You are in the middle of a meeting. The lights suddenly feel too bright. Your colleague's voice is a little too loud. There is a dull throb starting behind one eye, and you already know where this is going.
Someone says, "It's just stress. Drink some water."
If this sounds familiar, this article is for you. I am Dr Hardik Rajyaguru, a neurosurgeon. In my clinic, I meet people every week who have put up with these headaches for years, because everyone told them it was "just a headache." It is not. It is migraine, and it is very treatable.
Let me explain it the way I would to a friend.
In short: A migraine is a headache caused by a problem in the brain's pain system, not just by stress, weak eyes or gas. It brings throbbing pain, usually on one side of the head, with nausea and sensitivity to light and sound. An attack lasts 4 to 72 hours if untreated. Migraine can be treated with the right medicine, taken early, and with a few daily habits.
Key facts at a glance
- India: about 1 in 4 adults had migraine in the past year. Two big community surveys found 25.2% in Karnataka (south) and 26.3% in Delhi and the National Capital Region (north).
- World: about 1 in 9 people (11.6%), pooled from 302 community studies with over 6 million people. India's rate is more than double.
- Women are affected more: about 2 to 3 times as often as men in the Indian surveys, and about twice as often worldwide.
- Migraine is the second leading cause of years lived with disability worldwide. In India, headache disorders are the second biggest cause of lost healthy life among brain and nerve diseases, after stroke.
- Most migraines do not need a brain scan. A scan is for warning signs.
- Taking painkillers too often can cause daily headache.
Is it a migraine? A quick self-check
This is not a diagnosis, only a way to know whether it is time to talk to a doctor. Think about your usual bad headaches. How many of these sound like you?
- The pain throbs or pulses, and it is often on one side.
- You feel sick, or you vomit.
- Light or sound feels unbearable, and you want a dark, quiet room.
- Without treatment, it lasts hours, sometimes up to 3 days.
- Before it starts you may notice warning signs: mood change, food cravings, yawning, a stiff neck, or flashing lights and zig-zag lines.
If two or more feel familiar, please do not just live with it. Keep a headache diary for a few weeks and bring it to a doctor. A normal brain scan does not rule migraine out, as you will see below.
What is a migraine?
A migraine is a brain condition that causes repeated, often severe headaches. It is not just a bad headache.
In a migraine, the nerves that carry pain from the head become over-active. A chemical messenger called CGRP is involved in this pain. Genes also play a part. If your parents or siblings have migraine, you are more likely to have it too.
Here is something many patients do not know: the brain itself cannot feel pain. The pain comes from the nerves and blood vessels around it. This is also why a brain scan is often normal in a person with terrible migraines. A normal scan does not mean "nothing is wrong." It means the brain looks normal, but its pain system is behaving badly.
How common is migraine in India and the world?
Very common, and more common in India than the world average. If it feels like everyone around you gets these headaches, you are not imagining it.
India. Two large door-to-door surveys, using the same method, give almost the same answer. In Karnataka (south India), 25.2% of adults had migraine in the past year. In Delhi and the National Capital Region (north India), it was 26.3%. Among women it was 35.7%, and among men 15.1%. The researchers argue that these figures can reasonably be applied to the whole of India. Earlier Indian studies had given conflicting results, which is why the northern study was needed.
World. A review of 302 community studies found that 11.6% of people worldwide have migraine. By region: Asia 10.1%, Europe 11.4%, North America 9.7%, Africa 10.4%, and Central and South America 16.4%. It is more common in women (13.8%) than men (6.9%). A newer analysis of global data found that the share of people with migraine has stayed about the same since 1990, but the years lost to disability have gone up, mostly among young and middle-aged women.
What does this mean for you? If you live in India and get these headaches, you are far from alone. One survey estimated that about 1 in 4 adults in Delhi and the National Capital Region would benefit from professional headache care. Please note that the rural-versus-urban pattern differs between studies, and we still have fewer studies from east and west India. So treat these as good estimates, not exact counts.
Why does this matter for women? In the north India survey, 35.7% of women and 15.1% of men had migraine in the past year. Women had about 3 times the odds of men. If you are a woman who has been told your headaches are "hormones" or "overthinking," please know that the numbers say otherwise.
What are the symptoms of migraine?
The main symptoms are throbbing headache, nausea or vomiting, and discomfort with light and sound. Doctors describe four stages, though not every person has all four.
1. Warning stage (1 to 2 days before). You may feel moody, crave certain foods, yawn a lot, or have a stiff neck. Many people only realise later that their body was giving hints.
2. Aura (only in some people). This lasts up to an hour. You may see zig-zag lines or flashing lights, lose part of your vision, or feel tingling or weakness on one side. Doctors think aura is caused by a slow wave of electrical activity moving across the brain's surface.
3. The attack. Throbbing or pulsing pain, often on one side, with nausea, vomiting, and sensitivity to light, sound or smell. Untreated, it lasts 4 to 72 hours.
4. Recovery. You may feel tired and foggy for up to a day. Think of it as a "migraine hangover."
What causes migraine?
Nobody knows the exact cause, but genes and an over-sensitive pain system in the brain are the main reasons. The brainstem and a big facial nerve called the trigeminal nerve are involved. Chemicals such as serotonin and CGRP also play a part.
An old belief was that migraine happens because blood vessels in the head widen. Newer research says this is only a side effect, not the root cause.
What triggers a migraine?
A trigger is something that can set off an attack in a person who already has migraine. Triggers differ from person to person, so your list may not look like your friend's. Common ones are:
- Hormone changes around periods, pregnancy or menopause
- Too little (or too much) sleep
- Skipped or late meals
- Stress, and the "let-down" after stress
- Weather changes, such as heat or a change in air pressure
- Strong smells such as perfume, paint or smoke
- Bright or flickering light and loud noise
- Too much tea or coffee, alcohol (especially wine), aged cheese and salty processed food
What about chocolate? It is often blamed unfairly. A craving for chocolate can be an early sign that an attack has already started. So the chocolate may be a symptom, not the cause. Keep a headache diary before you cut foods out.
Why do young adults get migraines? (Late nights, skipped meals and too much coffee)
Migraine often starts in the teenage years and is common among young working adults. The triggers above fit a student or early-career routine very well: late nights and then sleeping in, skipping breakfast for an early class or a deadline, several cups of tea or coffee to get through the day, long hours in bright or flickering light, and constant stress. None of these cause migraine on their own, but in a person who already has migraine, they can set off an attack.
You do not have to give up your life to manage it. A regular sleep time, a proper meal on time and a bottle of water on your desk make a bigger difference than most people expect. The SEEDS habits below are built for exactly this.
Do I need a neurosurgeon for migraine?
Not always, but you should see one if you have warning signs or want to be sure it is not something structural. Most migraine is managed with medicines and habits, often by a neurologist or neuro-medicine doctor. See a neurosurgeon if you have red-flag symptoms, if your headache pattern has changed, or if headache comes with neck, spine or nerve symptoms. On Global Neuro & Spine Care, all these specialists are on one platform, so you reach the right person.
You do not have to suffer in silence
In the Karnataka survey, fewer than 1 in 4 people with headache had used any health service for it in the past year. In Delhi and the National Capital Region, about 1 in 4 adults were estimated to benefit from professional headache care. Many people simply put up with it. You do not have to.
What should I take to my doctor? A checklist
Save this or screenshot it before your visit:
- A simple headache diary: dates, how long each attack lasted, what came before it
- A list of every medicine you take, including painkillers and how many days a month you use them
- Old scans and prescriptions
- Your family history: does anyone else have migraine?
- Your questions, written down, so you do not forget them in the room
Know someone who always has a headache?
Send them this article. Many people live with migraine for years because no one told them it has a name and a treatment. If this sounds like a friend, a parent or a colleague, you may be the one who helps them finally get seen.
Find a migraine doctor near you
On Global Neuro & Spine Care, doctors are listed by distance from you, nearest first. It is not a paid ranking. You can see who is closest, read their profile, and book an appointment or teleconsultation.
[LINK NEEDED: Find a migraine specialist near you] · [LINK NEEDED: Book with Dr Hardik Rajyaguru] · [LINK NEEDED: Watch our 8-part migraine video series]
This article is for information and does not replace a medical consultation. If you have a sudden severe headache, weakness, confusion, fever with stiff neck, or a headache after a head injury, go to the nearest emergency room.