Migraine

Migraine is a common health condition. It affects around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood.

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms like nausea, vomiting and increased sensitivity to light or sound.

There are several types of migraine, including:

• migraine with aura – where there are warning signs before the migraine begins, like seeing flashing lights
• migraine without aura – the most common type, where the migraine occurs without warning signs
• migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, without a headache

Some people have frequent migraines up to several times a week. Other people only have occasional migraines. It's possible for years to pass between migraine attacks.

Symptoms of a migraine

The main symptom of a migraine is usually an intense headache on one side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck.

The pain is usually a moderate or severe throbbing sensation. The pain gets worse when you move and may prevent you from carrying out normal activities.

Other symptoms associated with a migraine include:

• nausea
• vomiting
• increased sensitivity to light and sound – which is why many people with a migraine want to rest in a quiet, dark room

Some people experience other symptoms, including:

• sweating
• poor concentration
• feeling very hot or very cold
• abdominal (tummy) pain
• diarrhoea
• dizziness (light headedness)

Not everyone with a migraine experiences these additional symptoms. Some people may experience them without having a headache.

The symptoms of a migraine usually last between 4 hours and 3 days. You may feel very tired for up to a week afterwards.

Symptoms of aura

About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine. These include:

• visual problems – such as seeing flashing lights, zig-zag patterns or blind spots
• numbness or a tingling sensation like pins and needles – which usually starts in one hand and moves up your arm before affecting your face, lips and tongue
• difficulty speaking

Sometimes, you might also experience:

• feeling dizzy or off balance
• loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. The aura might start before the headache or you might experience it at the same time as a headache. Some people may experience aura followed by only a mild headache or no headache at all.

Causes of a migraine

The exact cause of migraines is unknown. They're thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

Around half of all people who experience migraines have a close relative with the condition. This suggests that genes may play a role.

Migraine triggers

It may help to keep a diary to see if you can identify a consistent trigger. It can be difficult to tell if something is a trigger or if what you're experiencing is an early symptom of a migraine attack.

There might not always be a trigger for your headache.

Possible migraine triggers include:

Diagnosing migraines

There's no specific test to diagnose migraines. For an accurate diagnosis, your GP must identify a pattern of recurring headaches along with the associated symptoms.

Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Your GP might do a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms.

Your GP may ask if your headaches are:

• on one side of the head
• a pulsating pain
• severe enough to prevent you carrying out daily activities
• made worse by physical activity or moving about
• accompanied by nausea and vomiting
• accompanied by sensitivity to light and noise

Migraine diary

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks. Note down details like:

• the date
• time
• what you were doing when the migraine began
• how long the attack lasted
• what symptoms you experienced
• what medication you took (if any)

Taking too many painkillers is a reason why migraines can become difficult to treat. This is called medication overuse headache. Keep a record of what painkillers you take and how often you take them. You shouldn't take painkillers on more than 10 days every month in the long-term.

It can be helpful to make a note when your start your period, if you have one. This can help your GP identify potential triggers.

Read more about keeping a migraine diary on The Migraine Trust website.

Referral to a specialist

Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). They'll do further assessments and offer treatment if:

• a diagnosis is unclear
• you experience significant migraines not controlled by your current treatment

Treating migraines

There's no cure for migraines. There are treatments available to help reduce the symptoms. During an attack, many people find that sleeping or lying in a darkened room can also help.

It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. If you can't manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

Treatment during pregnancy and breastfeeding

In general, migraine treatment with medicines should be limited as much as possible when you're pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is recommended.

If medication is essential, paracetamol and sumatriptan are safe to take during pregnancy and when breastfeeding.

If you're pregnant or breastfeeding, speak to your GP or midwife:

• if you're getting regular migraines
• before taking medication

Preventing migraines

It's important to maintain a generally healthy lifestyle, including:

• regular exercise, sleep and meals
• ensuring you stay well hydrated
• limiting your intake of caffeine
• limiting your intake of alcohol

One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. 

Preventative medication

Medication is available to help prevent migraines. These medicines are usually used if your migraines remain frequent (more than 1 migraine per week) following a period of avoiding possible triggers.

The following medications can be prescribed by your GP. If they're not effective, you'll be referred to a neurologist. The neurologist will consider what advanced therapies might be best to try next.

Medications used to prevent migraines are taken every day to reduce the severity and frequency of headaches. It takes a few weeks to reach the right dose and you might need to take it for several weeks (usually 8 weeks once the right dose is reached) to find out if it works.

Advanced therapies for migraine

The following medicines are advanced therapies for migraine that can only be prescribed by a neurologist.

Preventing menstrual-related migraines

Menstrual-related migraines usually occur between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments.

Migraine clinic

If the treatments above aren't controlling your migraines, you might be referred to a specialist migraine clinic for further investigation and treatment.

A specialist might recommend other treatments like transcranial magnetic stimulation devices or greater occipital nerve blocks.

Complications of migraines

Migraines are linked to a very small increased risk of mental health problems. Migraines with aura are associated with a small increased risk of ischaemic strokes.