• Moderate to severe pain, which may be confined to one side of the head or may affect both sides
• Head pain with a pulsating or throbbing quality
• Pain that worsens with physical activity
• Pain that interferes with your regular activities
• Nausea with or without vomiting
• Sensitivity to any type of stimulation

Auras: Most people experience migraines without auras, which are also called common migraines. Some people have migraines with auras, which are also called classic migraines.

• Feelings of elation or intense energy
• Cravings for sweets
• Thirst
• Drowsiness
• Irritability or depression

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache gets worse
• A chronic headache that is worse after coughing, exertion, sex, straining or a sudden movement
• New headache pain if you're older than 50

• Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it's beneficial to take them.

• Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraines.

• Stress. Stress at work or home can be a trigger.

• Sensory stimuli. Bright lights and sun glare can produce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke, can also trigger migraines.

• Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraine attacks in some individuals, as can jet lag.

• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.

• Changes in the environment. A change of weather, humidity, temperature, or barometric pressure can prompt a migraine.

• Medications. Certain medications aggravate migraines.

• Having a family history. Most people with migraines have a family history. If one of your parents have migraines, there's a good chance you will too.

• Being younger than 40. Half the people who suffer from migraines started getting them before they were 20 and migraines are most common in people who are between 30 and 39 years old.

• Being female. Women are three times as likely to have migraines as men are. Headaches tend to affect boys more than girls during childhood, but by the time of puberty, more girls are affected.

• Experiencing hormonal changes. If you're a woman with migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Some women report that their migraines got worse during the first trimester of a pregnancy. Though for many, the migraines improved during later stages in the pregnancy.

• Abdominal problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others), naproxen, and aspirin, may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.

• Rebound headaches. If you take over-the-counter or prescription headache medications more than nine days per month or in high doses, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.

• Serotonin syndrome. This potentially life-threatening drug interaction can occur if you take migraine medicines called triptans, for example sumatriptan (Imitrex) or zolmitriptan (Zomig), along with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is very rare.

• Write down symptoms you're experiencing, even if they seem unrelated.

• Write down key personal information, including major stresses, recent life changes.

• Make a list of all medications, as well as any vitamins or supplements that you're taking. It is particularly important to list all medications that you have used to treat your headaches. Include the doses of the medications.

• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed.

• Write down questions to ask the doctor. Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.

• When did you first begin experiencing symptoms?
• Are your symptoms continuous or occasional?
• How severe are your symptoms?
• What, if anything, improves your symptoms?
• What, if anything, worsens your symptoms?

• Keep a headache diary. A diary can help you and your doctor determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also note the foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you're doing when headaches strike.

• Reduce stress. Because stress triggers migraines for many people, try to avoid overly stressful situations, or use stress-reduction techniques like meditation.

• Get enough sleep but don't oversleep. Aim for seven to eight hours of sleep a night.

• Computerized tomography (CT). This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose blood clots, tumors, infections and other possible medical problems that may be causing your headaches.

• Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very detailed views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.

• Spinal tap (lumbar puncture). If your doctor suspects an underlying condition of meningitis — an inflammation of the membranes (meninges) and cerebrospinal fluid, surrounding your brain and spinal cord — he or she may recommend a spinal tap. In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis.

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.

• Preventive medications. These drugs are prophylactic and taken regularly on a daily basis to reduce the severity or frequency of migraines. They will not eliminate or cure migraine.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others), naproxen, or aspirin, may help relieve mild migraine. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines but aren't effective alone for severe migraine. If taken too often or for long periods of time, NSAIDs can lead to ulcers, GI bleeding and/or rebound headaches.

• Triptans. For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness.

• A new, single-tablet combination of sumatriptan and naproxen sodium (Treximet) became available in 2008. It's more effective in relieving migraine symptoms than either medication on its own.

• Ergots. Ergotamine with caffeine(Cafergot) is much less expensive, but also less effective, than triptans. It seems most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine nasal (Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine.

• Anti-nausea medications. Because migraine attacks are often accompanied by nausea with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral, IM, IV; Reglan) or prochlorperazine (oral or suppository).

• Butalbital combinations. Medications that combine the sedative butalbital with aspirin or acetaminophen (Phrenlin) are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine (Esgic-Plus, Fioricet). These medications have a high risk of side effects, rebound headaches, and withdrawal symptoms. Therefore, they should be used infrequently.

• Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine pain when people can't take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.

• have five or more debilitating attacks/mos
• pain-relieving medications aren't helping
• your migraine signs and symptoms include a prolonged aura or numbness and weakness.

• Cardiovascular drugs.

Beta blockers: commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents.

Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful in preventing migraines and relieving symptoms from aura.

Antihypertensive medications lisinopril (Prinivil, Zestril; inhibits angiotensin converting enzyme) and candesartan (Atacand) are useful in reducing the length and severity of migraine

• Antidepressants.

Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor) and imipramine (Topranil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. You don't have to have depression to benefit from these drugs.

• SSRIs: Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), haven't been proven as effective for migraine prevention.

• Anti-seizure drugs. Some anti-seizure drugs, such as divalproex sodium (Depakote), topiramate (Topamax), and gabapentin (Neurontin), seem to reduce the frequency of migraines. However, these anti-seizure drugs sometimes may cause side effects, such as nausea, diarrhea, tremors, confusion, weight gain, weight loss, muscle cramps, somnolence, hair loss, and dizziness.

• TOPAMAX Advisory: Divalproex sodium, Depakote, topiramate, Topamax are associated with increased risk for birth defects in babies born to women who use these medication during pregnancy.

• A press release from March 4, 2011 from US Food and Drug Administration warns against topiramate in pregnancy:

• Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.

• Botulinum toxin type A (Botox). Botulinum toxin type A is sometimes used for treatment of chronic migraines. Studies have had mixed results with respect to effectiveness. However, some headache specialists believe that it can be helpful for some people. Injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every three months. Treatment is very expensive and not always covered by the insurance.

• Try muscle relaxation exercises. Progressive muscle relaxation, meditation and yoga don't require any equipment. You can learn them in classes or at home using books or tapes. Or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.

• Exercise. Research has shown  that people who exercise regularly have fewer headaches than those that do not. This is true also for teenagers with migraine or chronic daily headaches.

• Get enough sleep but don't oversleep. The average adult needs seven to eight hours of sleep a night. It's best to go to bed and wake up at regular times, as well.

• Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on.

• Keep a headache diary. Continue keeping your headache diary even after you see your doctor. It will help you learn more about what triggers your migraine and what treatment is most effective.

• Acupuncture. In this treatment, a practitioner inserts many thin needles into several areas of your skin at defined points. A number of clinical trials have found that acupuncture may be helpful for some people with headache pain.

• Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.

• Massage. Massage may help reduce the frequency of migraines. It can improve the quality of your sleep, which can, in turn, help prevent migraines.

• Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. Coenzyme Q10 supplements may be helpful in some individuals. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people. Studies don't all agree on these issue. Don't use feverfew or butterbur if you're pregnant.

• Magnesium intravenously may help some people during an acute headache, particularly people with magnesium deficiencies.

• Avoid triggers. If certain foods seem to have triggered your headaches in the past, avoid those foods. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.

• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.

• Obesity is also thought to be a factor in migraines. Proper diet and regular exercise may help you keep your weight down. Sleep apnea is associated with higher incidence of headaches.

• Reduce the effects of estrogen. If you're a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your gynecologist about the best alternatives or dosages for you.