Emily remembers her first bad headache: It was really scary. The pain was unbelievable and she felt like she was going to vomit. Emily had no idea what was happening. The headaches struck once a month, then once a week. So Emily's mom arranged for her to see a doctor.

The doctor asked Emily some questions about her headache pain and what she ate or did just before the headaches started. He also wanted to know if anyone in her family had headaches (turns out her mom had them as a teen). The doctor did a thorough physical exam and ran some tests. It turned out that Emily had migraines. The doctor prescribed medication for Emily's headaches and taught her things to do to avoid them.

What Makes a Headache a Migraine?

Almost everyone gets headaches. You might feel throbbing in the front of your head during a cold or bout with the flu, for example. Or you might feel pain in your temples or at the back of your head from a tension headache after a busy day. Most regular headaches produce a dull pain around the front, top, and sides of your head, almost like someone stretched a rubber band around it.

A migraine is different. Doctors define it as a recurrent headache that has additional symptoms. The pain is often throbbing and on one or both sides of the head. People with migraines often feel dizzy or sick to their stomachs. They may be sensitive to light, noise, or smells. Migraines can be disabling, and teens with migraines often need to skip school, sports, work, or other activities until they feel better.

If you have migraines, you are not alone. Experts estimate that up to 10% of teens and young adults in the United States get migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

What Causes a Migraine?

Not all scientists agree about what causes migraines. Many believe that a migraine is caused by narrowing and expanding of the blood vessels in the brain. There are also theories that the level of certain chemicals in the brain may affect the nerve system that regulates pain.

Whatever the cause, experts do agree that different things trigger (set off) migraines in people who have them. For some people, eating certain foods brings on a migraine. Others find that sleeping too long (or too little) provokes a migraine attack.

Some common migraine triggers are:

• stress
• menstruation
• skipping meals
• too much caffeine
• certain foods (alcohol, cheese, pizza, chocolate, ice cream, fatty or fried food, lunch meats, hot dogs, yogurt, aspartame, or anything with MSG, a seasoning often used in Asian foods)
• sudden changes in sleep patterns
• changes in hormone levels
• smoking
• weather changes
• travel

Experts believe that the likelihood of getting migraines is inherited. If one of your parents gets migraines, you have a greater chance of having these types of headaches than someone who doesn't have a family history of migraines.

What's a Migraine Attack Like?

Most migraines last from 30 minutes to 6 hours; some can last a couple of days.

Every migraine begins differently. Some people just don't feel right. Light, smell, or sound may bother them or make them feel worse. Sometimes, if they try to continue with their usual routine after the migraine starts, they may become nauseated and vomit. Often the pain begins only on one side of the head. Trying to perform physical activities may worsen the pain.

Some people get auras, a kind of warning that a migraine is on the way. The most common auras include blurred vision and seeing spots, colored balls, jagged lines, or bright or flashing lights or smelling a certain odor. The auras may only be seen in one eye. An aura usually starts about 10 to 30 minutes before the start of a migraine. Some individuals experience a migraine premonition hours to days prior to the actual headache. This is slightly different from auras and may cause cravings for different foods, thirst, irritability, or feelings of intense energy.

Some people with migraines also have muscle weakness, lose their sense of coordination, stumble, or even have trouble talking either just before or while they have a headache.

Diagnosing and Treating Migraines

Because migraine headaches and their triggers can vary between sufferers — in some people, for example, they're triggered by hormones; in others, by stress or even certain foods — how doctors treat someone depends on the type of migraine that person gets.

A doctor may ask someone having migraines to keep a headache diary to help figure out what triggers the headaches. If your doctor has asked you to keep such a diary, the information you record will help the doctor figure out the best treatment. A doctor may also take blood tests or imaging tests, such as a CAT scan or MRI of the brain, to rule out medical problems that might cause a person's migraines.

Part of treatment may involve making certain changes in your lifestyle — like changing your sleep patterns or dietary habits or avoiding certain stressors that trigger your migraines. Your doctor may also start you on a pain relief medication or also prescribe medicines that help with nausea and vomiting. Some people need preventive medicines that are taken every day to reduce the number and severity of the migraines.

Some doctors teach a technique called biofeedback to their patients with migraines. This technique helps a person learn to relax and use the brain to gain control over certain body functions (like heart rate and muscle stress) that cause tension and pain. If a migraine begins slowly, many people can use biofeedback to remain calm and stop the attack.

There have also been studies indicating that some alternative methods, such as acupuncture and the use of certain herbs, can help some people. However, it is important to ask your physician about alternative medicines before trying them for yourself. This is especially true of herbal treatments because they can interfere with more traditional methods of treatment.

Preventing a Migraine

The best way to prevent migraines is to learn what triggers (sets off) your migraines and then try to avoid these triggers. Take a break from activities that provoke a migraine, such as using the computer for a long time. If you know that certain foods trigger your migraines, try to avoid them. Some people find that cutting back on caffeine intake or drinking a lot of water can help prevent migraines.

Make a plan for all the things you have to do — especially during stressful times like final exams — so you don't feel overwhelmed when things pile up. Regular exercise can also reduce stress and make you feel better. If your doctor has prescribed medication, always have a dose on hand. Then if you feel a migraine coming, take your medicine. You can also try lying down in a quiet, dark room until the pain starts to go away.

Because migraines are so different for different people, it helps to keep a headache diary and get to know what provokes migraines in your own case. The more you understand your headaches, the better prepared you can be to fight them.

Reviewed by: Harry S. Abram, MD
Date reviewed: November 2010
Originally reviewed by: Margaret C. McBride, MD