Migraines: Symptoms, Causes, and Treatments with CGRP Inhibitors
Migraines affect many families and workplaces. They can be disabling, yet effective care is possible when people know what to look for and what treatments exist. Migraines affect over a billion people worldwide, and new medications such as CGRP inhibitors are providing effective relief. Timely information helps people get diagnosed sooner, avoid complications, and choose therapies that fit their lives.
Understanding Migraines
Migraines are more than just severe headaches; they are complex neurological events that can cause a range of symptoms, including nausea, vomiting, and visual disturbances. They often occur in phases, including a prodrome phase (warning signs), the headache phase, and a postdrome phase (aftereffects). Recognizing these phases can help individuals prepare and seek appropriate treatment.
Common Triggers
- Stress and anxiety
- Certain foods (e.g., aged cheeses, chocolate)
- Alcohol consumption
- Changes in sleep patterns
- Environmental factors (e.g., bright lights, strong odors)
Effective Treatments
While there is no cure for migraines, various treatments can help manage symptoms and reduce the frequency of attacks. These include:
- Over-the-counter pain relievers (e.g., ibuprofen, acetaminophen)
- Prescription medications (e.g., triptans, CGRP inhibitors)
- Preventive therapies (e.g., beta-blockers, antidepressants)
- Lifestyle modifications (e.g., diet, exercise, stress management)
FAQs
1. How can I tell if I have migraines?
If you experience recurrent headaches accompanied by symptoms like nausea, sensitivity to light or sound, and visual disturbances, it’s advisable to consult a healthcare professional for an accurate diagnosis.
2. What are CGRP inhibitors?
CGRP inhibitors are a class of medications specifically designed to prevent migraines by blocking the peptide involved in migraine attacks. They have shown promise in reducing the frequency and severity of migraine episodes.
3. Can lifestyle changes help with migraines?
Yes, lifestyle changes such as maintaining a regular sleep schedule, managing stress, staying hydrated, and avoiding known triggers can significantly help reduce the occurrence of migraines.
4. When should I seek medical attention for migraines?
If your migraine symptoms are severe, do not respond to treatment, or change in pattern, you should seek medical attention. Additionally, if you experience a sudden headache that is different from your usual migraines, it’s important to seek immediate care.
Conclusion
Understanding migraines and their treatment options is essential for those affected. With the right approach, individuals can manage their symptoms effectively and improve their quality of life.
What Are Migraines?
Migraines are not just “bad headaches.” They are a chronic neurological disorder that can cause repeated attacks of head pain and sensitivity to light, sound, or movement. Attacks can last hours to days and often disrupt work, school, and family life.
During a migraine, nerves in the head and the brain’s pain network become overactive. The trigeminal system releases chemicals like calcitonin gene–related peptide (CGRP). CGRP widens blood vessels and increases inflammation around nerves, which boosts pain signals.
There are two main types: migraine without aura and migraine with aura. People may also be classified as having episodic migraine (fewer than 15 headache days per month) or chronic migraine (15 or more headache days per month for over three months, with at least eight days that have migraine features).
Less common subtypes include hemiplegic migraine (temporary weakness), vestibular migraine (dizziness and balance problems), and menstrual migraine (linked to hormone cycles). These require careful diagnosis because symptoms can mimic other conditions.
Migraine is one of the leading causes of disability worldwide in people under 50. It affects work productivity, school performance, mood, sleep, and relationships. The burden is high but often hidden because many people self-treat without a diagnosis.
Migraine is a spectrum. Attack patterns and severity vary by person and can change over time. The same person may have different symptoms from one attack to the next, which is why a tailored approach to care works best.
Signs and Symptoms (Including Migraine Phases and Aura)
Migraine attacks often unfold in phases. Not everyone has every phase, and phases may blend. Recognizing your pattern helps you treat early, when medicines work best.
- Common symptoms include throbbing or pulsing head pain (often one-sided), nausea or vomiting, sensitivity to light, sound, or smells, neck pain or stiffness, worse pain with activity, and trouble concentrating.
The first phase, called the prodrome, can start hours to a day before head pain. People may notice yawning, food cravings, mood changes, fatigue, neck aching, or frequent urination. Treating early here can sometimes stop an attack.
An aura is a short-lived neurological symptom that can occur before or during the headache. It often involves visual changes like flashing lights, zigzag lines, or blind spots. Some people have tingling, numbness, trouble speaking, or dizziness. Aura usually lasts 5–60 minutes and should fully resolve.
The headache phase brings moderate to severe pain, often on one side, that throbs and worsens with movement. Nausea, vomiting, and sensitivity to light and sound are common. Without treatment, this phase can last 4–72 hours.
After the pain fades, the postdrome or “migraine hangover” can last up to a day. People may feel drained, foggy, or sensitive to light and sound. Gentle activity, hydration, and rest help recovery.
Some people also describe interictal symptoms—the time between attacks—such as mild light or smell sensitivity. Keeping a diary helps track phases, triggers, and what treatments work.
Causes and Common Triggers
Migraine runs in families. Genetics account for much of the risk, and many genes are involved. If a parent has migraine, their child has a higher chance of developing it. The condition often begins around puberty and can change over a lifetime.
The trigeminal pain pathway and the trigeminovascular system drive most migraine symptoms. During attacks, the brain releases CGRP and other neuropeptides. These increase inflammation and pain signaling. In people with aura, a wave of electrical activity called cortical spreading depression is thought to cause visual and sensory symptoms.
Hormones play a strong role, especially estrogen. Many women notice attacks just before or during a period, when estrogen drops. Pregnancy often improves migraine without aura, while the postpartum period can worsen it. Perimenopause may temporarily increase attacks; many improve after menopause.
Common triggers include stress or let-down after stress, irregular sleep, dehydration, skipping meals, and rapid weather or barometric pressure changes. Bright lights, screen glare, loud noise, and strong smells also trigger attacks for many.
Foods do not cause migraine, but certain items can trigger attacks in some people. Alcohol (especially red wine), aged cheeses, processed meats with nitrates, foods high in tyramine, monosodium glutamate (MSG), and excessive or withdrawal from caffeine are common examples. Triggers are personal; a diary helps identify yours without overly restricting your diet.
Some medicines can provoke or worsen headaches. Nitroglycerin and some hormonal therapies can trigger migraine. Overusing pain relievers, including over-the-counter drugs, can lead to medication overuse headache, which makes attacks more frequent and harder to treat.
Risk Factors: Who Is Most Affected
Migraine can affect anyone, including children, but it is most common in people aged 20–50. Women are about three times more likely than men to have migraines, due in part to hormonal influences. Boys and girls are affected equally before puberty.
A family history of migraine greatly increases risk. It can also affect the age of onset and severity. Knowing family patterns can help doctors make an earlier diagnosis and choose preventive options.
Certain health conditions occur more often with migraine, including anxiety, depression, sleep disorders (especially obstructive sleep apnea), asthma, irritable bowel syndrome, and epilepsy. These conditions can heighten pain sensitivity and increase migraine frequency.
Lifestyle factors matter. Irregular sleep, high stress, shift work, and low physical activity are linked with more frequent attacks. Obesity increases the risk of chronic migraine. Treating sleep issues and building routines often reduces attack frequency.
Hormonal life stages affect risk. The postpartum period and perimenopause can be challenging times. Some people with migraine with aura have a higher stroke risk, especially women under 45 who smoke or use estrogen-containing birth control; safer contraceptive choices exist.
Disparities in care mean many people go undiagnosed or undertreated. Cost, time, and access to specialists are barriers. Awareness of newer treatments and telehealth options can help close the gap.
Diagnosis: How Migraines Are Identified
Doctors diagnose migraine based on your history and a focused exam. There is no single blood test or scan that “proves” migraine. Clear descriptions of attacks, symptoms, and triggers are key.
Diagnostic criteria (ICHD-3) include at least five attacks that last 4–72 hours when untreated, with features such as one-sided, throbbing pain, moderate to severe intensity, worse with activity, and nausea/vomiting or sensitivity to light and sound. There are specific criteria for migraine with aura.
A headache diary is a powerful tool. Note when headaches start, how long they last, symptoms, possible triggers, menstrual timing, and what treatments help. This guides choices for acute and preventive medicines.
A neurological exam should be normal between attacks. Doctors check for “red flags” that suggest another cause. The SNOOP10 checklist (systemic symptoms, neurological deficits, sudden onset, onset after age 50, change in pattern, and others) helps flag serious problems.
Brain imaging (MRI or CT) is not routinely needed for typical migraine with a normal exam. Imaging is used if there are red flags, new headaches after age 50, seizures, cancer or immune problems, or unusual findings on exam.
Doctors also consider other diagnoses: tension-type headache, cluster headache, sinus disease, medication overuse headache, concussion, dental or jaw problems, and eye or neck disorders. Sometimes more than one headache type is present.
Treatment Options: Acute, Preventive, and CGRP Inhibitors
The goals of treatment are to stop or lessen pain during an attack, prevent future attacks, and reduce disability. Plans often include both acute and preventive strategies, plus lifestyle changes. Early treatment during the attack works best.
- Acute options include NSAIDs (ibuprofen, naproxen), acetaminophen, triptans (sumatriptan, rizatriptan), gepants for acute use (ubrogepant, rimegepant), a ditan (lasmiditan) for those who cannot take triptans, anti-nausea medicines (metoclopramide, prochlorperazine), and dihydroergotamine. Opioids are discouraged due to poor efficacy and risk of dependence.
Preventive medicines reduce frequency and severity. Options include beta-blockers (propranolol, metoprolol), antiepileptics (topiramate; valproate is effective but unsafe in pregnancy), and antidepressants (amitriptyline, venlafaxine). OnabotulinumtoxinA helps in chronic migraine. Preventive therapy is considered if you have four or more migraine days per month, attacks that are very disabling, or if acute treatments fail or are overused.
CGRP inhibitors target the migraine pathway directly. Monoclonal antibodies block CGRP or its receptor and are used for prevention: erenumab (monthly injection), fremanezumab (monthly or quarterly), galcanezumab (monthly), and eptinezumab (IV every 3 months). Oral gepants can be used for acute treatment (ubrogepant, rimegepant) and prevention (atogepant daily; rimegepant every other day for prevention).
CGRP therapies are effective and generally well tolerated. They do not constrict blood vessels, so they may be safer than triptans for people with cardiovascular disease. Common side effects include injection site reactions, constipation (more with erenumab), nausea, fatigue, and rare hypersensitivity. Some reports note increased blood pressure; monitoring is advised.
Choosing a CGRP inhibitor depends on attack frequency, prior treatment response, medical history, and access. Benefits can appear within the first month for many, with continued improvement over 3–6 months. Insurance coverage varies; patient assistance programs may help with costs.
People who should use caution include those who are pregnant or trying to conceive (data are limited; monoclonal antibodies have long half-lives), those breastfeeding, and people with severe liver disease (for some gepants). Gepants interact with strong CYP3A4 inhibitors/inducers; review all medicines with your clinician. CGRP drugs can be combined with other preventives or triptans under medical guidance.
Prevention and Lifestyle Strategies
Daily habits can lower attack frequency and make medicines work better. The goal is a steady routine that reduces brain sensitivity and avoids known triggers without being overly restrictive.
- Helpful steps: keep regular sleep and wake times; drink enough water; eat balanced meals on schedule; exercise most days (even walking helps); manage stress with relaxation or mindfulness; take screen breaks; limit alcohol; keep caffeine modest and consistent; build a calm wind-down routine at night.
Some supplements have evidence. Magnesium (citrate, 400–600 mg/day, watch for diarrhea) can reduce attacks. Riboflavin (vitamin B2) at 400 mg/day, and Coenzyme Q10 (100 mg three times daily) help some people. Melatonin (2–3 mg at bedtime) may aid sleep and reduce headaches. Avoid butterbur unless it is PA-free and physician supervised due to liver toxicity risk; feverfew evidence is mixed.
Behavioral therapies are effective. Cognitive behavioral therapy (CBT), biofeedback, and relaxation training reduce attack frequency and disability. Mindfulness, yoga, and paced breathing can calm the nervous system and improve coping.
Noninvasive devices can help. Options include external trigeminal nerve stimulation (forehead device), noninvasive vagus nerve stimulation (neck device), and single-pulse transcranial magnetic stimulation. These can be used alone or with medication, depending on your pattern.
Prevent medication overuse headache. Limit triptans, gepants, ditans, or combination pain pills to no more than 9–10 days per month, and simple pain relievers like NSAIDs or acetaminophen to no more than 14–15 days per month. If overuse is present, work with your clinician on a plan to taper and switch to preventive strategies.
Small, steady changes add up. Track your progress, celebrate gains, and adjust your plan with your care team. What works best is personal and may change over time.
Complications and Long-Term Impact
Some people transition to chronic migraine, defined as 15 or more headache days per month for over three months, with at least eight days that have migraine features. Risk rises with high attack frequency, medication overuse, obesity, untreated sleep problems, and high stress.
Medication overuse headache can occur when acute medicines are taken too often. The headache becomes more frequent and less responsive to treatment. The solution is supervised withdrawal, adding prevention, and rebuilding healthy routines.
Migraine affects mental health. Anxiety and depression are common and can worsen pain perception. Poor sleep and fatigue can lead to lower mood and less activity, creating a cycle. Treating both migraine and mental health together improves outcomes.
Neurological risks are small but important. People with migraine with aura have a higher risk of ischemic stroke than those without aura, especially women under 45 who smoke or use estrogen-containing birth control. Safer contraceptive options and smoking cessation reduce risk. Migraine in pregnancy is linked with higher risk of preeclampsia and other complications; close prenatal care is key.
Complicated attacks can occur. Status migrainosus lasts longer than 72 hours and may need urgent care. Persistent aura without infarction and hemiplegic migraine are rare and need specialist evaluation. Vestibular migraine causes dizziness and balance problems that impact safety and work.
Migraine also brings economic and social costs. Missed work or school, reduced productivity, and health care expenses are common. Families and caregivers are affected too. Advocacy, workplace accommodations, and coordinated care with primary care, neurology, behavioral health, and therapy services can reduce the burden.
When to Seek Medical Help
Seek care if you have severe or frequent headaches, new or changing patterns, or if your current plan is not working. Early evaluation helps rule out serious causes and prevents chronic problems.
- Go to emergency care for: a “thunderclap” headache that peaks in seconds; a new neurological symptom like weakness, trouble speaking, confusion, or double vision; a headache with fever, stiff neck, rash, or after a head injury; a new severe headache after age 50; a headache with cancer, HIV, or pregnancy; or a headache that is the “worst ever.”
Schedule a visit with your clinician if attacks are becoming more frequent, last longer, or limit daily life. Also seek help if you use acute medicines more than 9–10 days per month or simple pain relievers more than 14–15 days per month.
Children, teens, older adults, and people who are pregnant or postpartum should be evaluated promptly for new or changing headaches. Treatment choices differ for these groups, and some medicines are not safe in pregnancy.
Bring a headache diary to visits. List your medicines (including supplements), past treatments, triggers, menstrual timing, and family history. This speeds diagnosis and guides a tailored plan.
If local access is limited, consider telehealth or a headache specialist. Patient organizations and employer resources can help with education, devices, and accommodations.
FAQ
What is the difference between a migraine and a regular headache?
Migraine is a brain disorder with repeated attacks and sensitivity to light, sound, or movement, often with nausea. A tension headache is usually milder, steady, and not worsened by activity.
Are migraines genetic?
Yes. Migraine often runs in families. Many genes are involved, which is why patterns vary from person to person.
Can children get migraines?
Yes. Children can have migraines, sometimes with stomach pain (abdominal migraine). Attacks may be shorter, and pain can be on both sides. Pediatric evaluation guides safe treatment.
Are CGRP inhibitors safe if I have heart disease?
CGRP inhibitors do not constrict blood vessels, unlike triptans. They may be a safer choice for many people with cardiovascular disease, but you should still review risks and blood pressure monitoring with your clinician.
Can I take a CGRP inhibitor with a triptan?
Often yes, with medical guidance. Many people use a CGRP preventive plus a triptan for acute attacks. Check for interactions with gepants (they interact with some CYP3A4 drugs).
Do weather changes really trigger migraine?
They can. Shifts in barometric pressure, heat, or humidity trigger attacks for some people. Planning hydration, rest, and early treatment around weather changes can help.
Is caffeine good or bad for migraine?
Both. Small, consistent amounts can help some people. Too much or sudden withdrawal can trigger attacks. Keep intake steady and avoid late-day caffeine.
Can I use CGRP medicines in pregnancy or while breastfeeding?
Data are limited. Most experts advise avoiding them in pregnancy and using caution while breastfeeding. Discuss family planning and timing—monoclonal antibodies can stay in the body for months.
More Information
Mayo Clinic overview of migraine, symptoms, and treatment: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes
MedlinePlus patient-friendly migraine resources: https://medlineplus.gov/migraine.html
CDC Headache and Migraine information: https://www.cdc.gov/traumaticbraininjury/headaches.html
WebMD migraine guide for patients: https://www.webmd.com/migraines-headaches/guide/migraines-headaches
Healthline on CGRP inhibitors and how they work: https://www.healthline.com/health/migraine/cgrp-inhibitors
If this article helped you, please share it with someone who may be struggling with migraine. For personalized advice, talk with your healthcare provider. To explore related topics, visit Weence.com for more patient-friendly guides and resources.
