Migraine

What is migraine?

Migraine is a neurological condition that causes repeated attacks of headache, often alongside symptoms such as feeling sick and being very sensitive to light and sound. There's no cure, but treatment can help you manage individual attacks and reduce how often they happen.

Symptoms of migraine

A migraine attack usually includes:

• a throbbing headache, often on one side of your head, that gets worse when you move around
• feeling or being sick
• being very sensitive to light and sound.

In the hours or even days before the headache starts, you might notice early warning signs, such as feeling unusually tired and yawning a lot, craving certain foods, feeling thirsty, changes in your mood, a stiff neck, or needing to pee more often.

Some people also get 'aura' symptoms, which are warning signs that come on shortly before or during a migraine attack. These can include seeing zigzag lines or flashing lights, numbness or pins and needles, feeling dizzy, or difficulty speaking. Aura symptoms usually pass within an hour.

A migraine attack typically lasts from 4 hours up to 3 days, and you may feel drained, weak or confused for a while after the headache itself has eased. Some people have attacks several times a week, while for others, years can pass between attacks.

Causes and risk factors

The exact cause of migraine isn't known, but it's thought to involve temporary changes in nerve signals, chemicals and blood vessels in the brain. You're more likely to have migraine if a close family member also has it, suggesting genes play a role, and it's about 3 times more common in women than men.

Many people find certain triggers can bring on an attack, though these vary a lot from person to person and can be hard to tell apart from early migraine symptoms.

Common triggers include:

• stress
• anxiety
• hormonal changes
• poor or excessive sleep
• skipping meals
• dehydration
• strong smells
• loud noises
• bright or flickering lights
• changes in weather
• too much caffeine or alcohol
• certain foods, such as chocolate, aged cheese and cured meats.

Eye strain is a common trigger that's often overlooked, and an eye test can sometimes uncover a contributing cause, such as an out-of-date glasses prescription, dry eyes, or an imbalance in how your eyes work together.

Migraine is also more likely if you have another health condition, such as depression, anxiety or epilepsy.

Types of migraine

The two main types of migraine are:

• Migraine with aura: This is where warning signs appear before the headache
• Migraine without aura: This is the most common type and starts without any warning signs.

Migraine attacks that happen just before or during a period are called menstrual migraines. These tend to last longer and feel more severe than migraine attacks at other times.

How is migraine diagnosed?

There's no specific test for migraine. Your doctor will usually ask about your symptoms and medical history and carry out a physical and neurological examination.

You may also have blood tests, or a brain scan such as an MRI or CT scan. These aren't used to diagnose migraine, but to rule out other conditions that could be causing similar symptoms.

How is migraine treated?

There's no cure for migraine, but treatment can help manage individual attacks and reduce how often they happen. It often takes some trial and error to find what works best for you.

During an attack

• Take painkillers such as ibuprofen or paracetamol as soon as your headache starts. If these don't help enough, your doctor might prescribe a triptan (medicines developed specifically for migraine), or an anti-sickness medicine if nausea is a problem.
• During an attack, resting or sleeping in a dark, quiet room, placing a cool cloth or ice pack on your forehead, and drinking plenty of fluids can also help ease your symptoms.

Try not to take painkillers for migraine on more than two days a week, since this can cause medication-overuse headaches and make your migraines harder to treat in the long run.

Preventative treatments

If you have frequent or severe migraines:

• Your doctor may suggest daily medicine to help prevent attacks, such as beta blockers, antidepressants, epilepsy medicines or gepants – a new class of migraine medication
• Acupuncture, relaxation techniques, cognitive behavioural therapy (CBT),vitamin B2 may help some people.

Lifestyle changes

These can reduce how often you get migraine too:

• eating at regular times
• cutting back on caffeine
• staying well hydrated
• keeping to a healthy weight
• exercising regularly
• getting enough sleep
• managing stress.

Keeping a migraine diary can help you spot your own personal triggers.

An eye test is also worth considering, since correcting your prescription, treating dry eyes, or addressing a binocular vision imbalance can sometimes reduce how often or how badly migraine attacks affect you.

When should I see a doctor?

See your GP if your migraine attacks are severe or getting worse, happen more than once a week, are difficult to control, or regularly occur around your period.

Contact 111, or ask for an urgent GP appointment, if a migraine attack has lasted longer than 72 hours, your aura symptoms last more than an hour, or you're pregnant or have recently had a baby.

Call 999, or get someone to take you to A&E, if you or your child have:

• a headache that came on suddenly and is extremely painful
• problems speaking or remembering things
• lost vision, or blurred or double vision
• felt very drowsy or confused
• had a seizure or fit
• a very high temperature with symptoms of meningitis
• weakness or an inability to move on one side of your body or face
• recently had a head injury.