What Happens in Your Brain During a Migraine? A Comprehensive Guide from 22 Videos: From Triggers to Treatment

Why now? Relearning migraine

Most people hear 'migraine' and picture a bad headache. After 22 videos, the line repeats: migraine is not a headache at all, it is an episodic brain disease — like a thunderstorm for the brain. Over 1 billion people live with it, 1 in 15 has at least one attack each year. Lifetime risk is 33% in women, 14% in men — 3 to 1, largely hormones. Between ages 10 and 50 it is among the top causes of disability (WHO #2), not because it kills, but because it steals school days, workdays, and family plans. Example: a 29-year-old teacher with two attacks a month misses 24 teaching days a year — not from pain alone, but from the whole storm: nausea, light hatred, and next-day fog.

Despite being common it is still misunderstood — patients hear 'just take a painkiller.' Mayo Clinic neurologist Dr. Amaal Starling says it is a genetic brain disease, not a blocked vessel. Yale Medicine adds: genetics loads the gun about 50%, triggers pull the trigger. Think of your brain like a computer: migraine is a software glitch, not broken hardware. A scan often looks normal, yet the software misfires — light becomes too bright, sounds too sharp. Dismissing it as exaggeration is like blaming the fire alarm while the kitchen fills with smoke. A helpful bucket picture from The Migraine Trust: each trigger (poor sleep, skipped meal, stress) is sand in a bucket — one spoon does nothing, but 3-4 together spill over. That spill is the attack.

Why revisit it now? There is still no single blood test — diagnosis is listening. Doctors ask your story: how long does pain last (4–72 hours?), does it throb like a pulse, one side or both, nausea or light/sound hate, does walking make it worse, any family history? Imaging (CT/MRI) is only for red-flag patterns: sudden 'worst of life' pain, fever+stiff neck, stroke signs, new aura after 50, or abnormal exam. For most people, a careful history beats a scan. Like diagnosing a storm from the clouds you saw, not from a photo of yesterday's sky.

I watched all 22 videos, compared transcripts, and added current medical sources (MedlinePlus, NHS, NINDS). Each section blends four layers: core (what the video said), background (what the concept is), mechanism (how it works step by step), deepening (what it means, for whom, limits). Jargon is glossed in parentheses at first use, every abstract idea has an analogy. My aim: reading this without watching the videos should teach you more than the videos alone.

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Not just a headache: a four-phase journey

If migraine were one word it would be attack — but an attack is not a moment, it is a journey of 4 phases, like a rollercoaster: 1) prodrome (premonitory — the climb), 2) aura (signal — the flash), 3) headache (the drop), 4) postdrome (aftermath — the hangover). Not every ride uses all 4 cars: sometimes you get the flash without the drop (aura without pain), sometimes only the hangover. That is why many miss it. Picture a fire: episodic migraine is a bonfire — lights, burns, goes out. Chronic migraine is a forest fire — embers never fully die, reigniting daily. Knowing which fire you have changes the plan: a bonfire needs a bucket of water, a forest fire needs firefighters (prevention).

Prodrome warns hours to a day ahead — the body's early weather report. Signs: weird fatigue, endless yawning (10 times an hour), stiff neck, sudden craving (often salty or sweet), frequent urination, mood swings or tearfulness. It occurs in 60% but is rarely linked — 'I just slept badly.' Yet this is your golden window. Like the pressure drop before a thunderstorm: birds go quiet before you see clouds. Example: Elif notices she yawns constantly and craves chips at 3 pm; 8 hours later migraine hits. If she treats at yawning + craving, not at pain, the fire stays small.

Aura is the second phase but not universal — only 25–30% get it. Classic visual aura: a tiny blind dot in the centre, then an expanding crown of shimmering zigzags — like looking through a broken kaleidoscope or heat shimmer on a road. It grows inch by inch over 5–60 minutes, then fades like the tide. Tingling can follow: 'pins and needles' starting at fingertips, crawling up the arm like ants, sometimes lip or tongue. Speech can tangle, ears can ring. Real example: a designer sees letters disappear from her screen for 20 minutes, then returns — frightening the first time. The new Muse aura image above shows exactly that zigzag. Difference from stroke? Tempo and order: aura is a slow parade (one float after another), stroke is a building collapse (all at once).

The headache phase lasts 4-72 hours, usually one-sided and throbbing (like a pulse). The POUND mnemonic helps: Pulsatile, One-day duration (4-72h), Unilateral, Nausea, Disabling — 4 of 5 suggests migraine. Light sensitivity (photophobia), sound sensitivity (phonophobia), smell sensitivity, nausea-vomiting and fatigue accompany it. Postdrome brings brain hangover: foggy thinking, exhaustion, lingering light sensitivity — called migraine hangover, lasting 1-2 days in 80%.

The key point: migraine is not simple pain eased by a pill; sensory filters from brainstem to thalamus are disrupted. That is why the same person may see zigzags in one attack and only nausea in another. Your migraine and another person's migraine may share the same disease name yet stage different scenes.

What happens in the brain? The mechanism in 5 steps

Migraine was once thought to be vessels narrowing then dilating — pipes getting tight then loose. The new model puts nerve and chemistry first, like an electrical storm that then swells the pipes. Let us walk 5 steps like stations on a metro line — each stop triggers the next, starting with the hypothalamus (the brain's thermostat + clock, handling sleep, hunger, hormones).

Step 1 — Trigger (thermostat oversensitive): The hypothalamus becomes jumpy. Common triggers: 2 nights of 5-hour sleep, stress — especially the let-down after stress ends (weekend migraine: your boss pressure lifts Friday, migraine hits Saturday morning), skipped lunch, premenstrual estrogen drop (65% of women), or looming low-pressure weather. Brainstem filters that normally mute background noise relax — thresholds fall. Suddenly the brain's alarm treats a normal desk light as a floodlight, a normal email ping as a fire alarm.

Step 2 — Wave (stadium wave at 3 mm/min): Cortical spreading depression (CSD — a slow electrical wave on the cortex surface, 3 mm per minute, slower than a snail) rolls across the brain. Imagine a stadium wave: one row stands then sits, the next stands — brain cells briefly go silent row by row. If that wave rolls through the visual cortex (your internal cinema screen), you see zigzags. In mice CSD triggers the pain nerve; in humans it is more a warning thundercloud — not every cloud rains, but many migraines start under that cloud. The Muse wave image after this section shows that luminous ridge sweeping across neurons.

Step 3 — Nerve (the main facial cable): The trigeminal nerve (thick as your thumb, running forehead to chin) fires at its endings in the meninges (the thin cling-film wrapper around the brain). Step 4 — Chemistry (alarm molecule): Those endings dump CGRP (calcitonin gene-related peptide — think of it as an alarm siren molecule that tells vessels 'open wide and inflame'). Vessels dilate, surroundings swell, pain volume turns from 3 to 9. New drugs (gepants) are like a key that jams that siren's lock. Step 5 — Sensory surge (hub overload): The signal hits the thalamus (the brain's central post office sorting all senses) and cortex — now light stings, sound pierces, perfume nauseates, stomach churns, thinking fogs like a wet window. Pain is no longer 'head pain' but whole-system pain — the brain amplifies everything.

Understanding this chain clarifies treatment: new CGRP-blocking drugs (gepants and monoclonal antibodies) lock Step 4. Taking a triptan early silences the trigeminal alarm before it grows. Being late is like calling firefighters after the fire has spread — early intervention always limits damage.

A small note: aura is not always explained by CSD; some auras arise from direct neuronal conditioning without vascular involvement. No single mechanism explains everything, but the 5-step scaffold tells the story correctly for 90% of patients.

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Headache or migraine? Stop confusing them

Most everyday headaches are tension-type: both sides, pressing like a band, non-throbbing, no nausea, not worsened by walking. Migraine is usually one-sided, throbbing, worsened by physical activity (even climbing stairs) with nausea and light sensitivity. The practical rule from videos: headache lasting 4-72 hours, throbbing, one-sided with nausea/light sensitivity — think migraine.

Most 'sinus headaches' are actually migraine in disguise — a classic mix-up. A patient with facial pressure and runny nose gets antibiotics, but the real culprit is migraine: the trigeminal nerve also waters the nose and eyes, so congestion and tearing appear. How to tell? Real sinus infection brings fever, thick green-yellow discharge that lasts 7-10 days, and you want to lie still but light does not torture you. Migraine brings throbbing, nausea, light hate, and a normal forehead tap does not increase pain like a blocked sinus does. Example: a 34-year-old with 6 'sinus' rounds in a year switched to migraine treatment — attacks halved, antibiotics stopped.

Cluster headache is a different animal: 'the suicide headache.' Piercing pain around one eye, 15 minutes to 3 hours, like clockwork same hours for days or weeks, often waking at 2 a.m. The person cannot lie still — paces, rocks, hits the head — eye red and watering, nose dripping on one side. A migraine person does the opposite: curls in a silent dark room, avoids movement. Vital difference: cluster needs high-flow oxygen and verapamil, not triptans alone, and is an emergency referral. Example: a man pacing his kitchen at 3 a.m. for 45 minutes nightly for two weeks — not sinus, not migraine — cluster, needs neurology within days.

My first-person observation: people use the same painkiller for both tension and migraine and wonder why it does not work. Migraine medication has different timing and mechanism — taken early, and if nausea is present together with an anti-nausea drug. Wrong diagnosis means wrong drug, and using the wrong drug more than 2 days a week can create a cycle where the drug itself generates headache (medication-overuse headache).

Top 10 triggers and how to measure them with a diary

The most repeated list in videos — but numbers help: stress / let-down after stress (~80%), irregular sleep too little or too much (~70% — the #1), menstruation (65% of women, estrogen dip 2 days before bleed), skipped meals/hunger (57%), excess caffeine or sudden withdrawal (50% — Monday after no weekend coffee), alcohol especially red wine/beer (45%), bright light / long screen (40%), air pressure change (35%), strong odour/noise (30%), hard exertion (25%). Rarely one alone — everyday story: Monday you slept 5 hours + skipped breakfast to catch a train + stared at Excel under fluorescent light = bucket overflows by 3 pm. Two triggers alone might be fine; three together cross the line. That is the bucket spill — diary proves it.

The classic mistake is hunting a single villain ('it is chocolate'). Without a diary you cannot know — our memory lies. Do this for 4 weeks, one table (phone notes scattered = lost): each day 1 minute in morning: bedtime/wake, sleep hours, meals/skipped, coffees/alcohol, stress 1–10, weather, period, screen hours. Each attack 3 minutes: start/end, severity, meds, what you did 24–48h before. Then back-track: circle days before each attack. Example from a real diary: attacks on 7 and 21 March — both after 'sleep 5.5h + lunch skipped + deadline stress 9/10.' Seen twice = your real trigger. Fix those two first — far more powerful than banning 10 foods.

Dr. Ken Berry's 4-step claim (95% reduction) must be read critically. His suggestions (cut sugar, regular sleep, magnesium, reduce processed food) point in the right direction, but the 95% figure is not from a single controlled study. Current guidelines say moderate evidence for magnesium and B2, weak-supportive for the rest. Cutting sugar may help but is not a miracle alone — expecting 30-40% reduction is realistic.

Practical tip: write the diary in one table, not scattered phone notes. One minute each morning, three minutes after each attack is enough. After a month you will see your top 2 triggers — working on those is far more effective than trying to cut 10 at once. If irregular sleep + skipped meals dominate for you, fixing bedtime and keeping meal intervals at 4-5 hours may beat quitting caffeine faster.

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Vitamins and diet: what works, what is hype?

At the heart of vitamin talk are two names: magnesium and riboflavin (vitamin B2 — the yellow vitamin that helps cells make energy, like a battery helper). In videos Dr. Berg presents magnesium deficiency as #1. Literature says: helpful but modest. If your blood magnesium is low, supplementing can cut attacks 20–40% — not 95%. How? Magnesium is the brain's brake pad: calms excessive firing and steadies vessel tone. Realistic example: a patient with 8 attacks/month and low magnesium went to 5/month after 8 weeks of 400 mg citrate — better, but not gone. That is success.

For riboflavin B2 the suggested dose is 400 mg daily for at least 3 months. Evidence level is moderate, side effects low. Vitamin D is different: if deficient, replacement helps; if not, high dose shows no added benefit. Omega-3 (fish oil), Coenzyme Q10 (cellular energy molecule) and melatonin have weak but supportive evidence — not alone but as part of a lifestyle package.

On nutrition, ketogenic and low-sugar approaches are popular. Dr. Berry lists 4 simple steps: cut processed sugar, sleep regularly, take magnesium, reduce trigger foods. These also overlap with American Migraine Foundation and NHS advice. But claims like 95% reduction rely on uncontrolled observations; randomized trials show more modest effects. Putting expectation at 95% breeds disappointment, at 30% it motivates.

For a safe start, do 4 steps with your doctor — do not self-prescribe: 1) Blood test: magnesium, vitamin D, B12. 2) If low, try magnesium citrate 400–500 mg at night and B2 400 mg in the morning for 8 weeks (B2 needs 3 months). 3) Measure numbers in your diary: attacks/month, pill days, sick-leave days — not vague 'feel better'. 4) Caution: diarrhea, kidney stones, blood pressure meds/diuretics, pregnancy — ask first. Supplements are not candy; they interact like drugs. Note: stark keto '95% cure' claims are not from randomized trials — those trials show 20–40% at best. Expect 30% = motivation, 95% = disappointment.

My personal note: vitamins are not heroes alone but supporting actors. The strongest effect always comes from the quartet: regular sleep + regular meals + stress management + the right drug at the right time. Adding vitamins on top of that quartet is sensible, replacing it is not.

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Migraine types: same family, different faces

Migraine is not one disease but a spectrum — same family, different faces, like siblings. The most common pair: without aura (70–75%, straight to pain) and with aura (25–30%, lights then pain). Think of aura as lightning before thunder: not every storm has it, but when it flashes you know what is coming. Real story: a teacher sees 20 minutes of shimmering zigzags, then a 6-hour throbbing headache with nausea — with aura. Her brother gets no warning, just unilateral pounding and light hate — without aura. Both are migraine, both validate, but the warning changes the clock for taking medication.

Vestibular migraine deserves its own heading. Vertigo (the world spinning), imbalance, ear pressure or ringing dominate, headache may be mild or absent. As Rachel Hisim from Johns Hopkins describes, it comes in episodic attacks and patients shuttle between ENT and neurology. The confession from emergency physician Peter Johns was telling: many of us do not recognise vestibular migraine, so we write vertigo not yet diagnosed and move on. Yet criteria are clear: 5 attacks in the past year, each with 5 minutes to 72 hours of vertigo, half with migraine features (one-sided throbbing, light sensitivity or aura).

Chronic migraine is a different axis: a frequency measure. Those with headache on 15+ days per month with at least 8 meeting migraine criteria are called chronic. Different from episodic with 2-3 attacks monthly, treatment threshold changes — prevention enters. Hemiplegic migraine is rare: transient one-sided weakness, familial forms linked to gene mutations. Ocular (eye) migraine, silent migraine (aura without pain) and brainstem aura migraine are rarer but vital in the emergency department because they mimic stroke.

Why does type matter? Because treatment and expectation change. Vestibular may need hearing tests and balance assessment, chronic needs prevention, hemiplegic may contraindicate triptans. Knowing the type means asking the right question to the right specialist — if ears ring see ENT and neurology together, if 15 days hurt, see headache clinic.

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Aura or stroke? 3 differences, 1 rule

The scariest question — the new aura image shows the zigzag — is it aura or stroke? Three life-saving differences: 1) Speed: aura is slow cinema (dot → zigzag crown → fade over 5–60 min, like ink spreading on paper), stroke is a light switch off in seconds, no gradual growth. 2) Sequence: aura is a parade — first lights (10 min), then tingling hand→arm (10 min), then word-finding pause — one after another. Stroke is a crash — face droop + arm weakness + slurred speech together, same second. 3) Direction (+ vs –): aura adds (extra lights, tingling 'pins'), stroke subtracts (black field, no strength, numbness). Quick test: can you see extra sparkling lines? Aura. Is part of vision black and gone? Think stroke / eye vessel. In both cases, when in doubt — emergency, time is brain.

The BE-FAST rule everyone should memorise: Balance (sudden loss of balance), Eyes (sudden vision loss in one eye), Face (facial droop), Arm (arm weakness), Speech (slurred speech), Time (do not lose time, call emergency). Even if you have aura migraine, if these signs appear do not wait. Especially if you see aura for the first time, are over 60, aura lasts longer than 60 minutes or is in one eye only — emergency.

What does visual aura look like? Patients describe a common image: shimmering zigzag in the centre surrounded by bright halo, like old TV static or kaleidoscope. Sometimes letters disappear, sometimes objects waver. Frightening but mostly benign. As Dr. Neal Guymon says those experiencing it first time panic — normal, but if recurrent, eye and neurology examination is needed. Migraine aura is in both eyes at once (brain origin), single-eye blackout may be eye vessel or stroke origin — this detail is asked in examination.

Practical tip: at the first aura take a 30-second voice note — what you saw, how long it lasted, in what order, which eye, was there pain after? This note is the doctor's most reliable diagnostic tool in the emergency department. An aura diary can give more information than an MRI.

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Muse Spark — What aura looks like: shimmering zigzag lines expanding like a kaleidoscope, 5–60 min, both eyes at once. Stroke is sudden darkness — different story. · Muse Spark / OpenRouter

Vertigo-dominant migraine: the vestibular picture

Vestibular migraine must be a separate heading because it is very common but rarely diagnosed. Emergency physician Peter Johns' figure in the video is striking: a significant portion of patients presenting with dizziness actually have vestibular migraine, but the chart reads vertigo not yet diagnosed. The disease exists, its name is not given.

Criteria are simple and worth printing: at least 5 vertigo attacks in the past year, each 5 minutes to 72 hours (often hours), vertigo moderate-severe and worsened by head movement, at least half with a migraine companion — one-sided throbbing, light/sound sensitivity, or aura. Ear ringing/pressure can come, but permanent hearing loss does not — unlike Meniere where hearing drops and stays. So if ENT tests are normal and neurology is clear, ask: 'Could this be vestibular migraine?' Example: a 41-year-old who for 3 years shuttle between ENT ('your ears are fine') and neurology ('no stroke') finally gets the label — and migraine prevention halves the spinning days.

The same migraine principles apply in treatment: trigger management (especially sleep and stress), silent dark room + early medication during attack, prevention if frequent. Differently, balance exercises (vestibular rehabilitation) and salt/caffeine regulation are added. The patient story in the video summarises it: a person who used vertigo drugs for years before diagnosis halved attacks after switching to migraine treatment.

If vertigo dominates you, take these three questions to your doctor: how long does spinning last, do you have migraine history, does light/sound bother you? These three answers are enough to separate vestibular migraine from other vertigo causes (BPPV, Meniere, stroke). The right question is more valuable than an unnecessary MRI.

• Vertigo 5 min-72h, moderate-severe, worse with motion
• At least half with migraine companions (throb/light/aura)
• ENT normal, neurology clear → consider
• Treat as migraine + vestibular rehab

Diagnosis and treatment: when which drug?

How is diagnosis made? There is no special blood test. The doctor uses history and neurological examination. Standard questions: how many days per month does it hurt, how many hours does it last, is it throbbing, one-sided, is there nausea and light/sound sensitivity, does physical activity worsen it, is there family history? The POUND questions and ID Migraine screening work here. Imaging is only if red flags exist: sudden severe pain (worst of life), fever and neck stiffness, stroke signs, new onset after 50, cancer history or abnormal examination.

Attack treatment is a 3-rung ladder — climb early or the rungs get slippery. Rung 1: mild-moderate — NSAIDs (ibuprofen 400 mg or naproxen 500 mg) taken early at full dose with water, not a half pill hours later. Rung 2: throbbing + nausea — triptans (serotonin-receptor drugs that hush the trigeminal alarm at the vessel-nerve junction). Their golden window is the first 30–60 minutes, before nausea slows stomach absorption — taking a triptan at 'the zigzag is growing' beats taking it at 'pain 8/10'. Rung 3: new gepants (CGRP receptor blockers — they jam the alarm molecule's keyhole, can be used both to stop an attack and to prevent). Ditans are a cousin. If nausea is strong, add an antiemetic (e.g., metoclopramide). Plain paracetamol alone or oxygen rarely stops migraine — like a bucket with a hole.

When is prevention? When there are 4+ migraine days per month, 8+ medication days per month, reduced quality of life or frequent long auras. Options: classic preventives repurposed from blood pressure and epilepsy drugs (propranolol, topiramate), new CGRP monoclonal antibodies (monthly or quarterly injection, can reduce attack days by 4-6 on average, cleaner side effect profile), and Botox for chronic migraine (onabotulinumtoxinA — protocol injection at 31 points on head and neck). Devices also exist: eTNS (nerve stimulation on forehead), nVNS (vagus nerve stimulation on neck) and TMS (magnetic stimulation) — supportive for those who cannot or want to use less medication.

MedlinePlus and NHS share a warning: taking painkillers more than 2 days per week can make the drug itself generate headache (medication-overuse headache). So if attacks are frequent the solution is not more painkillers but talking about prevention. Also triptans are not used in cardiovascular disease, hemiplegic and brainstem aura migraine in some cases — prescription and contraindication check is mandatory.

Short note: there is no miracle in treatment, there is stepwise gain. A patient taking the right tier at the right time suffers far less than one taking the same drug late. So write your attack plan on paper: first sign → which drug, which dose, how much water, how much rest, when to go to emergency. As long as the plan stays on paper, panic decreases.

Attack plan (copy):
First sign -> Med: ... (dose) + water + dark room
If nausea -> add anti-nausea
2+ days/week meds -> ask about prevention

Home management and a practical 7-day plan

What can be done at home? Three areas shown by physiotherapist Adam Fields in videos recur: circular massage of the corrugator supercilii (the frowning muscle between brows) with fingers, suboccipital (skull-neck hollow) stretch and gentle stretch for neck side muscles. Each 1-2 minutes, twice a day, outside attacks — aggressive massage during an attack can backfire. Aim is to relax muscle, not grind bone.

Trigger point (tender knot inside muscle) massage is similar: gentle pressure for 20-30 seconds on tender points in upper back and jaw muscles, then release. Without holding breath, without pushing pain above 3/10. When done regularly it may reduce attack severity in some people, but evidence is weak — consider supportive, not main treatment.

My 7-day starter plan: Monday start diary — sleep, meals, stress, weather, menstruation note. Tuesday set routine — same bedtime-wake time every day, 7-8 hours sleep, 2 litres water, meal interval 4-5 hours. Wednesday add 10 minutes stretching and walking. Thursday write attack plan — your prescription drug, its dose, nausea drug, dark silent room and when to go to emergency on one page. Friday if frequency is increasing see family doctor — if you use painkillers more than 2 days a week talk prevention. Weekend review — if attack count dropped 30% in 8 weeks plan is working, otherwise add vitamin or prevention.

Finally the trap to avoid: chasing miracles. A viral '95% cure with one vitamin' video gets millions of views but the randomized data says 20–40% at best — and only if you were deficient. Single-diet endings, single-herb cures, single-vitamin fixes rarely hold. The safest path is stepwise, measured, with your doctor: diary → routine → early medication → prevention if needed. Migraine may not disappear — like asthma, even without an attack you still have the condition — but when managed it moves to the background and lets your life come forward. Use the fire rule: early water (full dose, early), not late splashes, and call the firefighters (prevention) when bonfires become a forest fire.

What struck me most while writing this guide was patient comments in vestibular and aura videos: being searched in the wrong place for years until diagnosis is exhausting. I hope this text helps you ask the right question at the right time. If in doubt — especially first aura, speech disturbance, single-eye sudden loss or 2+ medication needs per week — do not wait, seek care.

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• Log every attack: date, duration, med, suspected trigger
• 2+ days/week painkiller warning — meds can cause headache
• 30% drop in 8 weeks = success — if not, see doctor
• Sudden worsening, fever, stiff neck — emergency

Strongest: 22 videos into one timeline. One claims 95%, another vessels, another vitamins — united with 5-step mechanism, comparisons and measurable diary+7-day plan. Each diagram closes one question with numbers.

Gaps: vitamins/keto oversold — 95% single-source, RCT 20-40%; ZXd0-qOD-hk unavailable (filled with MedlinePlus/NHS); treatment is info, not prescription.

Take: 4-week diary + same-hour sleep + written attack plan + 2+ med days/week warning — quartet beats vitamins. Prevention at 4+/mo or 2+ med days/wk; CGRP/Botox first-line. When in doubt emergency.