Migraine: triggers, treatment, and when a headache is more
Last updated September 3, 2026.
A migraine is not just a bad headache. It is a specific neurological pattern: attacks that last 4 to 72 hours, usually one-sided and pounding, made worse by movement, and often paired with nausea and sensitivity to light and sound. About a third of people with migraine get an aura first, typically shimmering zigzag lines or blind spots that build over minutes and fade within an hour. Most migraines are very treatable, but the treatment depends on getting the diagnosis and the timing right.
How do I know it is migraine and not a regular headache?
The pattern tells you. Migraine attacks are typically one-sided, throbbing, moderate to severe, and worse with routine activity like climbing stairs. They come with at least one of: nausea or vomiting, and sensitivity to light and sound. Tension-type headaches, the other common kind, are usually a dull band-like pressure on both sides that does not stop you functioning. Keeping a short diary for a few weeks, noting when attacks hit, what you ate, sleep, stress, and for women where you are in your cycle, often reveals a trigger pattern and makes the diagnosis obvious.
What actually treats a migraine attack?
- Treat early. Whatever you use works far better in the first hour than after the pain is established.
- Over-the-counter first: ibuprofen or aspirin, with or without caffeine, settles many mild to moderate attacks.
- Triptans (like sumatriptan) are the standard prescription for moderate to severe attacks, and a clinician can prescribe them after reviewing your history. Not for people with certain heart or stroke history.
- An anti-nausea medicine helps when nausea blocks pills from absorbing.
- Dark, quiet, cool room. Many attacks can be slept off once medication is on board.
When does migraine need prevention, not just treatment?
If you are having four or more migraine days a month, or attacks regularly disable you, guidelines support preventive treatment rather than just reacting to each attack. Prevention options range from blood pressure medicines and certain antidepressants used off-label, to newer CGRP-targeting drugs designed specifically for migraine. Also watch medication-overuse headache: using acute painkillers on more than 10 to 15 days a month can itself start driving daily headaches, which is a common trap.
When is a headache an emergency?
Go to an emergency room now for a thunderclap headache (worst-ever pain peaking within a minute), a headache with weakness, slurred speech, confusion, or fainting, a headache with fever and a stiff neck, a new headache after a head injury, or a headache that is new and progressively worsening after age 50. A first-time headache pattern in pregnancy also deserves prompt review. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
What a Pymander AI doctor consult looks like
Illustrative example, not a real member's messages.
Common questions
What is the difference between a migraine and a headache?
A migraine is a specific neurological condition, not just a strong headache. Migraine attacks last 4 to 72 hours, are usually one-sided and throbbing, get worse with movement, and come with nausea or vomiting and sensitivity to light and sound. About a third of people also get an aura, typically visual zigzags or blind spots that build over minutes before the pain. Tension-type headache, the most common ordinary headache, is a dull band-like pressure on both sides without those features and usually lets you keep functioning. The distinction matters because the treatments differ: migraines respond to triptans, tension headaches generally do not.
What triggers migraines?
The common triggers are stress (and oddly, the let-down after stress), poor or irregular sleep, skipped meals, dehydration, alcohol (red wine especially), caffeine excess or withdrawal, bright or flickering light, strong smells, weather pressure changes, and hormonal shifts, which is why many women get attacks around their period. Certain foods like aged cheese and processed meats show up for some people. Triggers are individual, so the reliable way to find yours is a two to four week diary noting attacks alongside sleep, food, stress, and cycle day rather than guessing.
What is a migraine aura?
An aura is a set of reversible neurological symptoms that usually comes before the headache, most often visual: shimmering zigzag lines, flashing lights, or a blind spot that expands over 5 to 60 minutes and then fades. Some people get tingling in a hand or face, or brief trouble finding words. Aura itself is not dangerous, but a first-ever aura, an aura lasting over an hour, or one without headache after age 40 is worth a medical review because it can be mimicked by other conditions. People with frequent aura should mention it when discussing birth control pills, since the combination with estrogen raises stroke risk slightly.
When should migraines be treated preventively?
Guidelines suggest considering preventive treatment when you have four or more migraine days a month, when attacks regularly disable you despite acute treatment, or when you cannot take triptans. Prevention options include beta blockers, certain antidepressants and anti-seizure medicines used off-label, and newer CGRP-targeted antibodies designed specifically for migraine. Prevention is judged over two to three months, not days. Before medication, the free version is trigger management: regular sleep, regular meals, hydration, and limiting acute painkillers to under 10 to 15 days a month, because overusing them can itself cause daily headache.
Can a doctor help with migraines over text or video?
Yes, migraine is one of the better-suited conditions for telehealth because the diagnosis comes almost entirely from the history: attack pattern, duration, associated symptoms, triggers, and what you have tried. There is no scan or blood test that diagnoses migraine; imaging is only for ruling out dangerous causes when red flags appear. A clinician can review your pattern, prescribe triptans or prevention, and set a follow-up plan remotely. The in-person situations are the red flags: sudden worst-ever headache, neurological symptoms like weakness or slurred speech, fever with stiff neck, or a new headache pattern after 50. Texting an AI doctor is a quick way to sort which situation you are in.
Related questions
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