Migraine: Symptoms, Causes, Treatments
What Is A Migraine?
Migraine is a neurological condition characterised by recurrent moderate to severe headaches, often accompanied by additional symptoms. It can impact daily functioning and varies significantly between individuals. Standard medical treatments are commonly used. For some individuals with limited response to or intolerance of these treatments, non-invasive neuromodulation approaches such as transcranial magnetic stimulation (TMS) have been investigated in research settings.
Symptoms of Migraine
Common symptoms include:
- Nausea
- Vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
Other features may include visual or sensory disturbances (aura in some cases), and the experience differs between individuals.
What are the Treatment Options for Migraine?
Treatment is individualised following clinical assessment and focuses on reducing frequency, severity, and impact on daily function. Options require discussion with a qualified health professional to determine suitability, risks, and benefits.
Medications
Acute treatments — Over-the-counter analgesics (e.g., paracetamol, ibuprofen, aspirin); triptans (e.g., sumatriptan) for moderate to severe episodes; anti-nausea medications (e.g., metoclopramide).
- Preventive treatments — Beta-blockers (e.g., propranolol); certain antidepressants (e.g., amitriptyline); anticonvulsants (e.g., topiramate); CGRP inhibitors (e.g., erenumab).
Therapies
- Repetitive Transcranial Magnetic Stimulation (rTMS) — A non-invasive technique delivering magnetic pulses to targeted brain regions under specialist supervision. It has been investigated for chronic migraine in individuals with inadequate response to standard treatments. Reported side effects are generally mild (e.g., headache or scalp discomfort) and are monitored during consultation.
- Cognitive Behavioural Therapy — To address stress-related or psychological contributors.
- Physiotherapy — When posture or neck tension contributes to symptoms.
Lifestyle Approaches
- Consistent sleep routines
- Balanced nutrition
- Individualised physical activity
- Adequate hydration
- Stress management strategies (e.g., mindfulness)
- Avoidance of identified personal triggers (e.g., certain foods, caffeine)
Alternative Approaches
- Acupuncture — Used by some individuals for symptom support.
- Hypnotherapy — For stress or pain management (evidence limited).
- Supplements (e.g., magnesium, riboflavin, coenzyme Q10) — Under medical supervision.
- Biofeedback — To increase awareness of physical stress responses.
All approaches require professional guidance and coordination with the treating team.
rTMS for Migraine
rTMS is under investigation as a non-invasive, drug-free neuromodulation technique targeting brain regions involved in migraine pathways. Evidence from clinical studies (including systematic reviews up to 2025) indicates variable outcomes, with some protocols showing potential reductions in migraine frequency or severity in selected individuals with chronic or refractory migraine.
Current status (as of 2026):
- Single-pulse TMS (sTMS) devices are FDA-cleared in the US for acute and preventive treatment of migraine (including with aura), often portable for home use under prescription.
- Repetitive TMS (rTMS) is not routinely Medicare-eligible in Australia for migraine (funding is limited to treatment-resistant major depressive disorder). It remains investigational for migraine in many settings and is considered only in specialist consultation.
Key Investigational Findings (Examples from Studies)
- Single-pulse TMS: Studied for acute relief during episodes, with variable pain reduction reported in some trials (e.g., higher rates of pain freedom at 2 hours in aura-associated migraine compared to sham in early RCTs).
- Repetitive TMS: Investigated for preventive effects, with some protocols showing reductions in monthly migraine days over weeks to months in research populations (outcomes vary by protocol, target, and individual factors).
These findings relate to investigational use and do not imply guaranteed outcomes. Evidence is evolving, with ongoing research required.
Considerations and Cautions
- Evidence base remains limited in quantity and quality for some applications; outcomes differ between individuals.
- Treatment requires specialist assessment, including review of clinical history and risk factors.
- Time commitment: Multiple sessions over weeks may be needed for rTMS protocols.
- Side effects: Generally mild and transient (e.g., headache, scalp discomfort, temporary sensory changes).
Important Note
Responses to any treatment vary. Decisions regarding TMS or other neuromodulation occur only after consultation with a qualified health professional (e.g., neurologist or headache specialist), including discussion of potential benefits, risks, and alternatives.
Read More
- Bhola, R., et al. (2022). Single-pulse Transcranial Magnetic Stimulation for Acute Migraine Relief: A Randomised Clinical Trial. Headache, 62(8), 978–986.
- Lipton, R. B., et al. (2010). Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. The Lancet Neurology, 9(4), 373–380.
- Rossi, S., et al. (2015). Repetitive TMS over the visual cortex for migraine prevention.
- Grangeon, L., Lange, K. S., Waliszewska-Prosół, M., Onan, D., Marschollek, K., Wiels, W., Mikulenka, P., Farham, F., Gollion, C., & Ducros, A. (2023). Genetics of migraine: where are we now? The Journal of Headache and Pain, 24, Article 12. https://doi.org/10.1186/s10194-023-01547-8
Learn More
FAQ about Migraines
Migraines are a neurological condition involving changes in brain signalling, neurotransmitters, and vascular factors. The exact mechanisms are not fully understood. Genetic, environmental, and lifestyle influences contribute, with family history increasing likelihood (particularly for migraine with aura; genetic factors estimated up to 42% in some analyses).
Common triggers vary between individuals and may include:
- Hormonal changes (e.g., menstrual cycles, pregnancy, menopause)
- Stress (emotional or physical)
- Dietary factors (e.g., caffeine, alcohol, aged cheeses, processed foods, skipped meals)
- Sleep disturbances (insufficient or irregular)
- Environmental factors (bright lights, loud noises, strong smells, weather changes)
- Physical factors (overexertion, fatigue, dehydration)
- Certain medications (e.g., oral contraceptives)
Tracking symptoms and triggers supports individualised management.
Family history increases the likelihood, especially for migraine with aura. Environmental factors also play a role in expression. Discussing family history with a health professional aids care planning.
Diagnosis is made through clinical assessment by a GP or neurologist, based on symptom review, medical history, and neurological examination. No single diagnostic test exists. Imaging or blood tests may be used if symptoms are atypical.
There is no cure. Management strategies aim to reduce frequency, severity, and impact. Some individuals experience changes over time. Individualised care supports improved quality of life.
A multidisciplinary approach coordinated by a GP is often effective, involving:
- General Practitioner (GP): Initial diagnosis, treatment, and referrals
- Neurologist: For complex or severe cases
- Pain Specialist: For chronic migraine, including discussion of emerging options
- Psychologist/Counsellor: For stress or mental health factors
- Physiotherapist: For physical triggers (e.g., neck tension)
- Pharmacist: For medication advice
- Dietitian: For dietary trigger management
Consult a doctor if:
- Migraines occur frequently (e.g., >4–5 days/month) or worsen
- They significantly affect daily life, work, or relationships
- Over-the-counter medications are ineffective or cause side effects
- New or atypical symptoms appear (e.g., sudden severe headache, vision loss, weakness, confusion)
- Headaches follow head injury
- You are pregnant, planning pregnancy, or using medications like oral contraceptives
Seek urgent medical attention for sudden, severe, or atypical headaches.
- Migraine & Headache Australia (www.migraine.org.au): Resources and support for migraine management.
- Healthdirect Australia (www.healthdirect.gov.au): Trusted health information.
- Pain Australia (www.painaustralia.org.au): Chronic pain resources.
- Your GP or Neurologist: For personalised advice or specialist referrals.
- Support Groups: Via Migraine & Headache Australia for peer support.
- Lifeline (13 11 14) or Beyond Blue (1300 22 4636): For mental health support.
For rTMS details, consult a specialist clinic or doctor. Verify online information with a healthcare professional.