Migraine

Migraine

A migraine is a severe headache that often has a number of associated symptoms, such as nausea, increased sensitivity and visual problems.

Who is affected by migraines?

Migraines are common, affecting about one in four women and one in 12 men in the UK. It is thought that hormonal influences may be the reason why migraines affect more women than men. For example, some women find that migraine attacks are more frequent around the time of their period. However, this association has not been fully proven.

It is possible for migraines to begin later in life. However, it is more common for the condition to begin in childhood or as a young adult. About nine out of 10 people who experience migraines have their first one before they are 40 years old.

Types of migraine

There are two types of migraine, classical and common:

  • Classical migraine is when the headache includes symptoms of aura (see the "symptoms" section).
  • Common migraine is when a person does not experience aura symptoms.

Some people experience migraine attacks frequently, up to several times a week. Other people only experience a migraine occasionally. It is possible for years to pass between migraine attacks.

Stages of migraine

There are five distinct stages to migraine, although not everyone experiences all the stages:

1. 'Prodromal' (pre-headache) stage. Some people experience changes in mood, energy levels, behaviour and appetite, and sometimes aches and pains, several hours or even days before an attack.

2. Aura. In about one in six cases, a migraine is preceded by an aura. Symptoms include flashes of light or blind spots, difficulty focusing and seeing things as though through a broken mirror. This stage normally lasts around 15 minutes to an hour.

3. Headache stage. This is usually a pulsating or throbbing pain on one side of the head. There is often nausea or vomiting, extreme sensitivity to bright light and loud sounds, and a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours.

4. Resolution stage. Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms.

5. 'Postdromal' or recovery phase. There may be a stage of exhaustion and weakness afterwards.

It is thought that migraines may be caused by changes in the chemicals of the brain. In particular, the level of the serotonin (the message-sending chemical) decreases during a migraine.

Low levels of serotonin can make the blood vessels in a part of your brain spasm (suddenly contract), which makes them narrower. This may cause the symptoms of aura. Soon after, the blood vessels then dilate (widen), which is thought to cause the headache. However, the exact cause of the drop in serotonin levels is not yet fully understood.

Hormones

Some scientists believe that hormones are closely linked to the cause of migraines. Some women who experience migraines say they are more likely to have an attack around the time of their period. This is known as a menstrual migraine. Fluctuating hormones are thought to be the reason why more females have migraines compared with males.

Just before women have their period, levels of the hormone oestrogen fall. It is not the low levels of oestrogen that cause a migraine, but it is linked to the changes from one level to another.

Women can experience menstrual migraines from two days before to three days after the first day of their period. About one in seven women who experience migraines only have an attack around the time of their period. This is known as a pure menstrual migraine. However, it is possible to have migraine attacks at other times as well. This happens to around six in 10 women who experience migraines.

Migraine triggers

Many factors have been identified as triggering the onset of a migraine. These triggers include emotional, physical, dietary, environmental and medicinal factors, and are outlined below.

Emotional triggers:

  • stress,
  • anxiety,
  • tension,
  • shock,
  • depression, or
  • excitement.

Physical triggers:

  • tiredness,
  • poor sleep quality,
  • shift work,
  • poor posture,
  • neck or shoulder tension, and
  • travelling for a long period of time.

The menopause can also trigger migraines.

Dietary triggers:

  • lack of food (dieting),
  • delayed or irregular meals,
  • dehydration,
  • alcohol,
  • food additives (specifically tyramine),
  • caffeine products, such as tea and coffee, and
  • specific foods like chocolate, citrus fruit and cheese.

Environmental triggers:

  • bright lights,
  • flickering screens, such as a television or computer screen,
  • smoking (or smoky rooms),
  • loud noises,
  • changes in climate, such as changes in humidity or very cold temperatures,
  • strong smells, and
  • a stuffy atmosphere (a lack of fresh air).

Medicinal triggers:
Some medicines can trigger migraines, including some sleeping tablets, the contraceptive pill and hormone replacement therapy (HRT), which is sometimes used to treat the menopause.

Migraines can often be treated at home using over-the-counter medication and self-help techniques. However, you should see your GP if you feel that painkillers such as paracetamol are not working, or if you experience any of the things listed below.

  • You have aura symptoms that occur on the same side of your body with every attack.
  • Your first ever migraine occurs when you are over 50 years of age.
  • Your usual migraine symptoms have changed.
  • Your migraine attacks are becoming more frequent.

Diagnosing migraine

There is no specific test to diagnose migraine. On your first visit, your GP may give you a physical and neurological examination. This includes an examination of your mental functions by checking your vision, coordination, reflexes and sensations. These checks will be carried out to make sure there are no other underlying conditions that are causing your symptoms.

To give an accurate migraine diagnosis, your GP must identify a pattern of reoccurring headaches alongside the associated symptoms. Migraines can be unpredictable, with periods of time where no symptoms are experienced. Therefore, obtaining an accurate diagnosis can sometimes be a lengthy process.

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks. You should note down details including the date, time and what you were doing when the migraine began. It is also helpful to make a note of the food you ate that day, as this can help your GP to identify any potential triggers.

Your GP may ask if your headaches are:

  • located on one side of the head (unilateral),
  • characterised by a pulsating pain,
  • moderate or severe and prevent you carrying out your daily activities,
  • made worse by physical activity or moving about,
  • accompanied by nausea and/or vomiting,
  • accompanied by sensitivity to light (photophobia) and/or noise (phonophobia).

The main symptom of a migraine is an intense headache. This usually occurs at the front or on one side of the head. However, during a migraine attack, the area of pain can sometimes change position. The pain can feel like a throbbing sensation and it can be moderate or severe. The throbbing is usually made worse when you move.

Classical migraine symptoms (with aura)

Aura means a warning sign. It is the name that is used to describe the symptoms that you experience before the migraine begins. Around one in four people who experience migraines have aura symptoms. These can include:

  • Visual problems – you may experience visual disturbances, such as flashing lights, zigzag patterns, blind spots and other visual distortions.
  • Stiffness – you may have stiffness, or a tingling sensation like pins and needles in your neck, shoulders or limbs.
  • Problems with coordination – you may feel disorientated or off-balance.
  • Difficulty speaking – you may find it difficult to express yourself properly using words.
  • Loss of consciousness – this only happens in very rare cases.

Aura symptoms typically start between 15 minutes and one hour before the headache begins. Some people may experience aura with only a very mild headache.

Common migraine symptoms

Symptoms associated with a common migraine include:

  • Nausea – you may feel queasy and sick. This may sometimes be followed by vomiting.
  • Increased sensitivity – you may experience photophobia (sensitivity to light), phonophobia (sensitivity to sound) and/or osmophobia (sensitivity to smells). This is why many people who have migraines want to rest in a quiet, dark room.

The symptoms of a common migraine often begin at the same time as the headache. However, these symptoms will usually disappear once the headache eases.

Other associated symptoms

During either a common or classical migraine, a number of associated symptoms can sometimes occur. These symptoms can include:

  • poor concentration
  • sweating
  • feeling very hot or very cold
  • abdominal pain (which can sometimes cause diarrhoea), and
  • a frequent need to pass urine.

However, not everyone experiences associated symptoms, and they do not usually all occur at once.

The symptoms of a migraine can last anywhere between four hours and three days. In between each migraine attack, all associated symptoms will usually disappear. You may feel very tired after a migraine attack, and this feeling can sometimes last for several days afterwards.

Introduction | Symptoms | Causes | Diagnosis | Treatment Treating Migraine

There is currently no cure for migraine. However, a number of treatments can be used for the symptoms of migraine, mostly in the form of medicines. It may take time to work out which is the best treatment for you. You may have to try different types of medicines or different combinations before you find the most effective ones.

Painkillers

Many people who experience migraine find that over-the-counter painkillers help to ease their symptoms. Paracetamol and aspirin are painkillers that are commonly used to treat a migraine.

When taking paracatemol or aspirin, always make sure you read the instructions on the packaging and follow the dosage recommendations.

Children under 16 years of age should not take aspirin, unless it is under the specific guidance of a healthcare specialist.

Aspirin is also not recommended for adults who have (or have had in the past) stomach problems, such as a peptic ulcer, liver problems or kidney problems.

Painkillers are usually the first method of treatment for migraine, and they tend to be more effective if they are taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms.

Some people only take painkillers when their headache becomes very bad. However, this is not advisable because it is often too late for the painkiller to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good choice because they are absorbed quickly by your body.

If you cannot swallow painkillers due to nausea or vomiting, suppositories may be a better option. These are ‘bullet-shaped’ capsules that contain specific medicines. The suppository is inserted into the anus (back passage).

Stronger types of painkillers are also available, but they need to be prescribed either by your GP or by a specialist.

Anti-inflammatory medicines

Due to their anti-inflammatory properties, you may find that anti-inflammatory medicines such as ibuprofen are more effective in treating your symptoms of migraine.

You can buy ibuprofen over the counter at a pharmacy, and it is also available on prescription. However, as with aspirin, you should not take ibuprofen if you have (or have had in the past) stomach problems, such as a peptic ulcer, or if you have liver or kidney problems.

Diclofenac, naproxen and tolfenamic acid are other types of anti-inflammatory medicines that are only available on prescription

Anti-sickness medicines

If nausea is a symptom of your migraine, you can take anti-sickness medicines. These can be prescribed by your GP and can be taken alongside painkillers.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. Anti-sickness medicines usually come in the form of a tablet, but they are also available in a suppository.

Combination medicines

There are a number of combination medicines for migraine that you can buy over the counter at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which medicine is best for you, ask your pharmacist for advice.

Many people who experience migraines find that combination medicines are convenient. However, you may find that either the dose of painkillers or anti-sickness medicine is not high enough to combat your symptoms. If this is the case, you may prefer to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each. Again, ask your GP or pharmacist if you are not sure about which medication is most suitable for you.

Triptan medicines

If ordinary painkillers are not helping to relieve your migraine symptoms, triptan medicines might be the next option. Triptan medicines are only prescribed by your GP or by a specialist.

Triptan medicines are not the same as painkillers. They make the blood vessels around the brain contract. This combats the dilating (widening) of blood vessels that is believed to be part of the migraine process. Triptans are available in the form of tablets, injections and nasal sprays.

Some triptan medicines work for some people, but not for others. If one type of triptan medicine does not seem to be working, you should see your GP and ask them about other types.

Complementary medicines

Some people find that complementary therapies such as acupuncture and homeopathy help with migraines. However, there is a lack of scientific evidence as to the effectiveness of such treatment methods.

Migraine clinics

If you’re not responding to treatment or if your migraines are not being well managed, further investigation may be needed. The reasons your GP may refer you to a specialist clinic include:

  • Doubt over the diagnosis of migraine.
  • A rarer form of migraine may be suspected.
  • Other headaches besides migraine are present and may complicate your diagnosis.
  • The treatment is not working well for you.
  • Your migraines or headaches are getting worse/more frequent.
  • At your request.