What is migraine?
Migraine is much more than a bad headache. It is a condition of the brain and nerves that causes repeated attacks of head pain, usually lasting from a few hours to up to three days. Between attacks, people feel normal. It often starts in the teenage years or early adulthood and is more common in women, sometimes linked to periods.
Migraine tends to run in families. It is one of the leading causes of missed school and work days. Although it is not dangerous in most people, it can seriously affect quality of life. With the right care, most people can reduce how often attacks happen and how bad they are.
Symptoms of migraine
The headache is typically throbbing or pulsing, often on one side of the head, though it can be on both sides. It is moderate to severe and gets worse with movement, such as climbing stairs. Many people prefer to lie down in a dark, quiet room during an attack. Common symptoms include:
- Nausea or vomiting
- Sensitivity to light, sound or smells
- Tiredness, yawning or mood changes a day before the headache
- Aura in some people: flashing lights, zigzag lines or blind spots before the headache, lasting minutes
- Tingling or numbness in the face or hand as part of the aura
- Feeling drained for a day after the attack
Common triggers
Triggers do not cause migraine, but they can set off an attack in a person who has it. Triggers differ from person to person. Common ones include skipped meals, not drinking enough water, poor or irregular sleep, stress or relaxation after stress, bright sunlight or glare, strong smells, loud noise, long screen time, travel, and hormonal changes around periods.
Some people notice that certain foods or drinks, such as alcohol, too much caffeine, aged cheese or processed foods, bring on an attack. Keeping a headache diary of dates, food, sleep, periods and activities for a few weeks helps you spot your personal triggers.
How migraine is diagnosed
Migraine is diagnosed from your history and a normal examination. There is no blood test or scan that confirms it. Your doctor will ask about the pattern of your headaches, how long they last, other symptoms, and family history. A headache diary is very useful for this visit.
A CT or MRI scan is not needed in most people. Your doctor may order one if there are unusual features, such as a sudden severe headache, a change in pattern, weakness, confusion, or a headache that starts after the age of 50. Eye checks may be advised if you have visual problems.
Treating an attack
Treat early, at the first sign of headache. Simple painkillers such as paracetamol, ibuprofen or aspirin can work well for many people; follow the label or your pharmacist's advice. Rest in a dark, quiet room, sip water and try to sleep. A cold pack on the forehead may help. Anti-sickness medicines can be prescribed if nausea is a problem.
For moderate to severe attacks, doctors often prescribe triptans, which are specific migraine medicines. These are only on a doctor's prescription and are not suitable for people with certain heart or blood vessel problems. Aspirin should not be given to children under 16.
Avoid medication overuse headache
Using painkillers or migraine medicines too often can itself cause daily headaches, called medication overuse headache. If you find yourself taking painkillers on many days each month, talk to your doctor. Stopping the overused medicine under a doctor's guidance usually improves headaches over time.
This is one reason why preventive treatment is important for people with frequent attacks, rather than relying only on painkillers. Keep a record of how many days each month you take any painkiller or migraine medicine, and share it with your doctor. Combination painkillers containing caffeine or codeine are especially likely to cause this problem, so avoid them unless your doctor advises otherwise.
Preventing migraine
Healthy habits make a real difference. Eat meals at regular times, drink enough water, sleep and wake at the same times, exercise regularly, and manage stress with walks, yoga or breathing exercises. Limit caffeine and alcohol. Use sunglasses in bright sun and take breaks from screens.
If attacks are frequent or disabling, your doctor may prescribe a daily preventive medicine. Options include certain BP medicines, antidepressants or anti-seizure medicines, used at doses meant for migraine. These are only on a doctor's prescription, take weeks to work, and should not be stopped on your own.
Women who have migraine with aura should tell their doctor before starting hormonal contraceptive pills. A headache diary helps your doctor judge whether the treatment is working. In pregnancy and breastfeeding, many migraine medicines are not suitable, so always check with your doctor or pharmacist before taking anything.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Simple painkillers: paracetamol, ibuprofen or aspirinRelieve mild to moderate migraine when taken early in an attack.Follow the label or your pharmacist's advice; aspirin is not for children under 16, and frequent use can cause medication overuse headache.
- Triptans such as sumatriptan, rizatriptan or naratriptanSpecific migraine medicines that relieve moderate to severe attacks.Only on a doctor's prescription; not for people with heart disease, stroke or uncontrolled BP.
- Anti-sickness medicines such as domperidone or metoclopramideReduce nausea and vomiting and help other medicines absorb.Only on a doctor's prescription; not for long-term use.
- Preventive medicines such as propranolol, amitriptyline, flunarizine or topiramateTaken daily to reduce how often and how badly attacks happen.Only on a doctor's prescription; some are unsafe in pregnancy and all need regular review.
See a doctor urgently if
- A sudden, severe headache that peaks within a minute, like a thunderclap
- Headache with fever, stiff neck, rash or confusion
- Weakness, numbness, slurred speech or loss of vision that does not fully go away
- Headache after a head injury
- A new headache after age 50, or a clear change in your usual pattern
- Severe headache in pregnancy or after delivery
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.