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Why do I keep getting migraines and what can I do about them?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: July 9, 2025Updated: July 9, 2025

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Key Takeaways

Most migraines arise from an inherited hypersensitivity in the brainstem that over-reacts to specific triggers—such as hormonal swings, skipped meals, bright light, or certain smells—causing waves of neuro-inflammation and pulsing pain on one side of the head. Recognising your personal triggers, watching for danger signs, and using evidence-based treatments (from magnesium to prescription preventives) can sharply cut attack frequency.

Could my genetics and environment both be driving my migraines?

Up to 75 % of people with migraine report a family history, yet attacks usually need an environmental trigger to start. “Think of migraine as a loaded gun (genes) that still needs a trigger (stress, sleep loss, hormones) to fire,” says the team at Eureka Health.

  • Migraine runs in familiesMore than 40 gene variants involved in brain ion channels and glutamate signaling have been linked to migraine in genome-wide studies.
  • Triggers stack, not isolateMissing breakfast plus bright office lighting raises attack odds 3-fold compared with either trigger alone, according to a 2021 UK cohort study.
  • Sensory processing is hyper-excitableFunctional MRI shows the visual cortex in migraineurs fires 50 % more strongly to light flashes even between attacks.
  • Estrogen drop plays a major role in womenThree out of four female patients report migraines clustering in the two days before menstruation when estrogen falls sharply.
  • Parental migraines confer up to 75 % riskIf one biological parent has migraine your lifetime chance is about 50 %, and it climbs to roughly 75 % when both parents are affected. (Mayo)
  • Modifiable triggers fuel chronic migraine shiftStress, sleep loss, fasting, hormonal changes, weather and sensory overload are key external factors that can turn episodic migraine into chronic disease in people carrying susceptibility genes. (NIH)

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Which migraine symptoms should make me seek urgent care?

Most migraines, though miserable, are not life-threatening. But some red flags demand rapid evaluation. “If your ‘worst ever’ headache hits like a thunderclap, do not assume it’s just migraine,” warns Sina Hartung, MMSC-BMI.

  • Sudden ‘thunderclap’ pain can signal bleedingA subarachnoid hemorrhage peaks in seconds; call 911 if pain is instant and explosive.
  • New neurological deficits are alarmingWeakness, slurred speech, or double vision during a first-time headache could be a stroke or meningitis.
  • Age over 50 with first migraine-like pain needs imagingBrain tumors or temporal arteritis appear later in life and mimic migraine in 5 % of cases.
  • Fever with stiff neck suggests infectionAdd neck rigidity and photophobia to headache and meningitis tops the list until ruled out.
  • Worsening pain after head injury is an emergencyA headache that begins or intensifies following trauma can signal a concussion or intracranial bleed and warrants prompt evaluation. (Stanford)
  • Seizures or sudden pattern change justify an ER visitMigraine is the most common identifiable headache seen in U.S. emergency departments, but any attack accompanied by seizures, confusion, or new vision or speech changes should send you straight to the ER. (HealthCentral)

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What exactly happens inside the brain during a migraine attack?

A migraine begins with over-active trigeminal nerves releasing CGRP (calcitonin gene-related peptide). This inflames blood vessels and sensitises pain pathways. “CGRP is so central that blocking it can prevent attacks in one in two chronic sufferers,” notes the team at Eureka Health.

  • Cortical spreading depression triggers auraA slow wave of electrical silence travels at 3 mm per minute across the cortex, explaining visual zig-zags.
  • CGRP drives vessel dilation and painBlood CGRP levels spike up to 300 % during attacks and fall after effective treatment.
  • Brainstem nuclei misfireThe periaqueductal grey and dorsal pons show sustained activation on PET scans even between attacks.
  • Inflammation sensitises facial nervesPro-inflammatory cytokines lower pain thresholds so even brushing hair can hurt (allodynia).
  • CGRP infusion reproduces migraine in most patientsIntravenous CGRP provoked migraine-like attacks in roughly 60–70 % of susceptible adults, underscoring how pivotal the peptide is to initiating pain pathways. (NIH)
  • Ion-channel gene variants raise cortical excitabilityMutations in neuronal calcium, sodium and ATPase channels (e.g., CACNA1A, SCN1A, ATP1A2) account for the majority of familial hemiplegic migraine cases and lower the threshold for cortical spreading depression. (NIH)

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How can I cut attacks at home starting today?

Target the modifiable triggers first. “A predictable sleep-food-stress routine reduces monthly migraines by about 40 % in trials,” says Sina Hartung, MMSC-BMI.

  • Keep a trigger diary for four weeksRecording sleep hours, foods, stress and menses pinpoints patterns most patients overlook.
  • Maintain regular caffeine—not zero, not binge200 mg daily is neutral, but caffeine withdrawal doubles attack risk the following day.
  • Supplement wisely with magnesium glycinate400 mg nightly lowered attack frequency by 22 % in a 2020 meta-analysis.
  • Use cold therapy in the first 20 minutesAn ice pack over the carotid arteries dropped pain scores by 2 points on a 0–10 scale in small RCTs.
  • Hydrate at the first hint of painEven mild dehydration can spark a migraine; MedlinePlus recommends drinking water as soon as symptoms start to ease intensity and prevent progression. (NIH)
  • Retreat to a dark, quiet roomReducing light and noise stimulation—by lying down in a dark, silent room—is listed by WebMD as a simple way to shorten attacks without medication. (WebMD)

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Which tests and prescription options actually matter for migraine?

No lab confirms migraine, but targeted tests rule out mimics and guide medication decisions. The team at Eureka Health explains, “Checking a prolactin level in new daily headaches can uncover a pituitary tumor that looks like migraine.”

  • MRI is recommended for atypical aura or red-flag signsAmerican Headache Society advises imaging if aura lasts >60 minutes or onset is after age 50.
  • TSH and CBC can expose masqueradersHypothyroidism and anemia each account for roughly 2 % of ‘refractory migraine’ referrals.
  • Two acute drug classes dominateTriptans abort 60–70 % of attacks; newer gepants work even if triptans fail or are contraindicated.
  • Preventives are considered at 4+ attacks per monthTop choices include CGRP monoclonal antibodies, certain beta-blockers, and daily magnesium or riboflavin.
  • CGRP antibodies nearly double the drop in monthly migraine days versus placeboPhase III data summarized in the review show erenumab 140 mg lowers monthly migraine days by about 3.7 compared with 1.8 on placebo after 12 weeks. (NatRevNeuro)
  • Triptan–NSAID combination boosts 2-hour pain relief over either drug aloneThe CMAJ review reports fixed-dose sumatriptan 85 mg / naproxen 500 mg achieves 2-hour pain relief in roughly 57 % of attacks versus 28 % with placebo. (CMAJ)

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How can Eureka’s AI doctor support my migraine care right now?

Eureka’s AI asks focused questions, analyses your symptom timeline, and suggests evidence-based next steps within minutes. “Users often learn they qualify for preventive therapy they were never offered,” notes Sina Hartung, MMSC-BMI.

  • Personalised trigger mappingUpload your diary and the AI highlights statistically significant triggers using time-series analysis.
  • Safe medication reviewThe system flags rebound-causing over-use when rescue drugs exceed 10 days per month.
  • Lab ordering with clinician oversightIf red flags appear, the AI drafts an MRI order that a licensed physician reviews within 2 hours.
  • 24/7 follow-up promptsPush notifications check pain scores after each attack, supporting early intervention.

Why do migraine sufferers rate Eureka so highly?

People with chronic migraine often feel dismissed. Eureka’s secure, judgment-free chat gives them the control they need. Women using Eureka for migraine prevention rate the app 4.8 out of 5 stars for “feeling heard,” according to in-app surveys.

  • Respects privacy and autonomyAll data are end-to-end encrypted and never sold.
  • Bridges gaps between visitsThe AI summarises attack trends for your neurologist, reducing appointment prep time by 30 %.
  • Evidence-based recommendations onlyEvery suggestion cites peer-reviewed guidelines and is reviewed by board-certified physicians.
  • Free core featuresSymptom tracking, education modules, and lifestyle coaching cost nothing to start.

Frequently Asked Questions

Are migraines and headaches the same thing?

All migraines are headaches, but not all headaches are migraines. Migraine pain is usually one-sided, throbbing, and accompanied by nausea or light sensitivity.

Can dehydration alone cause a migraine?

Yes. Losing as little as 1.5 % of body water can trigger an attack in susceptible people, so hydration is an easy preventive step.

Is it safe to take over-the-counter painkillers every attack?

Occasional use is fine, but using analgesics more than 10 days per month can cause rebound headaches; talk to a clinician about preventives instead.

Do weather changes influence migraines?

Rapid drops in barometric pressure and high humidity have been linked to a 20 % increase in attacks within 48 hours.

Will pregnancy make my migraines worse?

About 60 % of women see improvement in the second and third trimesters, likely due to steady estrogen levels, but a minority worsen.

Should I try a ketogenic diet for migraine?

Early studies show a 40 % reduction in attacks after 3 months, but strict carb limits can be hard to maintain; consult a dietitian.

When should I ask for preventive medication?

If you have four or more disabling attacks per month, or if acute drugs are failing, evidence supports starting a preventive treatment.

Can eye strain from screens trigger migraine?

Yes. High-contrast blue light and 60-Hz flicker can set off visual cortex hyper-excitability; blue-light filters and regular breaks help.

Is Botox only for cosmetic use?

No. OnabotulinumtoxinA injections every 12 weeks cut chronic migraine days by around 8 per month in FDA trials.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

References

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