Migraine

What is a migraine?

A migraine is a specific type of headache that usually causes intense, one-sided pain in your head and is often accompanied by other symptoms, like visual changes.

Migraines often start in early adulthood and are more frequent in women than men. Some people suffer migraines frequently, while others only have them occasionally.

What causes migraines?

The exact cause of migraine headaches is unknown, but it’s thought to be related to a change in brain activity that affects blood vessels, chemicals and signals within the brain.

Although a migraine can happen at any time, but certain things are more likely to trigger one, including:

• Stress

• Tiredness or lack of sleep

• Bright or flashing lights

• Excessive screen time

• Hormonal changes (such as before a period)

• Dehydration

• Missed or delayed meals

• Caffeine

• Alcohol, particularly red wine

• Foods that contain tyramine (which includes certain cheeses such as camembert and stilton, cured meats and pickled foods)

• Medication, including oral contraceptives, hormone replacement therapy (HRT) and some sleeping tablets

Migraine symptoms

The main symptoms of migraine are:

• Headache – Usually a one-sided, throbbing sensation that gets worse when you move, but it can also be on both sides of your head

• Sensitivity to light

• Sensitivity to sound

• Nausea (and sometimes vomiting)

• Migraine aura – This includes visual problems (see more information below)

Symptoms usually last for at least several hours and can persist for several days.

Migraine aura

Migraines may occur with or without an ‘aura’. An aura is a sensory disturbance that often happens before the headache and can act as a warning sign that a migraine is coming.

Migraine aura symptoms generally last for around an hour and include:

• Visual problems, like flashing lights, seeing wavy lines or blank spots

• A tingling sensation across the face or arm that feels like pins and needles

• Numbness

• Feeling dizzy

• Problems with speaking

About one in three people who have migraines experience an aura before the onset of headache. However, some may experience the headache without an aura, and in rarer cases, the aura appears alone.

Migraine diagnosis

There’s no set test to find out if you have migraines, so it can take time to diagnose them accurately. The doctor will start by doing a physical examination, looking at your vision, reflexes and coordination.

They will also want to know more about your symptoms, for example, what sort of pain you feel, where you feel it and if you experience other symptoms.

They may ask you to keep a migraine diary to help them spot any patterns or triggers, and it can be helpful if you do this before seeing the doctor. To keep a diary, make a note of the date and time of each migraine, along with information about how long it lasted, what you were doing before the migraine, and specific symptoms you experienced.

When to see a GP

It’s a good idea to see a doctor if:

• You suffer frequent attacks of migraine (over five episodes a month)

• Your migraines are severe and can’t be controlled by over-the-counter medications such as paracetamol or ibuprofen

• Migraines are affecting your work or personal life

Migraine treatment

There’s no cure for migraines, but there are things you can do to help control your symptoms and reduce the number of migraines you have.

Home treatments that you can try include:

• Resting in a darkened room

• Sleeping

• Drinking plenty of water

• Identifying and avoiding your triggers whenever possible

Medical treatments

Medical treatments for migraines focus on controlling the symptoms of a migraine when it occurs or on preventing migraines from happening in the first place. These include:

• Painkillers – Over-the-counter painkillers like paracetamol and ibuprofen can be effective for some people

• Triptans – There are various types of triptans, and they can be prescribed as an oral tablet or as a nasal spray. They should be used as soon as your migraine starts to prevent it from becoming severe. This avoids the need to take regular medication and can be thought of as ‘a pill in the pocket’ to be used when needed.

• Anti-sickness medication – These can also be effective for some people and can be taken alongside painkillers and triptans.

• Preventative treatment – If you have frequent or very severe migraines or other medication isn’t helping, you can consider preventive medicine. There are various medications available, including beta-blockers and anticonvulsants. These need to be taken every day consistently.

If your medication doesn’t help control your symptoms, the GP may consider referring you to a neurologist.

Migraine complications

Signs of a headache that need immediate medical attention include:

• A sudden, extremely severe headache that comes on ‘like a thunderclap’

• A headache accompanied by slurred speech or weakness in one arm, leg or side of the face

• A headache accompanied by a high temperature, stiff neck or rash