref>{{Cite journal|title=Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine|date=2023-04-20|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC10483198/|journal=Journal of Neurosciences in Rural Practice|volume=14|issue=3|pages=424–431|last=Kumar|first=Hemant|last2=Dhamija|first2=Kamakshi|last3=Duggal|first3=Ashish|last4=Khwaja|first4=Geeta Anjum|last5=Roshan|first5=Sujata|language=en|doi=10.25259/JNRP_63_2022|pmc=10483198|issn=0976-3155}}</ref>

Discriminating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and comorbid conditions using metabolomics in UK Biobank<ref>{{Cite journal|title=Discriminating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and comorbid conditions using metabolomics in UK Biobank|date=2024-11-26|url=https://www.nature.com/articles/s43856-024-00669-7|journal=Communications Medicine|volume=4|issue=1|last=Huang|first=Katherine|last2=G. C. de Sá|first2=Alex|last3=Thomas|first3=Natalie|last4=Phair|first4=Robert D.|last5=Gooley|first5=Paul R.|last6=Ascher|first6=David B.|last7=Armstrong|first7=Christopher W.|language=en|doi=10.1038/s43856-024-00669-7|pmc=11599898|issn=2730-664X}}</ref>

Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?<ref>{{Cite journal|title=Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?|date=2021-06-03|url=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2021.646692/full|journal=Frontiers in Human Neuroscience|volume=15|last=Nazia|first=Karsan,|last2=J.|first2=Goadsby, Peter|language=English|doi=10.3389/fnhum.2021.646692/full|issn=1662-5161}}</ref>

Chronic Overlapping Pain Conditions in people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a sample from the Multi-site Clinical Assessment of ME/CFS (MCAM) study<ref>{{Cite journal|title=Chronic Overlapping Pain Conditions in people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a sample from the Multi-site Clinical Assessment of ME/CFS (MCAM) study|date=2024-10-18|url=https://pubmed.ncbi.nlm.nih.gov/39425035/|journal=BMC Neurology|volume=24|issue=1|last=Fall|first=Elizabeth A.|last2=Chen|first2=Yang|last3=Lin|first3=Jin-Mann S.|last4=Issa|first4=Anindita|last5=Brimmer|first5=Dana J.|last6=Bateman|first6=Lucinda|last7=Lapp|first7=Charles W.|last8=Podell|first8=Richard N.|last9=Natelson|first9=Benjamin H.|last10=Kogelnik|first10=Andreas M.|last11=Klimas|first11=Nancy G.|language=en|doi=10.1186/s12883-024-03872-0|pmc=11488184|issn=1471-2377}}</ref>

==Possible causes==
Migraine is believed to be genetic, with [https://e-hpr.org/journal/view.php?number=921 monogenic and polygenic contributions to its pathophysiology].<ref>{{Cite journal|title=Genetic Architecture of Migraine: From Broad Insights to East Asian Perspectives|date=2025-06-30|url=https://e-hpr.org/journal/view.php?number=921|journal=Headache and Pain Research|volume=26|issue=2|pages=116–129|last=Kim|first=Joonho|last2=Chu|first2=Min Kyung|language=English|doi=10.62087/hpr.2025.0003|issn=3022-9057}}</ref> It is believed to be caused by genetic and epigenetic factors. Migraine also has physiological and biochemical factors, e.g. insulin or oestrogen [[hormone]] levels, increased [[oxidative stress]]<ref name="Khan2021" /><ref name="NHS-overall" />

==Potential treatments==
Migraine treatment consists of:
*Acute therapies that aim to stop a migraine attack or reduce the symptoms: gepants, triptans, NSAIDs, neuromodulation devices, DHE, and anti-nausea medication

*Preventive therapies that manage the disease, including reducing attack frequency and symptom severity.
Considering the high comorbidity rate of migraine in patients with me/cfs, it is increasingly recognized that receiving a migraine diagnosis and appropriately (and likely aggressively) treating migraine will improve the overall outcomes and quality of life of me/cfs patients. [https://journals.sagepub.com/doi/10.1177/03331024241245658 If chronic migraine is not identified and treated, these ongoing sensory sensitivities can exacerbate neurological stress and increase the overall burden on the central nervous system.] This heightened neural stress may contribute to the worsening of symptoms and triggers post-exertional malaise (PEM)<ref>{{Cite journal|title=Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study|date=2021-11|url=https://doi.org/10.1016/j.jpsychores.2021.110624|journal=Journal of Psychosomatic Research|volume=150|pages=110624|last=Bourke|first=Julius H.|last2=Wodehouse|first2=Theresa|last3=Clark|first3=Lucy V.|last4=Constantinou|first4=Elena|last5=Kidd|first5=Bruce L.|last6=Langford|first6=Richard|last7=Mehta|first7=Vivek|last8=White|first8=Peter D.|doi=10.1016/j.jpsychores.2021.110624|issn=0022-3999}}</ref>, a hallmark and debilitating feature of ME/CFS characterized by worsening of fatigue, pain, and cognitive dysfunction after minimal physical or mental exertion.

=== Acute migraine treatments ===
*'''General [[analgesic|pain medications]]''', including [[acetaminophen]] and [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatories]] (NSAID), for mild to moderate migraines. Naproxen is often preferred. Different types of medications are sometimes combined, for example acetaminophen and [[naproxen]].<ref name="Khan2021">{{Cite journal | last = Khan | first = Johra | last2 = Asoom | first2 = Lubna Ibrahim Al | last3 = Sunni | first3 = Ahmad Al | last4 = Rafique | first4 = Nazish | last5 = Latif | first5 = Rabia | last6 = Saif | first6 = Seham Al | last7 = Almandil | first7 = Noor B. | last8 = Almohazey | first8 = Dana | last9 = AbdulAzeez | first9 = Sayed | date = 2021-07-01 | title = Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine|url=https://www.sciencedirect.com/science/article/pii/S0753332221003425|journal=Biomedicine & Pharmacotherapy|language=en|volume=139|pages=111557|doi=10.1016/j.biopha.2021.111557|issn=0753-3322}}</ref>
*'''Prescription NSAIDs,''' such as Toradol (Sprix), diclofenac, and nabumetone, flurbiprofen, indomethacin, etc. While not often prescribed, flurbiprofen is one of the most effective NSAIDs and has the strongest effect when treating migraine.
*'''[[:Category:Triptans|Triptans]] or ditans''' for moderate or severe migraine e.g. [[sumatriptan]] (Imitrex): 13 out of 14 newly diagnosed migraine subjects responded to sumatriptan in one [[Chronic fatigue syndrome|CFS]] patient cohort<ref name="Ravindran2011" /> or [[zomitriptan]] (Zomig)<ref name="drugscom">{{Cite web|url=https://www.drugs.com/health-guide/migraine.html | title = Migraine Guide: Causes, Symptoms and Treatment Options|website=Drugs.com|language=en|access-date=2021-10-12}}</ref>
*'''Small molecule [[:Category:CGRP antagonists|CGRP antagonists]]''', known as [[:Category:Gepants|gepants]], which are the newest group of migraine drugs<ref name="Negro2019">{{Cite journal | last = Negro | first = Andrea | authorlink = | last2 = Martelletti | first2 = Paolo | authorlink2 = | date = Jun 2019 | title = Gepants for the treatment of migraine|url=https://pubmed.ncbi.nlm.nih.gov/31081399/|journal=Expert Opinion on Investigational Drugs|volume=28|issue=6 | pages = 555–567|doi=10.1080/13543784.2019.1618830|issn=1744-7658|pmc=|pmid=31081399|access-date=|quote=|via=}}</ref>
*'''Dihydroergotamine''' interacts with multiple receptors in the brain, including serotonin, dopamine, and adrenergic receptors, to stop the release of substances that contribute to headache pain and inflammation, as well as central sensitization. DHE can hold promise as an acute ME/CFS option due to how it reduces inflammation and targets central sensitization.
*'''Antinausea medications''' - reglan, prochlorperazine, promethazine, and zofran. Note: both reglan & prochlorperazine treat the process of migraine in addition to migraine-associated gastroparesis and dyspepsea.
*'''Neuromodulation devices''' treat migraine by applying targeted electrical or magnetic stimulation to specific nerves or brain areas involved in migraine pathophysiology, modulating their activity to reduce pain and prevent attacks. Devices include e-TNS (Cefaly), TENS (HeadATerm), sTMS (savi dual), nVNS (gammaCore or Truvaga), REN (Nerivio), and COT-NS (Relivion).<ref>{{Cite journal|title=Update on Neuromodulation for Migraine and Other Primary Headache Disorders: Recent Advances and New Indications|date=2025-02-15|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC11829934/|journal=Current Pain and Headache Reports|volume=29|issue=1|last=Cocores|first=Alexandra N.|last2=Smirnoff|first2=Liza|last3=Greco|first3=Guy|last4=Herrera|first4=Ricardo|last5=Monteith|first5=Teshamae S.|language=en|doi=10.1007/s11916-024-01314-7|pmc=11829934|issn=1531-3433}}</ref>

=== Migraine preventive and management treatments ===
Depending on the migraine type, various mechanisms contribute to the disease and its symptoms. Migraine treatments target various mechanisms that are part of migraine pathophysiology.
*[https://www.neurology.org/doi/10.1212/WNL.0000000000213852 '''CGRP targeting medications''',] such as [[Calcitonin gene-related peptide monoclonal antibody|CGRP monoclonal antibodies]]<ref name="Negro2019" /> like Amovig, Ajovy, Emgality and Vyepti, as well as gepants, such as Qulipta and Nurtec, that block the CGRP pathway. These medications target calcitonin gene related peptide (CGRP), which [https://www.neurology.org/doi/10.1212/WNL.0000000000213852 sensitize trigeminal neurons & lead to the development of allodynia and migraine attacks where normal stimuli can lead to nociceptive sensitizations].
*'''Botox injections''' (botulinum toxin type A via the PREEMPT Protocol)
*'''Off-label medications''', including beta blockers (propranolol, etc), anti-seizure medications (topiramate, etc), gabapentinoids, tricyclic antidepressants (Amitriptyline, Nortriptyline), calcium channel blockers (verapamil), sodium channel blockers (lamotrigine, mexiletine), antipsychotics (olanzapine), NMDA-receptor antagonists (Namenda, amantadine, etc). <ref name="Negro2019" /><ref name="NHS" /> These medications do things from block neuronal excitability (NMDA-receptor antagonists) and pain modulation (beta blockers) to reducing neuronal excitability (anti-seizure meds) and reducing cortical spreading depression and hyperexcitability (sodium channel blockers).
*[https://americanmigrainefoundation.org/resource-library/non-invasive-neuromodulation-devices/ '''Neuromodulation Devices'''] [https://www.migrainedisorders.org/video/chapter-5-episode-6-neuromodulation-devices/ ''apply external electrical or magnetic impulses to reduce, eliminate or prevent migraine attacks. They are worn or held against different parts of the body to stimulate nerves or areas of the brain and nervous system involved in the migraine process'']. Preventive neuromodulation devices include Cefaly, gammaCore, Nerivio, and savi dual. [https://otolithlabs.com/ Otolith is completing its clinical trials for vestibular migraine].
*'''Infusions''' - outpatient and inpatient infusions typically are used to treat status migrainosus, medication adaptation headache, and refractory chronic migraine. Vyepti is a quarterly CGRP targeting infusion that has been proven to be particularly effective for severe chronic migraine. Other infusions may include ketorolac, dihydroergotamine, lidocaine, ketamine, prochlorperazine, magnesium, antipsychotic medication, and saline.
''PACAP-targeting medications currently are in clinical trials and will be released to the public in the coming years''.

'''Complementary Care''' - these are not standalone treatments but instead may improve ones overall treatment plan and improve quality of life.
*'''Nerve blocks''': trigeminal nerve block, occipital nerve block, SPG block<ref>{{Cite web|url=https://www.migrainedisorders.org/video/chapter-5-episode-4-nerve-blocks-for-migraine-disease/|title=Chapter 5, Episode 4: Nerve Blocks for Migraine Disease - Association of Migraine Disorders|website=www.migrainedisorders.org|access-date=2025-11-23}}</ref>
*'''Biofeedback''' <ref>{{Cite journal|title=Efficacy of biofeedback for migraine: A systematic review and meta-analysis|date=2025-06|url=https://doi.org/10.1016/j.ctim.2025.103153|journal=Complementary Therapies in Medicine|volume=90|pages=103153|last=Paudel|first=Prayash|last2=Sah|first2=Asutosh|doi=10.1016/j.ctim.2025.103153|issn=0965-2299}}</ref>
*'''Green light therapy''' is a narrow band of green light that generates weaker electrical signals in the brain's pain-processing areas
*'''FL-41 lenses''' filter out specific wavelengths of light, primarily in the blue-to-green spectrum (approximately 480 to 520 nm). This range of light has been found to be particularly triggering for people with migraine due to its activation of certain retinal cells called intrinsically photosensitive retinal ganglion cells (ipRGCs), which influence both visual processing and pain pathways in the brain. This reduces photophobia, as well as eye strain.<ref>{{Cite journal|title=FL-41 Tint Reduces Activation of Neural Pathways of Photophobia in Patients with Chronic Ocular Pain|date=2024-03|url=https://doi.org/10.1016/j.ajo.2023.12.004|journal=American Journal of Ophthalmology|volume=259|pages=172–184|last=Reyes|first=Nicholas|last2=Huang|first2=Jaxon J.|last3=Choudhury|first3=Anjalee|last4=Pondelis|first4=Nicholas|last5=Locatelli|first5=Elyana V.T.|last6=Hollinger|first6=Ruby|last7=Felix|first7=Elizabeth R.|last8=Pattany|first8=Pradip M.|last9=Galor|first9=Anat|last10=Moulton|first10=Eric A.|doi=10.1016/j.ajo.2023.12.004|pmc=PMC10939838|issn=0002-9394}}</ref>
*Physical therapy, vestibular rehab therapy, and occupational therapy
*'''Acupuncture<ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/migraine/prevention/ | title = Migraine - Prevention | last = | first = | authorlink = | date = 2017-10-23 | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-12}}</ref>'''
*'''Supplements''' including [[magnesium]], [[feverfew]], the B vitamin [[riboflavin]], [[CoQ10]], and others.<ref name="Sun2011">{{Cite journal|title=Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments: March 2011|date=Mar 2011|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01846.x|journal=Headache: The Journal of Head and Face Pain|volume=51|issue=3|pages=469–483|last=Sun-Edelstein|first=Christina|authorlink=|last2=Mauskop|first2=Alexander|authorlink2=|language=en|doi=10.1111/j.1526-4610.2011.01846.x|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="Barmherzig2021">{{Cite journal|title=Nutraceuticals and Behavioral Therapy for Headache|date=2021-05-10|url=https://doi.org/10.1007/s11910-021-01120-3|journal=Current Neurology and Neuroscience Reports|volume=21|issue=7|pages=33|last=Barmherzig|first=Rebecca|last2=Rajapakse|first2=Thilinie|language=en|doi=10.1007/s11910-021-01120-3|issn=1534-6293}}</ref><ref name="Sun2009">{{Cite journal|title=Foods and Supplements in the Management of Migraine Headaches|date=Jun 2009|url=https://journals.lww.com/clinicalpain/Abstract/2009/06000/Foods_and_Supplements_in_the_Management_of.15.aspx|journal=The Clinical Journal of Pain|volume=25|issue=5|pages=446–452|last=Sun-Edelstein|first=Christina|authorlink=|last2=Mauskop|first2=Alexander|authorlink2=|language=en-US|doi=10.1097/AJP.0b013e31819a6f65|pmc=|pmid=|access-date=|issn=0749-8047|quote=|via=}}</ref> [[Butterbur]] is not recommended due to liver toxicity.<ref name="NCCIH">{{Cite web|url=https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science|title=Dietary Supplements for Headaches: What the Science Says|last=|first=|authorlink=|date=|website=[[National Center for Complementary and Integrative Health]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-13}}</ref> Some neurologists still recommend supplements with [[Butterbur]] as long as they are free of pyrrolizidine alkaloids.
*'''[[Daith piercing]],''' a type of ear piercings<ref name="Cascio2017">{{Cite journal | last = Cascio Rizzo | first = Angelo | last2 = Paolucci | first2 = Matteo | last3 = Altavilla | first3 = Riccardo | last4 = Brunelli | first4 = Nicoletta | last5 = Assenza | first5 = Federica | last6 = Altamura | first6 = Claudia | last7 = Vernieri | first7 = Fabrizio | date = 2017 | title=Daith Piercing in a Case of Chronic Migraine: A Possible Vagal Modulation|journal=Frontiers in Neurology|language=English|volume=8|pages=|doi=10.3389/fneur.2017.00624|issn=1664-2295|pmc=5711775|pmid=29230190|via=}}</ref> - there is no reproducible, peer-reviewed evidence supporting daith piercings. Given the migraine population's high rate of the placebo effect, daith piercing success is commonly believed to be placebo effect and somewhat short-lived.
*'''[[Migraine elimination diet]]s,''' which rely on identifying particular foods, drinks or additives that trigger migraines, for example avoiding food or drinks containing [[nitrates]] or [[tyramine]]<ref name="Khan2021" /><ref name="NHS" /> However more current research shows that trigger avoidance is not as effective as overall dynamic migraine disease management.
Other recommended measures include meditation, mindfulness, progressive muscle relaxation, sleep hygiene, stress reduction, and gentle, tolerable exercise (chair yoga, tai chi, stretching), as well as comorbidity symptom management.

==Notable studies==
*2011, Migraine headaches in [[chronic fatigue syndrome]] (CFS): comparison of two prospective cross-sectional studies.<ref name="Ravindran2011">{{Cite journal | last = Ravindran | first = Murugan K | last2 = Zheng | first2 = Yin | last3 = Timbol | first3 = Christian | last4 = Merck | first4 = Samantha J | last5 = Baraniuk | first5 = James N | authorlink5 = James Baraniuk | date = 5 Mar 2011 | title = Migraine headaches in Chronic Fatigue Syndrome (CFS): Comparison of two prospective cross-sectional studies|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058027/|journal=BMC Neurology|language=en|volume=11|issue=1|pages=|doi=10.1186/1471-2377-11-30|issn=1471-2377|pmc=|pmid=21375763|via=}}</ref>
*2013, Migraine in [[Gulf War Illness|gulf war illness]] and [[chronic fatigue syndrome]]: Prevalence, potential mechanisms, and evaluation.<ref name="Rayhan">{{Cite journal | last = Rayhan | first = Rakib U. | last2 = Ravindran | first2 = Murugan K. | last3 = Baraniuk | first3 = James N.| date = 2013 | title = Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation | url =https://www.ncbi.nlm.nih.gov/pubmed/23898301|journal=Frontiers in Physiology|volume=4|pages=181|doi=10.3389/fphys.2013.00181|issn=1664-042X|pmid=23898301|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721020/ (Full Text)]
*2016, Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the [[American Gut Project]] Cohort<ref>{{Cite journal | last = Gonzalez | first = Antonio | last2 = Hyde | first2 = Embriette | last3 = Sangwan | first3 = Naseer | last4 = Gilbert | first4 = Jack A. | last5 = Virre | first5 = Erik | last6 = Knight | first6 = Rob | date = Oct 18, 2016 | title = Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort|url=https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf | journal=American Society for Microbiology|volume=1|issue=5|pages=|via=}}</ref> [https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf (Full Text)]

==News and articles==
*May 19, 2018, [https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit?]<ref>{{Cite news | url=https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ | title = The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit? - Health Rising | last = Johnson | first =Cort | date = 2018-05-19|work=Health Rising|access-date=2018-08-11|archive-url=|archive-date=|url-status=|language=en-US}}</ref>

==Learn more ==
*[https://www.nhs.uk/conditions/migraine/treatment/ Migraine treatment] - National Health Service

== See also ==
* [[Headache]]
* [[Magnesium]]
* [[Analgesic]] (pain killer)

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Neurological diseases and disorders]]
[[Category:Potential comorbidities]]
[[Category:Signs and symptoms]]
[[Category:Pain signs and symptoms]]
[[Category:Neurological signs and symptoms]]

Migraine

2025-11-23T22:05:34Z

Chuck23:Updated & corrected the definition of migraine, including the various types and subtypes of migraine according to the ICHD-3 and current research. Corrected the phases of migraine section & updated the phases of migraine. Provided a thorough list of various migraine treatments & medications, including how they treat the disease. Corrected and updated outdated treatment information, and added context to treatments not supported by the headache community. Updated links & citations to be current

[[File:Migraine-art.jpg|left|thumb|320px|Source: [https://www.flickr.com/photos/tudedude/14019222689 Migraine by Tudor Barker]]] 
'''Migraine''' is highly comorbid in people with [[ME/CFS]]<ref>{{Cite news|url=https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/|title=Migraine and ME/CFS|last=Petrarca|first=Kylie|date=2022-05-12|work=Association of Migraine Disorders|access-date=2025-11-23|language=en-US}}</ref>. As much as 85% of people with ME/CFS also have migraine disease.

Migraine is a spectrum neurobiological disease with a genetic predisposition. It is the dysfunction of the central and peripheral nervous systems. There are many different types & subtypes of migraine. If not properly managed, migraine can be a progressive, ongoing disease.

In a 2011 study by Ravindran, et al, migraine were found in 84%, and [[tension-type headache]]s in 81% of a cohort of [[chronic fatigue syndrome]] patients.<ref name="Ravindran2011" /> This compared to 5% and 45%, respectively, in a cohort of healthy controls.<ref name="Ravindran2011" /> Receiving a migraine diagnosis and appropriately treating the disease may reduce overall symptoms and stress that could trigger post-exertional malaise.

==Symptoms==
<ref name="NHS-overall" />

Migraine symptoms include mild to moderate unilateral and/or throbbing or pulsating headache that may get worse with or lead to the avoidance of physicial activity (such as doing laundry, etc). Migraine pain is described as moderate to severe, but some types of migraine have little to no head pain.

Other symptoms include light and/or sound sensitivity, as well as nausea and/or vomiting. The majority of migraine patients will experience allodynia during their attack.

Migraine makes one incredibly sensitive to sensory & environmental stimuli that many call triggers. Triggers do not cause migraine disease; migraine disease makes one sensitive to triggers.
==Phases==
Migraine has 4-5 phases: prodromal, aura (for 30% of migraine patients), acute, postdrome, and interictal (between attacks). Many with chronic migraine experience ongoing migrainous symptoms between attacks.
;Prodromal (pre-headache) stage
:4-42 hours before the aura or acute phase. Symptoms include phantom smells, heightened sensory sensitivity (smells, sounds, visual stimuli), food cravings, neck pain, increased urination, increased energy, etc.
:Recent research shows that many prodromal symptoms may be confused for migraine attack triggers.
;Aura phase (~30% of migraine population)
:5-60 minutes before the acute phase. Outside of migraine with brainstem aura, auras typically are experienced sequentially, fully reversing before transitioning to the next aura. This is due to how cortical spreading depression works by slowly traveling across various cortexes of the brain.
:
:The majority of people with migraine with aura experience visual aura: flashes of light (scintillations), blind spots (scotoma), perceiving objects to be much larger or smaller than in reality, shimmering, flickering, tunnel vision, and blurred/distorted vision.
:Other auras include somatosensory (tingling, pins & needles, numbness, feeling like a limb is disconnected), dysphasic (mixing up words, difficulty thinking of words, slurred speech, stutter, difficulty understanding speech), vestibular (dizziness, vertigo, spacial disorientation), and motor (motor weakness, facial droop, dexterity issues, sensation of dead weight).
:Anecdotally, people have reported olfactory & taste-related auras but those are not acknowledged by the International Classification of Headache Disorders, Third Edition (ICHD-3).
;Acute phase
:Typically a moderate or severe pulsating or throbbing head pain on one side of the head (but can be on both sides), often accompanied by [[nausea]], [[vomiting]] or [[photophobia|extreme light sensitivity]] and extreme sensitivity to loud sounds, which last from 4 hours to 3 days without acute medication.
:Allodynia (a sign of central sensitization) begins during the acute phase.
:For those with vestibular migraine, the acute phase consists of moderate to severe dizziness, in addition to the more traditional head pain, nausea, vomiting, and severe sensory sensitivities (particularly motion & screens).
;Postdromal stage
:Often referred to the hangover phase, the postdrome is when acute and other symptoms gradually fade, but there may be [[fatigue|tiredness]] & exhaustion for few days after<ref name="NHS-symptoms">{{Cite web|url=https://www.nhs.uk/conditions/migraine/symptoms/ | title = Migraine - Symptoms | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref><ref name="Khan2021" /><ref name="NHS-overall" />
:Additional symptoms include brain fog, mood changes, sensory sensitivities, dull head pain, GI & urinary issues, temperature dysregulation, allodynia, and more. '''Interictal Phase'''
:Otherwise known as the phase between migraine attacks. For many, the interictal phase will be symptom-free, but for most with chronic migraine, vestibular migraine, or migraine with unilateral motor symptoms (MUMS), the interictal phase will have ongoing symptoms including dull headache, sensory sensitivities (light, sound, temperature, motion, etc), and other neurological symptoms. Those with chronic vestibular migraine typically experience ongoing baseline dizziness, and those with chronic MUMS may experience ongoing baseline unilateral weakness, tingling, & dysfunctioning proprioception.
[[File:Migraine-phases.jpg|left|thumb|600px|Migraine phases. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Khan et. al. (2021). Biomedicine & Pharmacotherapy, 139, 111557.]<ref name="Khan2021"/>]] 

==Types ==
===Migraine without aura===
'''Migraine without aura''' is defined by the following diagnostic criteria outlined in ''The International Classification Of Headache Disorders, 3rd edition'':

====Migraine without aura diagnostic criteria====
<ol style="list-style-type:upper-alpha"><li> At least '''five''' headache attacks that</li>
<li> Last 4–72 hours without successful treatment</li>
<li> Headaches have at least '''two''' of the following four characteristics:</li>
<ol><li> unilateral location;</li>
<li> pulsating quality;</li>
<li> moderate to severe pain intensity; and</li>
<li> aggravation by or causing avoidance of routine physical activity.</li></ol>
<li> During the headaches at least '''one''' of the following:</li>
<ol><li> [[nausea]] and/or vomiting</li>
<li> [[photophobia]] and phonophobia (avoidance of loud noises)</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.</li>
</ol>

:Migraines without aura may also be called '''common migraine'' or '''hemicrania simplex'''.<ref name="ICHD-3">{{Cite journal | last = Headache Classification Committee of the International Headache Society | date = 2018 | title = The International Classification of Headache Disorders|edition=3rd | url =https://doi.org/10.1177/0333102417738202|journal=Cephalalgia|language=en|volume=38|issue=1|pages=1–211|doi=10.1177/0333102417738202|issn=0333-1024}}</ref>

===Migraine with aura===
====Migraine with aura diagnostic criteria====

:Visual, sensory and central nervous system symptom in beginning shortly before a migraine headache are known as an '''aura''', although migraine with aura without migraine headaches are also recognized.

<ol style="list-style-type:upper-alpha"><li> At least '''two''' migraine attacks fulfilling criteria B and C</li>
<li>'''One''' or more of the following fully reversible aura symptoms</li>
<ol><li> visual </li>
<li> sensory </li>
<li> speech and/or language </li>
<li> motor </li>
<li> brainstem </li>
<li> retinal </li></ol>
<li> At least '''three''' of the following characteristics:</li>
<ol><li> at least '''one''' aura symptom spreads gradually over five minutes or longer</li>
<li> '''two''' or more aura symptoms occur in succession</li>
<li> each individual aura symptom lasts 5 to 60 minutes </li>
<li> at least one aura symptom is '''unilateral''' (one sided)</li>
<li> at least one aura symptom is '''positive''' </li>
<li> the aura is accompanied, or followed within 60 minutes, by headache</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.<ref name="ICHD-3" /></li></ol>

The recognized types of migraine with aura are:
*Typical aura with headache
*Typical aura without headache
*Migraine with brainstem aura
*Hemiplegic migraine, including familial hemiplegic migraine (FHM) type 1, type 2, type 3 and with other loci
* Sporadic hemiplegic migraine (SHM)
* Retinal migraine

Migraines without aura may also be called '''Classic or classical migraine''', '''ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine''', or '''complicated migraine'''.<ref name="ICHD-3" />

'''Note: Ocular and complex migraine are not official terms'''. Ocular migraine is used interchangeably with retinal migraine and migraine with (visual) aura. Retinal migraine is a very specific type of migraine where the aura appears in one eye only and is believed to be due to excitement in the retina. Migraine with visual aura is due to cortical spreading depression taking place in the brain, specifically the visual cortex.

[https://headaches.org/wp-content/uploads/2024/07/Complex-Migraine-Transcript.pdf Complex migraine is a catch-all term for migraine with atypical aura, migraine with brainstem aura, migraine with unilateral motor symptoms (MUMS), hemiplegic migraine, and vestibular migraine. Neurologists who use this term may not be well-versed in the specific mechanisms involved in each migraine type, which may lead to inappropriate treatment]. <ref>{{Cite web|url=https://headaches.org/what-is-complex-migraine/|title=What is Complex Migraine? {{!}} National Headache Foundation|website=headaches.org|access-date=2025-11-23}}</ref>

[https://www.milesformigraine.org/fighting-for-migraine-with-words/#:~:text=Here%20are%20some%20tips%20for%20using%20language,subtly%20blames%20the%20person%20who%20has%20it. Other outdated or inaccurate terms may include: classical migraine, cluster migraine, optical migraine, visual migraine, migraine headache, migraines, rebound headache, medication overuse headache]

===Epidosic vs Chronic migraine<ref>{{Cite journal|title=High-frequency episodic migraine: Time for its recognition as a migraine subtype?|date=October 22, 2024|url=https://journals.sagepub.com/doi/10.1177/03331024241291578|journal=Cephalalgia|volume=44|issue=10|pages=23|last=Cammarota|first=Francescantonio|author-link=https://journals.sagepub.com/reader/content/1951600cf8d/10.1177/03331024241291578/format/epub/EPUB/xhtml/index.xhtml?hmac=1763925246-mXuWtxp1NXr5RG41jihGsNVFQC2I1yUuSakdFIFA9Q8%3D#aff1-03331024241291578|last2=de Icco|first2=Roberto|author-link2=https://journals.sagepub.com/doi/10.1177/03331024241291578#con2|last3=Goadsby|first3=Peter|author-link3=https://orcid.org/0000-0003-3260-5904|last4=Vaghi|first4=Gloria|author-link4=https://journals.sagepub.com/authored-by/Vaghi/Gloria|last5=Corrado|first5=Michael|author-link5=https://journals.sagepub.com/authored-by/Corrado/Michele|doi=10.1177/03331024241291578|quote=Multiple features differentiate subjects with HFEM from low-frequency episodic migraine and from chronic migraine: education, employment rates, quality of life, disability and psychiatric comorbidities load. Some evidence also suggests that HFEM bears a specific profile of activation of cortical and spinal pain-related pathways, possibly related to maladaptive plasticity.|via=Sage Journals Home}}</ref> ===

* '''Very low frequency episodic migraine''' - 0-3 migraine and/or headache days/month
* '''Low frequency episodic migraine -''' 4-7 migraine and/or headache days/month
* '''High frequency episodic migraine -''' 8-14 migraine and/or headache days/month
* '''Chronic migraine -''' 15 headache days where at least 8 days have migrainous features (light/sound sensitivity, Nausea/vomiting, exacerbation by activity, etc)

Migrainous features can include sensory sensitivity (light, sound, smell, motion), nausea and/or vomiting, exacerbation by activity, neck pain, allodynia, etc. One does not have to have a stereotypical ''migraine attack'' to log a migrainous feature day; they can have a dull headache with light sensitivity, tinnitus, and allodynia, and that would count toward a migraine day, [https://journals.sagepub.com/doi/10.1177/03331024251393986 although the exact definition of a "migraine day" is still unstandardized by the headache community.]

Research does show a significant shift in quality of life as the person transitions from very low frequency episodic migraine to high frequency episodic migraine, which is why preventive treatment is now encouraged to begin when the person experiences 4 migraine and/or headache days in a month.

Note: '''as migraine progresses,''' it's symptoms become more persistent and neurological and less dominated by pain. This happens because the brain undergoes changes in how it processes pain and sensory information over time. With repeated migraine attacks, the nervous system becomes sensitized and more reactive—not just to pain but to non-painful sensory inputs. Patients are more liekly to develop vestibular migraine and MUMS (or both) during this time.

This can lead to:

* A reduction in the intensity of headache pain but an increase in unusual sensory symptoms (like visual disturbances, dizziness, or sensory sensitivities).
* A “normalization” or habituation effect where the brain adapts to frequent pain signals, leading to less intense pain but more complex neurological symptoms.
* Alterations in brain networks related to sensory integration, emotional regulation, and pain modulation, changing the migraine experience qualitatively.
* Changes in neurotransmitter systems and cortical excitability reduce pain perception but increase aura complexity, sensory disturbances, or fatigue.

===Migraine with Aura without Head Pain (silent or acephalgic migraine) ===
Migraine symptoms that do not result in a headache are known as migraine with aura without head pain, e.g. migraine aura symptoms without head pain.migraine aura without headache – where an aura or other migraine symptoms are experienced, but a headache does not develop.<ref name="NHS-overall">{{Cite web|url=https://www.nhs.uk/conditions/migraine/ | title = Migraine | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref>

===Abdominal migraine ===
Most often occurring in children, <ref name="ICHD-3" /> the person must have had at least five recurrent episodes of moderate to severe pain in the abdomen usually around the midsection or belly button. The person must also have at least two of the following: nausea, vomiting, paleness, or loss of appetite. A headache may or may not be present. An aura may occur before the abdominal symptoms.<ref>{{Cite web|url=https://www.migrainedisorders.org/video/abdominal-migraine/|title=Chapter 1, Episode 10: What is Abdominal Migraine? - Association of Migraine Disorders|website=www.migrainedisorders.org|access-date=2025-11-23}}</ref>

== Other Migraine Types & complications ==
''(either recognized in the ICHD-3 appendix or gathering international headache research support)''

* Menstrual migraine or menstrually-related migraine
* Vestibular migraine
* Migraine with Unilateral Motor Symptoms (MUMS)
* Multi-sensory migraine subtypes
* Prolonged aura without infarction
* Persistent migraine aura

==Triggers ==
[[File:Migraine_triggers.jpg|left|600px|Migraine triggers. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Biomedicine & Pharmacotherapy, 139, 111557]<ref name="Khan2021"/>]] ''Migraine is a neurological disease with an inherent sensitivity to a wide and ever-changing range of triggers, many of which are unavoidable normal daily environmental or lifestyle factors that become problematic when experienced irregularly or unpredictably.''
People with migraine are sensitive to stress, environmental factors, various sensory stimuli, some food, and various changes (hormonals, biochemical) that are called triggers. Research is beginning to support that the [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841237#250653113 brain's altered processing creates a varied vulnerability to varied and unpredictable triggers]<ref>{{Cite web|url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841237|title=Information-Theoretic Trigger Surprisal and Future Headache Activity|last=Turner, PhD|first=Dana P|authorlink=Https://www.ncbi.nlm.nih.gov/pubmed/31784989|last2=Patel, MD|first2=Twinkle|authorlink2=Https://health.usnews.com/doctors/twinkle-patel-116495|date=November 11, 2025|website=JAMA Network Open|archive-url=https://archive.is/wip/wSPeI|archive-date=November 23, 2025|url-status=live}}</ref> rather than the previously presented singular trigger cause + effect theory. [https://www.neurologylive.com/view/helping-your-patients-avoid-the-migraine-trigger-trap Migraine management is slowly transitioning away from strict trigger avoidance and toward dynamic trigger management via treatments and lifestyle measures]<ref>{{Cite journal|title=Triggers, Protectors, and Predictors in Episodic Migraine|date=2018-10-05|url=https://pubmed.ncbi.nlm.nih.gov/30291562/|journal=Current Pain and Headache Reports|volume=22|issue=12|last=Marmura|first=Michael J.|language=en|doi=10.1007/s11916-018-0734-0|issn=1531-3433}}</ref>.

==Migraine & ME/CFS==
Migraines is one of several illnesses or conditions common in people with [[ME/CFS]].<ref name="ammes">{{Cite web|url=https://ammes.org/overlapping-conditions/ | title = Overlapping Conditions – American ME and CFS Society|website=ammes.org|language=en-US|access-date=2018-08-12}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17= Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012
| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref>

The [[Canadian Consensus Criteria]] recognizes migraines in the [[:Category:Neurological signs and symptoms|possible neurological symptoms]] of [[ME/CFS]], and the [[International Consensus Criteria]] recognizes [[headache]] conditions including [[migraine]] and [[tension-type headache]] in the diagnostic criteria for [[myalgic encephalomyelitis]].<ref name="ICC2011primer" /> Though it is important to note that migraine is not a symptom of ME/CFS but instead is a comorbidity that requires its own standalone treatment. <blockquote>
=== T[https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/ he Relationship and Commonalities Between ME/CFS and Migraine]<ref>{{Cite news|url=https://www.migrainedisorders.org/migraine-and-chronic-fatigue-syndrome/|title=Migraine and ME/CFS|last=Petrarca|first=Kylie|date=2022-05-12|work=Association of Migraine Disorders|access-date=2025-11-23|language=en-US}}</ref> ===
It is believed central sensitization plays a key role in the connection between ME/CFS and migraine. Central sensitization is also known as hypersensitivity of the nervous system (brain and spinal cord) and causes allodynia and hyperalgesia. Allodynia occurs when someone experiences pain from something not normally painful. Some examples of allodynia are pain from touching cold water, brushing hair or moving the bed sheets across the skin. Hyperalgesia is when someone experiences an ''increased'' sensitivity to pain. Hyperalgesia can occur after injury to an area of the body or from opioid usage. Allodynia and hyperalgesia are common symptoms of migraine and ME/CFS which suggests central sensitization may be a key component underlying the physiology between both conditions.

'''''Other commonalities between migraine and ME/CFS include:'''''

* ME/CFS and migraine affect females more than males, although men can develop both diseases.
* Although both diseases have their own criteria for diagnosis, the diagnosis is made based on symptoms and elimination of other causes.
* Many people with ME/CFS or migraine are impacted by exercise, stress or sensitivity to sensory stimulation or changes in barometric pressure.
* They share many comorbidities such as fibromyalgia, irritable bowel syndrome, interstitial cystitis, temporomandibular joint disorder, chronic pelvic pain, depression, anxiety and more.

* Chronic pain, chronic migraine and ME/CFS are much more common in people with a history of abuse and PTSD.
</blockquote>Additional resources:

Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine<ref>{{Cite web|url=https://www.s4me.info/threads/fatigue-cfs-and-migraine-intersecting-the-lines-through-a-cross-sectional-study-in-patients-with-episodic-and-chronic-migraine-2023-kumar.35210/|title=Trial Report - Fatigue, CFS and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine, 2023, Kumar {{!}} Science for ME|website=www.s4me.info|access-date=2025-11-23}}</ref><ref>{{Cite journal|title=Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine|date=2023-04-20|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC10483198/|journal=Journal of Neurosciences in Rural Practice|volume=14|issue=3|pages=424–431|last=Kumar|first=Hemant|last2=Dhamija|first2=Kamakshi|last3=Duggal|first3=Ashish|last4=Khwaja|first4=Geeta Anjum|last5=Roshan|first5=Sujata|language=en|doi=10.25259/JNRP_63_2022|pmc=10483198|issn=0976-3155}}</ref>

Discriminating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and comorbid conditions using metabolomics in UK Biobank<ref>{{Cite journal|title=Discriminating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and comorbid conditions using metabolomics in UK Biobank|date=2024-11-26|url=https://www.nature.com/articles/s43856-024-00669-7|journal=Communications Medicine|volume=4|issue=1|last=Huang|first=Katherine|last2=G. C. de Sá|first2=Alex|last3=Thomas|first3=Natalie|last4=Phair|first4=Robert D.|last5=Gooley|first5=Paul R.|last6=Ascher|first6=David B.|last7=Armstrong|first7=Christopher W.|language=en|doi=10.1038/s43856-024-00669-7|pmc=11599898|issn=2730-664X}}</ref>

Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?<ref>{{Cite journal|title=Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?|date=2021-06-03|url=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2021.646692/full|journal=Frontiers in Human Neuroscience|volume=15|last=Nazia|first=Karsan,|last2=J.|first2=Goadsby, Peter|language=English|doi=10.3389/fnhum.2021.646692/full|issn=1662-5161}}</ref>

Chronic Overlapping Pain Conditions in people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a sample from the Multi-site Clinical Assessment of ME/CFS (MCAM) study<ref>{{Cite journal|title=Chronic Overlapping Pain Conditions in people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a sample from the Multi-site Clinical Assessment of ME/CFS (MCAM) study|date=2024-10-18|url=https://pubmed.ncbi.nlm.nih.gov/39425035/|journal=BMC Neurology|volume=24|issue=1|last=Fall|first=Elizabeth A.|last2=Chen|first2=Yang|last3=Lin|first3=Jin-Mann S.|last4=Issa|first4=Anindita|last5=Brimmer|first5=Dana J.|last6=Bateman|first6=Lucinda|last7=Lapp|first7=Charles W.|last8=Podell|first8=Richard N.|last9=Natelson|first9=Benjamin H.|last10=Kogelnik|first10=Andreas M.|last11=Klimas|first11=Nancy G.|language=en|doi=10.1186/s12883-024-03872-0|pmc=11488184|issn=1471-2377}}</ref>

==Possible causes==
Migraine is believed to be genetic, with [https://e-hpr.org/journal/view.php?number=921 monogenic and polygenic contributions to its pathophysiology].<ref>{{Cite journal|title=Genetic Architecture of Migraine: From Broad Insights to East Asian Perspectives|date=2025-06-30|url=https://e-hpr.org/journal/view.php?number=921|journal=Headache and Pain Research|volume=26|issue=2|pages=116–129|last=Kim|first=Joonho|last2=Chu|first2=Min Kyung|language=English|doi=10.62087/hpr.2025.0003|issn=3022-9057}}</ref> It is believed to be caused by genetic and epigenetic factors. Migraine also has physiological and biochemical factors, e.g. insulin or oestrogen [[hormone]] levels, increased [[oxidative stress]]<ref name="Khan2021" /><ref name="NHS-overall" />

==Potential treatments==
Migraine treatment consists of:
*Acute therapies that aim to stop a migraine attack or reduce the symptoms: gepants, triptans, NSAIDs, neuromodulation devices, DHE, and anti-nausea medication

*Preventive therapies that manage the disease, including reducing attack frequency and symptom severity.
Considering the high comorbidity rate of migraine in patients with me/cfs, it is increasingly recognized that receiving a migraine diagnosis and appropriately (and likely aggressively) treating migraine will improve the overall outcomes and quality of life of me/cfs patients. If chronic migraine is not identified and treated, these ongoing sensory sensitivities can exacerbate neurological stress and increase the overall burden on the central nervous system. This heightened neural stress likely contributes to the worsening of symptoms and triggers post-exertional malaise (PEM), a hallmark and debilitating feature of ME/CFS characterized by worsening of fatigue, pain, and cognitive dysfunction after minimal physical or mental exertion.

=== Acute migraine treatments ===
*General [[analgesic|pain medications]], including [[acetaminophen]] and [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatories]] (NSAID), for mild to moderate migraines. Naproxen is often preferred. Different types of medications are sometimes combined, for example acetaminophen and [[naproxen]].<ref name="Khan2021">{{Cite journal | last = Khan | first = Johra | last2 = Asoom | first2 = Lubna Ibrahim Al | last3 = Sunni | first3 = Ahmad Al | last4 = Rafique | first4 = Nazish | last5 = Latif | first5 = Rabia | last6 = Saif | first6 = Seham Al | last7 = Almandil | first7 = Noor B. | last8 = Almohazey | first8 = Dana | last9 = AbdulAzeez | first9 = Sayed | date = 2021-07-01 | title = Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine|url=https://www.sciencedirect.com/science/article/pii/S0753332221003425|journal=Biomedicine & Pharmacotherapy|language=en|volume=139|pages=111557|doi=10.1016/j.biopha.2021.111557|issn=0753-3322}}</ref>
*Prescription NSAIDs, such as Toradol (Sprix), diclofenac, and nabumetone, flurbiprofen, indomethacin, etc. While not often prescribed, flurbiprofen is one of the most effective NSAIDs and has the strongest effect when treating migraine.
*[[:Category:Triptans|Triptans]] for moderate or severe migraine e.g. [[sumatriptan]] (Imitrex): 13 out of 14 newly diagnosed migraine subjects responded to sumatriptan in one [[Chronic fatigue syndrome|CFS]] patient cohort<ref name="Ravindran2011" /> or [[zomitriptan]] (Zomig)<ref name="drugscom">{{Cite web|url=https://www.drugs.com/health-guide/migraine.html | title = Migraine Guide: Causes, Symptoms and Treatment Options|website=Drugs.com|language=en|access-date=2021-10-12}}</ref>
*Small molecule [[:Category:CGRP antagonists|CGRP antagonists]], known as [[:Category:Gepants|gepants]], which are the newest group of migraine drugs<ref name="Negro2019">{{Cite journal | last = Negro | first = Andrea | authorlink = | last2 = Martelletti | first2 = Paolo | authorlink2 = | date = Jun 2019 | title = Gepants for the treatment of migraine|url=https://pubmed.ncbi.nlm.nih.gov/31081399/|journal=Expert Opinion on Investigational Drugs|volume=28|issue=6 | pages = 555–567|doi=10.1080/13543784.2019.1618830|issn=1744-7658|pmc=|pmid=31081399|access-date=|quote=|via=}}</ref>
*Dihydroergotamine interacts with multiple receptors in the brain, including serotonin, dopamine, and adrenergic receptors, to stop the release of substances that contribute to headache pain and inflammation, as well as central sensitization. DHE can hold promise as an acute ME/CFS option due to how it reduces inflammation and targets central sensitization.
*Antinausea medications - reglan, prochlorperazine, promethazine, and zofran. Note: both reglan & prochlorperazine treat the process of migraine in addition to migraine-associated gastroparesis and dyspepsea.
*Neuromodulation devices treat migraine by applying targeted electrical or magnetic stimulation to specific nerves or brain areas involved in migraine pathophysiology, modulating their activity to reduce pain and prevent attacks. Devices include e-TNS (Cefaly), TENS (HeadATerm), sTMS (savi dual), nVNS (gammaCore or Truvaga), REN (Nerivio), and COT-NS (Relivion).<ref>{{Cite journal|title=Update on Neuromodulation for Migraine and Other Primary Headache Disorders: Recent Advances and New Indications|date=2025-02-15|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC11829934/|journal=Current Pain and Headache Reports|volume=29|issue=1|last=Cocores|first=Alexandra N.|last2=Smirnoff|first2=Liza|last3=Greco|first3=Guy|last4=Herrera|first4=Ricardo|last5=Monteith|first5=Teshamae S.|language=en|doi=10.1007/s11916-024-01314-7|pmc=11829934|issn=1531-3433}}</ref>

=== Migraine preventive and management treatments ===
Depending on the migraine type, various mechanisms contribute to the disease and its symptoms. Migraine treatments target various mechanisms that are part of migraine pathophysiology.
*[https://www.neurology.org/doi/10.1212/WNL.0000000000213852 CGRP targeting medications,] such as [[Calcitonin gene-related peptide monoclonal antibody|CGRP monoclonal antibodies]]<ref name="Negro2019" /> like Amovig, Ajovy, Emgality and Vyepti, as well as gepants, such as Qulipta and Nurtec, that block the CGRP pathway. These medications target calcitonin gene related peptide (CGRP), which [https://www.neurology.org/doi/10.1212/WNL.0000000000213852 sensitize trigeminal neurons & lead to the development of allodynia and migraine attacks where normal stimuli can lead to nociceptive sensitizations].
*Botox injections (botulinum toxin type A via the PREEMPT Protocol)
*Off-label medications, including beta blockers (propranolol, etc), anti-seizure medications (topiramate, etc), gabapentinoids, tricyclic antidepressants (Amitriptyline, Nortriptyline), calcium channel blockers (verapamil), sodium channel blockers (lamotrigine, mexiletine), antipsychotics (olanzapine), NMDA-receptor antagonists (Namenda, amantadine, etc). <ref name="Negro2019" /><ref name="NHS" /> These medications do things from block neuronal excitability (NMDA-receptor antagonists) and pain modulation (beta blockers) to reducing neuronal excitability (anti-seizure meds) and reducing cortical spreading depression and hyperexcitability (sodium channel blockers).
*[https://americanmigrainefoundation.org/resource-library/non-invasive-neuromodulation-devices/ Neuromodulation Devices] [https://www.migrainedisorders.org/video/chapter-5-episode-6-neuromodulation-devices/ ''apply external electrical or magnetic impulses to reduce, eliminate or prevent migraine attacks. They are worn or held against different parts of the body to stimulate nerves or areas of the brain and nervous system involved in the migraine process'']. Preventive neuromodulation devices include Cefaly, gammaCore, Nerivio, and savi dual. [https://otolithlabs.com/ Otolith is completing its clinical trials for vestibular migraine].
*Infusions - outpatient and inpatient infusions typically are used to treat status migrainosus, medication adaptation headache, and refractory chronic migraine. Vyepti is a quarterly CGRP targeting infusion that has been proven to be particularly effective for severe chronic migraine. Other infusions may include ketorolac, dihydroergotamine, lidocaine, ketamine, prochlorperazine, magnesium, antipsychotic medication, and saline.
''PACAP-targeting medications currently are in clinical trials and will be released to the public in the coming years''.

'''Complementary Care''' - these are not standalone treatments but instead may improve ones overall treatment plan and improve quality of life.
*Nerve blocks: trigeminal nerve block, occipital nerve block, SPG block<ref>{{Cite web|url=https://www.migrainedisorders.org/video/chapter-5-episode-4-nerve-blocks-for-migraine-disease/|title=Chapter 5, Episode 4: Nerve Blocks for Migraine Disease - Association of Migraine Disorders|website=www.migrainedisorders.org|access-date=2025-11-23}}</ref>
*Biofeedback <ref>{{Cite journal|title=Efficacy of biofeedback for migraine: A systematic review and meta-analysis|date=2025-06|url=https://doi.org/10.1016/j.ctim.2025.103153|journal=Complementary Therapies in Medicine|volume=90|pages=103153|last=Paudel|first=Prayash|last2=Sah|first2=Asutosh|doi=10.1016/j.ctim.2025.103153|issn=0965-2299}}</ref>
*Green light therapy is a narrow band of green light that generates weaker electrical signals in the brain's pain-processing areas
*FL-41 lenses filter out specific wavelengths of light, primarily in the blue-to-green spectrum (approximately 480 to 520 nm). This range of light has been found to be particularly triggering for people with migraine due to its activation of certain retinal cells called intrinsically photosensitive retinal ganglion cells (ipRGCs), which influence both visual processing and pain pathways in the brain. This reduces photophobia, as well as eye strain.<ref>{{Cite journal|title=FL-41 Tint Reduces Activation of Neural Pathways of Photophobia in Patients with Chronic Ocular Pain|date=2024-03|url=https://doi.org/10.1016/j.ajo.2023.12.004|journal=American Journal of Ophthalmology|volume=259|pages=172–184|last=Reyes|first=Nicholas|last2=Huang|first2=Jaxon J.|last3=Choudhury|first3=Anjalee|last4=Pondelis|first4=Nicholas|last5=Locatelli|first5=Elyana V.T.|last6=Hollinger|first6=Ruby|last7=Felix|first7=Elizabeth R.|last8=Pattany|first8=Pradip M.|last9=Galor|first9=Anat|last10=Moulton|first10=Eric A.|doi=10.1016/j.ajo.2023.12.004|pmc=PMC10939838|issn=0002-9394}}</ref>
*Physical therapy, vestibular rehab therapy, and occupational therapy
*Acupuncture<ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/migraine/prevention/ | title = Migraine - Prevention | last = | first = | authorlink = | date = 2017-10-23 | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-12}}</ref>
*Supplements including [[magnesium]], [[feverfew]], the B vitamin [[riboflavin]], [[CoQ10]], and others.<ref name="Sun2011">{{Cite journal|title=Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments: March 2011|date=Mar 2011|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01846.x|journal=Headache: The Journal of Head and Face Pain|volume=51|issue=3|pages=469–483|last=Sun-Edelstein|first=Christina|authorlink=|last2=Mauskop|first2=Alexander|authorlink2=|language=en|doi=10.1111/j.1526-4610.2011.01846.x|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="Barmherzig2021">{{Cite journal|title=Nutraceuticals and Behavioral Therapy for Headache|date=2021-05-10|url=https://doi.org/10.1007/s11910-021-01120-3|journal=Current Neurology and Neuroscience Reports|volume=21|issue=7|pages=33|last=Barmherzig|first=Rebecca|last2=Rajapakse|first2=Thilinie|language=en|doi=10.1007/s11910-021-01120-3|issn=1534-6293}}</ref><ref name="Sun2009">{{Cite journal|title=Foods and Supplements in the Management of Migraine Headaches|date=Jun 2009|url=https://journals.lww.com/clinicalpain/Abstract/2009/06000/Foods_and_Supplements_in_the_Management_of.15.aspx|journal=The Clinical Journal of Pain|volume=25|issue=5|pages=446–452|last=Sun-Edelstein|first=Christina|authorlink=|last2=Mauskop|first2=Alexander|authorlink2=|language=en-US|doi=10.1097/AJP.0b013e31819a6f65|pmc=|pmid=|access-date=|issn=0749-8047|quote=|via=}}</ref> [[Butterbur]] is not recommended due to liver toxicity.<ref name="NCCIH">{{Cite web|url=https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science|title=Dietary Supplements for Headaches: What the Science Says|last=|first=|authorlink=|date=|website=[[National Center for Complementary and Integrative Health]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-13}}</ref> Some neurologists still recommend supplements with [[Butterbur]] as long as they are free of pyrrolizidine alkaloids.
*[[Daith piercing]], a type of ear piercings<ref name="Cascio2017">{{Cite journal | last = Cascio Rizzo | first = Angelo | last2 = Paolucci | first2 = Matteo | last3 = Altavilla | first3 = Riccardo | last4 = Brunelli | first4 = Nicoletta | last5 = Assenza | first5 = Federica | last6 = Altamura | first6 = Claudia | last7 = Vernieri | first7 = Fabrizio | date = 2017 | title=Daith Piercing in a Case of Chronic Migraine: A Possible Vagal Modulation|journal=Frontiers in Neurology|language=English|volume=8|pages=|doi=10.3389/fneur.2017.00624|issn=1664-2295|pmc=5711775|pmid=29230190|via=}}</ref> - there is no reproducible, peer-reviewed evidence supporting daith piercings. Given the migraine population's high rate of the placebo effect, daith piercing success is commonly believed to be placebo effect and somewhat short-lived.
*[[Migraine elimination diet]]s, which rely on identifying particular foods, drinks or additives that trigger migraines, for example avoiding food or drinks containing [[nitrates]] or [[tyramine]]<ref name="Khan2021" /><ref name="NHS" /> However more current research shows that trigger avoidance is not as effective as overall dynamic migraine disease management.
Other recommended measures include meditation, mindfulness, progressive muscle relaxation, sleep hygiene, stress reduction, and gentle, tolerable exercise (chair yoga, tai chi, stretching), as well as comorbidity symptom management.

==Notable studies==
*2011, Migraine headaches in [[chronic fatigue syndrome]] (CFS): comparison of two prospective cross-sectional studies.<ref name="Ravindran2011">{{Cite journal | last = Ravindran | first = Murugan K | last2 = Zheng | first2 = Yin | last3 = Timbol | first3 = Christian | last4 = Merck | first4 = Samantha J | last5 = Baraniuk | first5 = James N | authorlink5 = James Baraniuk | date = 5 Mar 2011 | title = Migraine headaches in Chronic Fatigue Syndrome (CFS): Comparison of two prospective cross-sectional studies|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058027/|journal=BMC Neurology|language=en|volume=11|issue=1|pages=|doi=10.1186/1471-2377-11-30|issn=1471-2377|pmc=|pmid=21375763|via=}}</ref>
*2013, Migraine in [[Gulf War Illness|gulf war illness]] and [[chronic fatigue syndrome]]: Prevalence, potential mechanisms, and evaluation.<ref name="Rayhan">{{Cite journal | last = Rayhan | first = Rakib U. | last2 = Ravindran | first2 = Murugan K. | last3 = Baraniuk | first3 = James N.| date = 2013 | title = Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation | url =https://www.ncbi.nlm.nih.gov/pubmed/23898301|journal=Frontiers in Physiology|volume=4|pages=181|doi=10.3389/fphys.2013.00181|issn=1664-042X|pmid=23898301|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721020/ (Full Text)]
*2016, Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the [[American Gut Project]] Cohort<ref>{{Cite journal | last = Gonzalez | first = Antonio | last2 = Hyde | first2 = Embriette | last3 = Sangwan | first3 = Naseer | last4 = Gilbert | first4 = Jack A. | last5 = Virre | first5 = Erik | last6 = Knight | first6 = Rob | date = Oct 18, 2016 | title = Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort|url=https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf | journal=American Society for Microbiology|volume=1|issue=5|pages=|via=}}</ref> [https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf (Full Text)]

==News and articles==
*May 19, 2018, [https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit?]<ref>{{Cite news | url=https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ | title = The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit? - Health Rising | last = Johnson | first =Cort | date = 2018-05-19|work=Health Rising|access-date=2018-08-11|archive-url=|archive-date=|url-status=|language=en-US}}</ref>

==Learn more ==
*[https://www.nhs.uk/conditions/migraine/treatment/ Migraine treatment] - National Health Service

== See also ==
* [[Headache]]
* [[Magnesium]]
* [[Analgesic]] (pain killer)

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Neurological diseases and disorders]]
[[Category:Potential comorbidities]]
[[Category:Signs and symptoms]]
[[Category:Pain signs and symptoms]]
[[Category:Neurological signs and symptoms]]

Migraine

2025-11-23T17:40:56Z

Chuck23:I’m in the middle of updating migraine’s definition and diagnostic criteria but am moving g to my laptop so i can include citations

[[File:Migraine-art.jpg|left|thumb|320px|Source: [https://www.flickr.com/photos/tudedude/14019222689 Migraine by Tudor Barker]]] 
'''Migraine''' can be comorbid in people with [[ME/CFS]]. Migraine is a spectrum neurobiological disease with a genetic predisposition. It is the dysfunction of the central and peripheral nervous systems. There are many different types & subtypes of migraine. If not properly managed, migraine can be a progressive, ongoing disease.

In a 2011 study by Ravindran, et al, migraine were found in 84%, and [[tension-type headache]]s in 81% of a cohort of [[chronic fatigue syndrome]] patients.<ref name="Ravindran2011" /> This compared to 5% and 45%, respectively, in a cohort of healthy controls.<ref name="Ravindran2011" />

==Symptoms==
<ref name="NHS-overall" />

Migraine symptoms include mild to moderate unilateral and/or throbbing or pulsating headache that may get worse with or lead to the avoidance of physicial activity (such as doing laundry, etc). Migraine pain is described as moderate to severe, but some types of migraine have little to no head pain.

Other symptoms include light and/or sound sensitivity, as well as nausea and/or vomiting. The majority of migraine patients will experience allodynia during their attack.

Migraine makes one incredibly sensitive to sensory & environmental stimuli that many call triggers. Triggers do not cause migraine disease; migraine disease makes one sensitive to triggers.
==Phases==
Migraine has 4-5 phases: prodromal, aura (for 30% of migraine patients), acute, postdrome, and interictal (between attacks). Many with chronic migraine experience ongoing migrainous symptoms between attacks.
;Prodromal (pre-headache) stage
:4-42 hours before the aura or acute phase. Symptoms include phantom smells, heightened sensory sensitivity (smells, sounds, visual stimuli), food cravings, neck pain, increased urination, increased energy, etc.
:Recent research shows that many prodromal symptoms may be confused for migraine attack triggers.
;Aura phase (~30% of migraine population)
:5-60 minutes before the acute phase. The majority of people with migraine with aura experience visual aura: flashes of light (scintillations), blind spots (scotoma), perceiving objects to be much larger or smaller than in reality, shimmering, flickering, tunnel vision, and blurred/distorted vision.
:Other auras include somatosensory (tingling, pins & needles, numbness, feeling like a limb is disconnected), dysphasic (mixing up words, difficulty thinking of words, slurred speech, stutter, difficulty understanding speech), vestibular (dizziness, vertigo, spacial disorientation), and motor (motor weakness, facial droop, dexterity issues, sensation of dead weight).
:Anecdotally, people have reported olfactory & taste-related auras but those are not acknowledged by the International Classification of Headache Disorders, Third Edition (ICHD-3).
;Acute phase
:Typically a moderate or severe pulsating or throbbing head pain on one side of the head (but can be on both sides), often accompanied by [[nausea]], [[vomiting]] or [[photophobia|extreme light sensitivity]] and extreme sensitivity to loud sounds, which last from 4 hours to 3 days without acute medication.
:Allodynia (a sign of central sensitization) begins during the acute phase.
:For those with vestibular migraine, the acute phase consists of moderate to severe dizziness, in addition to the more traditional head pain, nausea, vomiting, and severe sensory sensitivities (particularly motion & screens).
;Postdromal stage
:Often referred to the hangover phase, the postdrome is when acute and other symptoms gradually fade, but there may be [[fatigue|tiredness]] & exhaustion for few days after<ref name="NHS-symptoms">{{Cite web|url=https://www.nhs.uk/conditions/migraine/symptoms/ | title = Migraine - Symptoms | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref><ref name="Khan2021" /><ref name="NHS-overall" />
:Additional symptoms include brain fog, mood changes, sensory sensitivities, dull head pain, GI & urinary issues, temperature dysregulation, allodynia, and more. '''Interictal Phase'''
:Otherwise known as the phase between migraine attacks. For many, the interictal phase will be symptom-free, but for most with chronic migraine, vestibular migraine, or migraine with unilateral motor symptoms (MUMS), the interictal phase will have ongoing symptoms including dull headache, sensory sensitivities (light, sound, temperature, motion, etc), and other neurological symptoms. Those with chronic vestibular migraine typically experience ongoing baseline dizziness, and those with chronic MUMS may experience ongoing baseline unilateral weakness, tingling, & dysfunctioning proprioception.
[[File:Migraine-phases.jpg|left|thumb|600px|Migraine phases. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Khan et. al. (2021). Biomedicine & Pharmacotherapy, 139, 111557.]<ref name="Khan2021"/>]] 

==Types ==
===Migraine without aura===
'''Migraine without aura''' is defined by the following diagnostic criteria outlined in ''The International Classification Of Headache Disorders, 3rd edition'':

====Migraine without aura diagnostic criteria====
<ol style="list-style-type:upper-alpha"><li> At least '''five''' headache attacks that</li>
<li> Last 4–72 hours without successful treatment</li>
<li> Headaches have at least '''two''' of the following four characteristics:</li>
<ol><li> unilateral location;</li>
<li> pulsating quality;</li>
<li> moderate to severe pain intensity; and</li>
<li> aggravation by or causing avoidance of routine physical activity.</li></ol>
<li> During the headaches at least '''one''' of the following:</li>
<ol><li> [[nausea]] and/or vomiting</li>
<li> [[photophobia]] and phonophobia (avoidance of loud noises)</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.</li>
</ol>

:Migraines without aura may also be called '''common migraine'' or '''hemicrania simplex'''.<ref name="ICHD-3">{{Cite journal | last = Headache Classification Committee of the International Headache Society | date = 2018 | title = The International Classification of Headache Disorders|edition=3rd | url =https://doi.org/10.1177/0333102417738202|journal=Cephalalgia|language=en|volume=38|issue=1|pages=1–211|doi=10.1177/0333102417738202|issn=0333-1024}}</ref>

===Migraine with aura===
====Migraine with aura diagnostic criteria====

:Visual, sensory and central nervous system symptom in beginning shortly before a migraine headache are known as an '''aura''', although migraine with aura without migraine headaches are also recognized.

<ol style="list-style-type:upper-alpha"><li> At least '''two''' migraine attacks fulfilling criteria B and C</li>
<li>'''One''' or more of the following fully reversible aura symptoms</li>
<ol><li> visual </li>
<li> sensory </li>
<li> speech and/or language </li>
<li> motor </li>
<li> brainstem </li>
<li> retinal </li></ol>
<li> At least '''three''' of the following characteristics:</li>
<ol><li> at least '''one''' aura symptom spreads gradually over five minutes or longer</li>
<li> '''two''' or more aura symptoms occur in succession</li>
<li> each individual aura symptom lasts 5 to 60 minutes </li>
<li> at least one aura symptom is '''unilateral''' (one sided)</li>
<li> at least one aura symptom is '''positive''' </li>
<li> the aura is accompanied, or followed within 60 minutes, by headache</li></ol>
<li> Not better accounted for by another ICHD-3 diagnosis.<ref name="ICHD-3" /></li></ol>

The recognized types of migraine with aura are:
*Typical aura with headache
*Typical aura without headache
*Migraine with brainstem aura
*Hemiplegic migraine, including familial hemiplegic migraine (FHM) type 1, type 2, type 3 and with other loci
* Sporadic hemiplegic migraine (SHM)
* Retinal migraine

Migraines without aura may also be called '''Classic or classical migraine''', '''ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine''', or '''complicated migraine'''.<ref name="ICHD-3" />

===Chronic migraine ===
<ref name="ICHD-3" />

===Silent migraine ===
Migraine symptoms that do not result in a headache are known as silent migraines, e.g. migraine aura symptoms without head pain.migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.<ref name="NHS-overall">{{Cite web|url=https://www.nhs.uk/conditions/migraine/ | title = Migraine | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref>

===Abdominal migraine ===
<ref name="ICHD-3" />

==Triggers ==
[[File:Migraine_triggers.jpg|left|600px|Migraine triggers. Source: [https://www.sciencedirect.com/science/article/pii/S0753332221003425 Biomedicine & Pharmacotherapy, 139, 111557]<ref name="Khan2021"/>]] 
Common migraine triggers include:
* Food and drinks, e.g., chocolate, alcohol, aged cheese, [[gluten sensitivity|gluten]], high histamine foods
* Lifestyle patterns, e.g. [[stress]], weather changes, or fasting
* Genetics
* Physiological and biochemical factors, e.g. insulin or oestrogen [[hormone]] levels, increased [[oxidative stress]]<ref name="Khan2021"/><ref name="NHS-overall" />

==Migraines in ME/CFS==
Migraines is one of several illnesses or conditions common in people with [[ME/CFS]].<ref name="ammes">{{Cite web|url=https://ammes.org/overlapping-conditions/ | title = Overlapping Conditions – American ME and CFS Society|website=ammes.org|language=en-US|access-date=2018-08-12}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17= Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012
| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> 

The [[Canadian Consensus Criteria]] recognizes migraines in the [[:Category:Neurological signs and symptoms|possible neurological symptoms]] of [[ME/CFS]], and the [[International Consensus Criteria]] recognizes [[headache]] conditions including [[migraine]] and [[tension-type headache]] in the diagnostic criteria for [[myalgic encephalomyelitis]].<ref name="ICC2011primer" />

==Possible causes==

==Potential treatments==
Migraine treatment consists of:
*Abortive treatments, that aim to stop a migraine attack or reduce the symptoms

*Prevention, which aims to reduce how often migraines occur and their intensity

=== Migraine attack treatments ===
*General [[analgesic|pain medications]], including [[acetaminophen]] and [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatories]] (NSAID), for mild to moderate migraines. Different types of medications are sometimes combined, for example acetaminophen and [[naproxen]].<ref name="Khan2021">{{Cite journal | last = Khan | first = Johra | last2 = Asoom | first2 = Lubna Ibrahim Al | last3 = Sunni | first3 = Ahmad Al | last4 = Rafique | first4 = Nazish | last5 = Latif | first5 = Rabia | last6 = Saif | first6 = Seham Al | last7 = Almandil | first7 = Noor B. | last8 = Almohazey | first8 = Dana | last9 = AbdulAzeez | first9 = Sayed | date = 2021-07-01 | title = Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine|url=https://www.sciencedirect.com/science/article/pii/S0753332221003425|journal=Biomedicine & Pharmacotherapy|language=en|volume=139|pages=111557|doi=10.1016/j.biopha.2021.111557|issn=0753-3322}}</ref>
*[[:Category:Triptans|Triptans]] for moderate or severe migraine e.g. [[sumatriptan]] (Imitrex): 13 out of 14 newly diagnosed migraine subjects responded to sumatriptan in one [[Chronic fatigue syndrome|CFS]] patient cohort<ref name="Ravindran2011" /> or [[zomitriptan]] (Zomig)<ref name="drugscom">{{Cite web|url=https://www.drugs.com/health-guide/migraine.html | title = Migraine Guide: Causes, Symptoms and Treatment Options|website=Drugs.com|language=en|access-date=2021-10-12}}</ref>
*Small molecule [[:Category:CGRP antagonists|CGRP antagonists]], known as [[:Category:Gepants|gepants]], which are the newest group of migraine drugs<ref name="Negro2019">{{Cite journal | last = Negro | first = Andrea | authorlink = | last2 = Martelletti | first2 = Paolo | authorlink2 = | date = Jun 2019 | title = Gepants for the treatment of migraine|url=https://pubmed.ncbi.nlm.nih.gov/31081399/|journal=Expert Opinion on Investigational Drugs|volume=28|issue=6 | pages = 555–567|doi=10.1080/13543784.2019.1618830|issn=1744-7658|pmc=|pmid=31081399|access-date=|quote=|via=}}</ref>
*There is some limited evidence for [[transcranial magnetic stimulation]] (TMS) in migraines with aura, this is a non-invasive brain based treatment<ref name="NHStreat">{{Cite web|url=https://www.nhs.uk/conditions/migraine/treatment/ | title = Migraine - Treatment | last = | first = | authorlink = | date = | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-15}}</ref>

=== Migraine prevention ===
*[[Migraine elimination diet]]s, which rely on identifying particular foods, drinks or additives that trigger migraines, for example avoiding food or drinks containing [[nitrates]] or [[tyramine]]<ref name="Khan2021" /><ref name="NHS" />
*CGRP antagonists, particularly [[Calcitonin gene-related peptide monoclonal antibody|CGRP monoclonal antibodies]] but possibly some gepants<ref name="Negro2019" />
*Drugs developed for other uses that are known to reduce migraines, including propranolol, [[amitriptyline]] (Elavil), [[topiramate]] (Topamax) or botulinum toxin type A (Botox injections)<ref name="Negro2019" /><ref name="NHS" />
*Acupuncture<ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/migraine/prevention/ | title = Migraine - Prevention | last = | first = | authorlink = | date = 2017-10-23 | website = [[National Health Service]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-12}}</ref>
*[[Daith piercing]], a type of ear piercings not routinely recommended<ref name="Cascio2017">{{Cite journal | last = Cascio Rizzo | first = Angelo | last2 = Paolucci | first2 = Matteo | last3 = Altavilla | first3 = Riccardo | last4 = Brunelli | first4 = Nicoletta | last5 = Assenza | first5 = Federica | last6 = Altamura | first6 = Claudia | last7 = Vernieri | first7 = Fabrizio | date = 2017 | title=Daith Piercing in a Case of Chronic Migraine: A Possible Vagal Modulation|journal=Frontiers in Neurology|language=English|volume=8|pages=|doi=10.3389/fneur.2017.00624|issn=1664-2295|pmc=5711775|pmid=29230190|via=}}</ref>
* Natural or alternative dietary supplements including [[magnesium]], [[feverfew]], the B vitamin [[riboflavin]], [[CoQ10]], and others.<ref name="Sun2011">{{Cite journal | last = Sun-Edelstein | first = Christina | authorlink = | last2 = Mauskop | first2 = Alexander | authorlink2 = | date = Mar 2011 | title = Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments: March 2011|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01846.x|journal=Headache: The Journal of Head and Face Pain|language=en|volume=51|issue=3 | pages = 469–483|doi=10.1111/j.1526-4610.2011.01846.x|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="Barmherzig2021">{{Cite journal | last = Barmherzig | first = Rebecca | last2 = Rajapakse | first2 = Thilinie | date = 2021-05-10 | title = Nutraceuticals and Behavioral Therapy for Headache|url=https://doi.org/10.1007/s11910-021-01120-3|journal=Current Neurology and Neuroscience Reports|language=en|volume=21|issue=7|pages=33|doi=10.1007/s11910-021-01120-3|issn=1534-6293}}</ref><ref name="Sun2009">{{Cite journal | last = Sun-Edelstein | first = Christina | authorlink = | last2 = Mauskop | first2 = Alexander | authorlink2 = | date = Jun 2009 | title = Foods and Supplements in the Management of Migraine Headaches|url=https://journals.lww.com/clinicalpain/Abstract/2009/06000/Foods_and_Supplements_in_the_Management_of.15.aspx|journal=The Clinical Journal of Pain|language=en-US|volume=25|issue=5 | pages = 446–452|doi=10.1097/AJP.0b013e31819a6f65|issn=0749-8047|pmc=|pmid=|access-date=|quote=|via=}}</ref> [[Butterbur]] is not recommended due to liver toxicity.<ref name="NCCIH">{{Cite web|url=https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science | title = Dietary Supplements for Headaches: What the Science Says | last = | first = | authorlink = | date = | website = [[National Center for Complementary and Integrative Health]]|language=en|archive-url=|archive-date=|url-status=|access-date=2021-10-13}}</ref> Some neurologists still recommend supplements with [[Butterbur]] as long as they are free of pyrrolizidine alkaloids.
*Migraines with aura may be reduce with [[transcranial magnetic stimulation]], although evidence for this is limited <ref name="NHStreat" />
*[https://americanmigrainefoundation.org/resource-library/non-invasive-neuromodulation-devices/ Neuromodulation Devices]

==Notable studies==
*2011, Migraine headaches in [[chronic fatigue syndrome]] (CFS): comparison of two prospective cross-sectional studies.<ref name="Ravindran2011">{{Cite journal | last = Ravindran | first = Murugan K | last2 = Zheng | first2 = Yin | last3 = Timbol | first3 = Christian | last4 = Merck | first4 = Samantha J | last5 = Baraniuk | first5 = James N | authorlink5 = James Baraniuk | date = 5 Mar 2011 | title = Migraine headaches in Chronic Fatigue Syndrome (CFS): Comparison of two prospective cross-sectional studies|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058027/|journal=BMC Neurology|language=en|volume=11|issue=1|pages=|doi=10.1186/1471-2377-11-30|issn=1471-2377|pmc=|pmid=21375763|via=}}</ref>
*2013, Migraine in [[Gulf War Illness|gulf war illness]] and [[chronic fatigue syndrome]]: Prevalence, potential mechanisms, and evaluation.<ref name="Rayhan">{{Cite journal | last = Rayhan | first = Rakib U. | last2 = Ravindran | first2 = Murugan K. | last3 = Baraniuk | first3 = James N.| date = 2013 | title = Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation | url =https://www.ncbi.nlm.nih.gov/pubmed/23898301|journal=Frontiers in Physiology|volume=4|pages=181|doi=10.3389/fphys.2013.00181|issn=1664-042X|pmid=23898301|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721020/ (Full Text)]
*2016, Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the [[American Gut Project]] Cohort<ref>{{Cite journal | last = Gonzalez | first = Antonio | last2 = Hyde | first2 = Embriette | last3 = Sangwan | first3 = Naseer | last4 = Gilbert | first4 = Jack A. | last5 = Virre | first5 = Erik | last6 = Knight | first6 = Rob | date = Oct 18, 2016 | title = Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort|url=https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf | journal=American Society for Microbiology|volume=1|issue=5|pages=|via=}}</ref> [https://msystems.asm.org/content/msys/1/5/e00105-16.full.pdf (Full Text)]

==News and articles==
*Oct 18, 2016, [https://www.theguardian.com/science/2016/oct/18/migraines-could-be-caused-by-gut-bacteria-nitrates-food-trigger-study-suggests Migraines could be caused by gut bacteria, study suggests]<ref>{{Cite web|url=http://www.theguardian.com/science/2016/oct/18/migraines-could-be-caused-by-gut-bacteria-nitrates-food-trigger-study-suggests | title = Migraines could be caused by gut bacteria, study suggests | last = Devlin | first = Hannah | date = 2016-10-18 | website = the Guardian|language=en|access-date=2018-08-11}}</ref>
*May 19, 2018, [https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit?]<ref>{{Cite news | url=https://www.healthrising.org/blog/2018/05/19/migraine-drug-explosion-fibromyalgia-chronic-fatigue/ | title = The Migraine Drug Explosion Begins: Could Fibromyalgia and ME/CFS Benefit? - Health Rising | last = Johnson | first =Cort | date = 2018-05-19|work=Health Rising|access-date=2018-08-11|archive-url=|archive-date=|url-status=|language=en-US}}</ref>

==Learn more ==
*[https://www.nhs.uk/conditions/migraine/treatment/ Migraine treatment] - National Health Service
*[https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-for-headaches-science Dietary Supplements for Headaches: What the Science Says] - National Center for Complementary and Integrative Health

== See also ==
* [[Headache]]
* [[Magnesium]]
* [[Analgesic]] (pain killer)

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Neurological diseases and disorders]]
[[Category:Potential comorbidities]]
[[Category:Signs and symptoms]]
[[Category:Pain signs and symptoms]]
[[Category:Neurological signs and symptoms]]