Migraine: The Complete Guide to Triggers, Treatment and Prevention

Migraine is one of the most common and most disabling conditions on earth. The World Health Organization lists it among the leading causes of years lived with disability worldwide, and it is the top cause of disability in women under 50. Around one in seven people live with migraine, yet many are never properly diagnosed, many use treatments that do not suit them, and many quietly accept losing days of their lives every month.

This complete guide explains what migraine really is, how an attack unfolds, what triggers it, which treatments work for acute attacks and for prevention, how to avoid the trap of medication-overuse headache, what is different for women, children and older adults, and the headache warning signs that mean you should seek urgent care.

What is migraine?

Migraine is a neurological condition, not simply a headache. The headache is the most obvious symptom, but migraine is a disorder of how the brain processes sensory information. During an attack, nerve pathways in the brainstem and the trigeminal nerve system become activated. This releases inflammatory chemical messengers, including a protein called calcitonin gene-related peptide (CGRP), around the blood vessels and coverings of the brain. The result is pain, sensitivity to light, sound and smell, nausea, and a wider disturbance of brain function that can last for days when you include the warning and recovery phases.

Migraine tends to run in families. If one of your parents has migraine, your chance of having it is considerably higher. Researchers have identified many genes that each add a small amount of risk. You do not inherit migraine attacks as such, but you inherit a brain that is more sensitive to change and more easily tipped into an attack.

Migraine is usually described as either episodic or chronic:

• Episodic migraine means headache on fewer than 15 days a month.
• Chronic migraine means headache on 15 or more days a month for more than three months, with at least eight of those days having migraine features.

Episodic migraine can turn into chronic migraine over time. Common reasons include frequent use of painkillers, poor sleep, obesity, depression and anxiety, and caffeine overuse. The good news is that chronic migraine can also turn back into episodic migraine with the right treatment.

How common is migraine?

Global estimates suggest that more than one billion people have migraine. It is found in every country, every income group and every ethnic background. It is about two to three times more common in women than in men after puberty, largely because of the influence of the hormone oestrogen. Migraine usually starts in childhood, adolescence or early adulthood, peaks between the ages of about 30 and 50, and often eases after menopause in women.

The cost is enormous. People with migraine miss work and school, perform less well when they do attend, miss family and social events, and often hide their condition because of stigma. Because migraine is invisible between attacks, others may assume the person is exaggerating. This misunderstanding is one of the reasons many people never seek proper help.

The four phases of a migraine attack

A full migraine attack can have up to four phases. Not everyone experiences all four, and the pattern can change from attack to attack. Recognising the phases helps you act early, when treatment works best.

1. Prodrome (the warning phase)

Hours or even a day or two before the pain, many people notice subtle changes. These can include yawning repeatedly, food cravings (especially for sweet foods), feeling irritable or low, neck stiffness, needing to pass urine more often, difficulty concentrating, and tiredness. Many people blame the food they craved for “causing” the migraine, when in fact the craving was an early symptom of an attack that had already started in the brain.

2. Aura

About one in four to one in three people with migraine experience aura in some or all of their attacks. Aura is a temporary neurological disturbance that usually develops gradually over five minutes or more and lasts up to an hour. The most common type is visual: zigzag lines, flashing or shimmering lights, blind spots, or a crescent of sparkling light that slowly expands. Other aura symptoms include pins and needles that spread up one arm or across the face, difficulty finding words, or, rarely, weakness. Headache usually follows within an hour, but aura can also happen without any headache at all, especially in older adults.

3. Headache

The headache phase typically lasts from four hours to three days if untreated. Classic features include:

• Pain on one side of the head, although it can be on both sides or switch sides.
• A throbbing or pulsating quality.
• Moderate or severe intensity.
• Worsening with routine physical activity such as climbing stairs, bending or walking.
• Nausea, and sometimes vomiting.
• Sensitivity to light (photophobia) and sound (phonophobia), and often to smells.

Many people also have dizziness, a blocked or runny nose, watery eyes, pale skin, and cold hands and feet. Children may have shorter attacks with more abdominal pain and vomiting.

4. Postdrome (the “migraine hangover”)

After the headache fades, many people feel drained, foggy, sore and slow for up to a day or two. Some feel unusually energised. Moving the head suddenly may bring back a brief flash of pain. This phase is real, and it is part of why migraine takes so much time away from people’s lives.

Types of migraine

The International Headache Society classification describes several kinds of migraine. The most important for everyday life are:

• Migraine without aura: the most common type, with the headache features above but no aura.
• Migraine with aura: attacks with visual, sensory or speech aura before or with the headache.
• Chronic migraine: headache on 15 or more days a month, as described above.
• Menstrual migraine: attacks linked to the drop in oestrogen just before and during a period.
• Vestibular migraine: episodes of vertigo, imbalance or motion sensitivity, with or without headache, in people with a migraine history.
• Abdominal migraine: mainly in children, with repeated episodes of central tummy pain, nausea and pallor, usually without headache.
• Hemiplegic migraine: a rare type where aura includes temporary weakness on one side of the body. It needs specialist assessment.
• Migraine with brainstem aura: rare, with aura symptoms such as double vision, slurred speech, vertigo or reduced consciousness.

Some of the rarer types share symptoms with stroke and other serious conditions. Any new weakness, loss of speech or change in consciousness must be assessed urgently, even if you have a migraine history.

Is it migraine, tension-type headache or something else?

Tension-type headache is the most common headache overall. It typically feels like a tight band or pressure around both sides of the head, is mild to moderate, is not made worse by activity, and does not usually cause nausea. Many people with migraine also have tension-type headaches, and some headaches have features of both. You can read more in our guide to migraine versus tension headache.

Other headache types include cluster headache, which causes excruciating one-sided pain around the eye lasting 15 minutes to three hours, often at the same time each day, with a watery eye and blocked nostril on the same side, and restlessness rather than lying still. Cluster headache is treated differently from migraine, so getting the diagnosis right matters.

A simple screening question used by many health professionals is: in the past three months, has headache limited your activities for a day or more, have you felt nauseated, and has light bothered you? If you answer yes to two of these three, migraine is very likely.

Headache red flags: when to seek urgent care

The vast majority of headaches, including severe migraines, are not caused by a dangerous underlying condition. But some warning signs mean you should get urgent medical help, such as calling your local emergency number or going to an emergency department:

• A sudden, explosive headache that reaches its worst within a minute, often described as “the worst headache of my life” or a “thunderclap” headache.
• Headache with fever, a stiff neck, a rash that does not fade when pressed, confusion or drowsiness.
• New weakness, numbness, drooping of the face, slurred speech, loss of vision or difficulty walking, especially if it is the first time or different from your usual aura.
• Headache after a head injury, particularly with vomiting, drowsiness or confusion.
• A seizure with headache.
• A new headache in pregnancy or soon after birth, especially with high blood pressure, swelling, visual disturbance or pain under the ribs.
• Headache with a painful red eye and blurred vision.

Other features need prompt, though not always emergency, review by a healthcare provider: a new headache after the age of 50, a headache that is steadily getting worse over weeks, a headache that is worse lying down or wakes you from sleep with vomiting, headache with jaw pain on chewing and scalp tenderness in an older person, and a new headache in someone with cancer or a weakened immune system.

What triggers migraine attacks?

A trigger is something that makes an attack more likely in someone who already has migraine. Triggers do not cause migraine itself. They are best thought of as adding to a “bucket” of load on the brain. When the bucket overflows, an attack starts. This is why the same trigger sometimes causes an attack and sometimes does not: it depends on what else is in the bucket that day.

Commonly reported triggers include:

• Changes in sleep: too little, too much, or irregular sleep, including lying in at the weekend.
• Stress, and the let-down after stress: many people get attacks at the start of a holiday or at the weekend.
• Missed meals and dehydration.
• Hormonal changes: periods, ovulation, the combined contraceptive pill-free week, perimenopause.
• Caffeine: both too much and sudden withdrawal.
• Alcohol: especially red wine for some people.
• Sensory overload: bright or flickering lights, loud noise, strong smells such as perfume or smoke.
• Weather changes: particularly changes in barometric pressure, heat and humidity.
• Intense or unaccustomed exercise, especially without enough food and fluids.
• Screen time and neck strain from long periods at a desk.

Specific foods such as chocolate, aged cheese, citrus fruits or processed meats are often blamed. For some people, a particular food is a genuine and consistent trigger. For many others, the craving for that food was part of the prodrome, as described earlier. Cutting out large numbers of foods is rarely helpful and can make life unnecessarily restricted. A careful diary is a better guide than guesswork.

How to keep a migraine diary

A headache diary is one of the most useful tools you have. It helps you and your healthcare provider confirm the diagnosis, spot patterns, measure how often you take painkillers, and see whether a treatment is working. Record for at least two to three months:

• The date, the start and end time of each headache, and how severe it was on a scale of 0 to 10.
• Symptoms such as aura, nausea, and light or sound sensitivity.
• Every medicine you took, the dose and the time, and whether it helped.
• Your sleep, meals, fluid intake, caffeine and alcohol.
• Your menstrual cycle, if relevant.
• Stressful events, travel, weather and anything unusual.
• How much the headache affected your work, study or family life.

Many free apps do this, but a simple notebook works just as well. Bring your diary to appointments: it is often the single most useful thing a clinician can see.

How migraine is diagnosed

Migraine is diagnosed from your history and, usually, a normal examination. There is no blood test or scan that confirms migraine. A healthcare provider will ask about the pattern of your headaches, the symptoms, your family history, your medicines and how much the headaches affect your life. They will check your blood pressure and examine your nervous system and eyes.

Brain scans are not needed for most people with typical migraine and a normal examination. Scans are used when there are red-flag features, an atypical pattern, or a change in a long-established headache. Many people feel reassured by the idea of a scan, but scans can also pick up harmless incidental findings that cause worry and further tests. A careful clinical assessment is the most important step.

Treating a migraine attack: the basics

Acute treatment aims to stop an attack or reduce it quickly so you can get back to normal life. Three principles make the biggest difference:

1. Treat early. Take your medicine as soon as you know the headache is a migraine, ideally while the pain is still mild. Once the attack is fully established, medicines are absorbed less well and work less well.
2. Take an effective dose. Many people take too small a dose and then repeat it, which works less well and raises the risk of medication overuse.
3. Combine and plan. A combination of medicines often works better than one alone, and it helps to have a written plan for what to take and when.

Nausea and vomiting matter. During a migraine, the stomach empties more slowly, so tablets may sit there and not be absorbed. An anti-sickness medicine can help both the nausea and the absorption of painkillers. If vomiting is a big problem, non-oral options such as nasal sprays, dissolving tablets, suppositories or injections may be more useful.

Acute medicines for migraine

Simple painkillers

For many people, a full dose of a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, naproxen or aspirin, or paracetamol (acetaminophen), taken early, is enough. Soluble or effervescent forms work faster. NSAIDs are not suitable for everyone, including some people with stomach ulcers, kidney disease, some heart conditions, or asthma that worsens with aspirin-type drugs. Check with a pharmacist or nurse if you are unsure.

Triptans

Triptans are migraine-specific medicines that act on serotonin receptors to calm the trigeminal nerve system and reverse blood vessel changes. Examples include sumatriptan, rizatriptan, zolmitriptan, naratriptan, eletriptan, almotriptan and frovatriptan. They come as tablets, dissolving wafers, nasal sprays and injections. Key points:

• Take a triptan at the start of the headache phase, not during aura.
• If one triptan does not work after trying it in three separate attacks, a different triptan may still work. Many people give up too soon.
• A triptan combined with an NSAID such as naproxen is often more effective than either alone.
• If the headache comes back after initially responding, a second dose can usually be taken after a set interval. Follow the instructions for your specific medicine.
• Side effects can include tingling, warmth, a heavy or tight feeling in the chest, neck or jaw, and drowsiness. These are usually short-lived.
• Triptans are not suitable for people with certain heart and circulation conditions, uncontrolled high blood pressure, or some rare migraine types. Your healthcare provider will check this.

Anti-sickness medicines

Medicines such as metoclopramide and prochlorperazine reduce nausea and can improve absorption of painkillers. They are generally used for short periods because they can occasionally cause muscle spasms and restlessness, especially in young people.

Newer acute treatments

In recent years, new classes of acute migraine medicines have been approved in a number of countries. Gepants, such as rimegepant and ubrogepant, block the CGRP receptor. Lasmiditan acts on a different serotonin receptor without narrowing blood vessels. These options can help people who cannot take triptans because of heart risk, or for whom triptans have not worked. Availability and cost vary widely between countries.

What to avoid

Opioid painkillers such as codeine, tramadol and morphine, and combination tablets containing them, are not recommended for migraine. They work poorly for migraine, cause nausea and constipation, are habit-forming, and are particularly likely to cause medication-overuse headache. Barbiturate-containing medicines are also best avoided.

Medication-overuse headache: the hidden trap

Medication-overuse headache is one of the most common reasons for chronic daily headache. It happens when acute headache medicines are used too often, and the brain adapts so that headaches become more frequent. It affects a significant share of people attending headache clinics.

Rough limits used by headache specialists are:

• Simple painkillers such as paracetamol or NSAIDs on 15 or more days a month.
• Triptans, opioids, or combination painkillers on 10 or more days a month.

If you go above these limits for more than three months, medication-overuse headache is likely. The answer is not to suffer in silence but to talk to a healthcare provider about stopping or reducing the overused medicine, usually while starting a preventive treatment. Headaches may get worse for a week or two before they improve. Many people are amazed at how much better they feel once the cycle is broken.

A practical rule: if you are taking acute medicines on more than two or three days a week on average, you need a preventive plan.

Preventing migraine: lifestyle foundations

Lifestyle changes will not cure migraine, but they can reduce how full the “bucket” is on any given day, making attacks less frequent and easier to treat. The most consistent advice from headache specialists is to keep your brain’s routine steady.

Sleep

Aim for a regular bedtime and waking time, including at weekends and on holidays. Both too little and too much sleep can trigger attacks. If you snore heavily, wake unrefreshed, or wake with headaches, ask about sleep apnoea, which can worsen headaches and is treatable. Our guide to better sleep has more detail on building a sleep routine.

Regular meals and fluids

Eat regular meals without long gaps, and carry a snack. Drink water steadily through the day. Dehydration is a common and easily fixed trigger, especially in hot climates and for shift workers.

Caffeine

Caffeine can help an attack in small amounts, which is why it appears in some painkiller combinations. But regular high intake and sudden withdrawal both trigger attacks. Keep caffeine moderate and consistent, for example no more than one or two cups of coffee a day at roughly the same times, and avoid big swings between workdays and days off.

Exercise

Regular moderate aerobic exercise, such as brisk walking, cycling or swimming for around 30 to 40 minutes three times a week, has been shown to reduce migraine frequency in some studies. Warm up gradually, eat and drink beforehand, and build up slowly, because sudden intense exercise can trigger attacks.

Stress management

Stress is not “all in your head”, but how the body responds to stress can be trained. Approaches with evidence in migraine include relaxation training, biofeedback, mindfulness and cognitive behavioural therapy (CBT). These also help with the anxiety and low mood that often accompany frequent migraine.

Weight

Obesity is linked to a higher risk of episodic migraine becoming chronic. For people living with obesity, gradual weight loss can reduce attack frequency.

Alcohol and smoking

If alcohol triggers your attacks, limit or avoid it. Smoking is particularly important to stop if you have migraine with aura, because the combination increases the risk of stroke, especially in women using oestrogen-containing contraception.

Preventive medicines: when and which

Preventive medicines are taken every day (or at regular intervals) to reduce how often attacks happen and how severe they are. They do not stop an individual attack. Your healthcare provider may suggest prevention if:

• You have migraine on four or more days a month, or fewer days but they are very disabling.
• Acute treatments are not working well or are not suitable.
• You are at risk of medication-overuse headache.
• You have rare migraine types with prolonged aura.

Commonly used older preventive medicines include:

• Beta blockers such as propranolol or metoprolol, often a first choice unless you have asthma or certain heart conditions.
• Amitriptyline, a low-dose tricyclic medicine that can also help sleep and coexisting tension-type headache.
• Topiramate, an anti-seizure medicine. It must not be used in pregnancy because of the risk of birth defects, and people who could become pregnant need highly effective contraception and specialist advice before using it.
• Candesartan, a blood pressure medicine with evidence in migraine prevention.
• Flunarizine or pizotifen in some countries.

Sodium valproate is sometimes used in men, but it must not be used in women and girls who could become pregnant except under strict specialist conditions, because of serious risks to an unborn baby.

Important tips for preventive medicines:

• Start low and increase slowly to reduce side effects.
• Give each medicine a fair trial, usually around two to three months at a good dose, before deciding it has not worked.
• Success usually means cutting attacks by about half, not stopping them completely.
• Keep your diary going so you can measure the change.
• After six to twelve months of good control, many people can try gradually reducing the dose under supervision.

CGRP-targeting treatments and Botox

The discovery of the role of CGRP in migraine led to a new generation of preventive treatments. Monoclonal antibodies such as erenumab, fremanezumab, galcanezumab and eptinezumab block CGRP or its receptor. They are given as injections once a month or every three months (eptinezumab is given into a vein). Oral gepants such as atogepant and rimegepant can also be used for prevention. In clinical trials these treatments reduced migraine days and were generally well tolerated, with constipation and injection-site reactions among the more common side effects.

In many health systems, these newer treatments are reserved for people who have tried several older preventive medicines without success, because they are more expensive. Rules differ from country to country.

For chronic migraine, injections of onabotulinumtoxinA (Botox) into multiple sites around the head and neck every 12 weeks are an established option. It can take two or three treatment cycles to show its full effect.

Other specialist options include nerve blocks (injections of local anaesthetic around the greater occipital nerve at the back of the head) and neuromodulation devices that deliver mild electrical or magnetic stimulation. Some of these devices can be used at home.

Supplements and complementary approaches

Some supplements have modest evidence and may be worth discussing with a pharmacist or healthcare provider, particularly for people who prefer to avoid prescription medicines or are planning pregnancy:

• Riboflavin (vitamin B2), in high doses, has some evidence for prevention. It turns urine bright yellow, which is harmless.
• Magnesium may help some people, particularly those with menstrual migraine or migraine with aura. It can cause loose stools.
• Coenzyme Q10 has limited but promising evidence.

Acupuncture has evidence of benefit in several systematic reviews, and is recommended as an option in some national guidelines for people who cannot use or do not respond to preventive medicines. Treatments promoted as cures, including expensive diets, devices or “detox” programmes, should be treated with caution. Some herbal products can interact with prescribed medicines or harm the liver. Always tell your healthcare provider and pharmacist what you take.

Migraine in women: periods, contraception, pregnancy and menopause

Menstrual migraine

Many women notice attacks in the two days before their period and the first three days of bleeding. These attacks are often longer, more severe and harder to treat. If your periods are regular, options include taking an NSAID or a long-acting triptan for a few days around the expected start of your period, under guidance from a healthcare provider. Hormonal approaches that reduce the drop in oestrogen may also be considered.

Contraception

Women who have migraine with aura are generally advised not to use combined hormonal contraception (pills, patches or rings containing oestrogen), because together they increase the risk of ischaemic stroke. Progestogen-only methods, copper or hormonal intrauterine devices, and implants are usually safe alternatives. Women with migraine without aura can usually use combined methods if they have no other stroke risk factors, but should report any new aura immediately. Discuss your individual situation with a nurse or healthcare provider who provides contraception.

Pregnancy and breastfeeding

Many women find their migraines improve during the second and third trimesters of pregnancy, particularly if they had menstrual migraine. Some get worse, especially in the first trimester. Paracetamol is generally considered the first choice for pain in pregnancy. Some other medicines may be used with specialist advice, while others, including topiramate and valproate, should be avoided. Ideally, discuss your migraine treatment before you try to conceive. A new or different headache in pregnancy, particularly in the second half, needs prompt assessment because it can be a sign of pre-eclampsia.

Perimenopause and menopause

Migraine often worsens during perimenopause, when hormone levels fluctuate widely, and then improves after periods stop. Hormone therapy can be used by women with migraine, including those with aura, but transdermal oestrogen (patches, gels or sprays) at standard doses is generally preferred because it gives steadier levels.

Migraine in children and teenagers

Migraine affects around one in ten school-age children. In young children, attacks are often shorter (sometimes just one to two hours), pain may be on both sides of the forehead, and abdominal pain, vomiting and pallor may be more prominent than headache. Children often want to lie down and sleep, and frequently feel better after sleeping.

Helpful steps for parents include:

• Keeping a simple diary with your child.
• Encouraging regular sleep, meals, fluids and physical activity, and limiting late-night screen use.
• Giving the right dose of ibuprofen or paracetamol for your child’s age and weight early in the attack, following the product label or a pharmacist’s advice.
• Agreeing a plan with your child’s school so they can rest, drink water and take their medicine during an attack.
• Watching for signs that stress, bullying, anxiety or low mood may be contributing.

Aspirin should not be given to children under 16 unless specifically advised by a healthcare provider, because of the risk of a rare but serious condition called Reye’s syndrome. Seek medical advice if your child has frequent headaches, headaches that wake them at night with vomiting, changes in behaviour, balance or vision, or any red-flag symptoms.

Migraine in older adults

Migraine often becomes less frequent with age, but some people develop aura without headache later in life. A new headache or new neurological symptoms after the age of 50 should always be assessed, because other conditions such as giant cell arteritis, stroke and medication side effects become more common. Older adults are also more likely to have heart disease, kidney problems and multiple medicines, which can affect which migraine treatments are safe.

Living and working with migraine

Migraine can affect careers, relationships and mental health. Practical steps can make a real difference:

• Talk to your employer or school. In many countries, migraine that substantially affects daily life may be protected under disability or equality laws. Reasonable adjustments might include flexible start times, reducing screen glare, a quiet space to rest, and time off for appointments.
• Adjust your workspace. Use anti-glare screens, increase font size, take regular breaks from screens, and position your desk away from flickering lights.
• Prepare a migraine kit. Keep your medicines, water, a snack, sunglasses, earplugs and an eye mask in your bag, car and workplace.
• Plan for travel. Keep to your sleep and meal routine as much as possible across time zones, stay hydrated on flights, and carry your medicines in hand luggage with a copy of your prescription.
• Look after your mental health. Depression and anxiety are more common in people with migraine and can make attacks worse. Treating them helps both.
• Connect with others. Patient organisations in many countries offer information, peer support and advocacy.

Migraine and shift work: a note for nurses and healthcare workers

Nurses, midwives, care workers and other healthcare professionals are not protected from migraine, and shift work can make it harder to control. Rotating shifts disrupt sleep timing, meals become irregular, hydration suffers when wards are busy, and bright clinical lighting and alarms add sensory load. If you are a healthcare worker with migraine:

• Ask about predictable rotas and, where possible, avoid rapid changes from nights to days.
• Keep water and a snack where you can reach them on shift, and protect your breaks.
• Use blackout blinds, earplugs and a consistent pre-sleep routine after night shifts.
• Speak with your occupational health service early about adjustments.
• Be cautious about self-prescribing or using workplace stock. Get a proper plan from your own healthcare provider.

Common myths about migraine

• “It’s just a bad headache.” Migraine is a complex neurological disorder with symptoms well beyond pain, and it is one of the leading causes of disability worldwide.
• “You need a scan to diagnose it.” Most people with typical migraine and a normal examination do not need a scan.
• “Painkillers can’t make headaches worse.” Frequent use can cause medication-overuse headache.
• “Chocolate causes migraine.” For most people, craving chocolate is an early symptom, not the cause.
• “Nothing can be done.” There are many effective acute and preventive treatments, and more options than ever before.
• “Children don’t get migraine.” Migraine is common in children and is often missed because it can look different.

Frequently asked questions

Can migraine be cured?

There is no permanent cure for migraine, but most people can reduce the frequency and severity of attacks significantly with the right combination of lifestyle changes, acute treatment and, where needed, prevention. Migraine also often improves with age.

Is migraine with aura dangerous?

Migraine with aura is associated with a small increase in the risk of ischaemic stroke, particularly in women who smoke or use oestrogen-containing contraception. For most people the absolute risk remains low. Stopping smoking and choosing suitable contraception reduce the risk further.

How many painkillers can I take in a month?

To reduce the risk of medication-overuse headache, try to keep simple painkillers to fewer than 15 days a month and triptans or combination painkillers to fewer than 10 days a month. If you need them more often, ask about prevention.

Why do I get migraines at weekends?

Weekend migraines are often linked to changes in sleep, caffeine timing and meal routines, and to the drop in stress hormones after a busy week. Keeping your routine steady seven days a week often helps.

Should I go to the emergency department for a migraine?

Go urgently if you have any red-flag symptoms such as a sudden thunderclap headache, fever with stiff neck, new weakness or speech difficulty, or a headache after a head injury. For a typical migraine that is not responding to your usual treatment, contact a healthcare provider or pharmacist for advice, and seek urgent care if you cannot keep fluids down or the attack lasts more than three days.

Can children take triptans?

Some triptans, particularly certain nasal sprays and tablets, are licensed for adolescents in some countries. Their use in children should be guided by a healthcare provider with experience in childhood headache.

But what if I have tried everything and nothing works?

Many people who feel they have “tried everything” have not yet had a careful review of their diagnosis, their painkiller use, their sleep and mental health, and a fair trial of several preventive options at good doses. Medication-overuse headache, untreated sleep apnoea, depression and hormonal factors are common reasons that migraine stays out of control. Ask your healthcare provider for a structured review or referral to a headache service, bring your diary, and do not accept “it’s just migraine” as the end of the conversation. New treatments have changed what is possible.

Related: Migraine vs tension headache · Sleep and insomnia: the complete guide

Sources: World Health Organization (headache disorders fact sheet), Global Burden of Disease Study, International Headache Society (ICHD-3 classification), American Headache Society consensus statements, National Institute for Health and Care Excellence (NICE) headache guidance, European Headache Federation guidelines, Cochrane reviews on acute and preventive migraine treatments.