Help & Advice

What is a Migraine?

A migraine is a complex condition, which includes a variety of symptoms, stages and types. Most often it is associated with a severe headache and can be accompanied by visual disturbances, sensitivity to light, sound or smells, nausea and vomiting. A migraine can be quite debilitating and last for hours or even days.
Migraines are more common in women (18%) than men (6%) but in children they are more common in boys than girls. Most people (80%) who suffer from migraine experience their first attack by age 30. Unfortunately, migraines are often underreported and misdiagnosed as other types of headaches so the percentages listed above may well be much higher.

What are the symptoms and stages of a Migraine?

A migraine progresses through the following stages although not everyone will experience all symptoms and stages.

  • Prodrome (1-24 hours): The first stage of a migraine associated with subtle mental or physical changes that signify an oncoming migraine
    • Mood changes (depression, irritability) or hyperactivity
    • Cravings
    • Neck stiffness
    • Yawning
    • Constipation
  • Aura (5-60 minutes): Neurological symptoms encountered before or during a migraine
    • Visual disturbances (most common)
      • Flashing light or vision loss
    • Sensory (touch), motor (movement) or verbal (speech) disturbances
      • Pins and needles
      • Language problems
      • Limb weakness
  • Main Attack (4-72 hours)
    • Pulsing or throbbing pain on typically one but sometimes both sides of the head
    • Sensitivity to light, sounds or smells
    • Nausea and vomiting
    • Blurred vision
    • Light headedness or feeling faint
    • Most find it preferable to lie down in a dark, quiet place until it passes
  • Postdrome (variable): Resolution of symptoms that can be sudden or fade slowly (most common)
    • Most sufferers feel fatigue afterwards

What are the causes of Migraine?

  • Not fully understood but potentially associated with:
    • Chemical imbalances in the brain chemical, serotonin
      • Serotonin levels drop during a migraine
    • The brainstem and trigeminal nerve (a major pathway of pain)
      • The trigeminal nerve is thought to release neuropeptides when serotonin drops
      • Neuropeptides can lead to head pain
  • Believed to be genetic and triggered by certain factors
    • Hormonal changes
      • Commonly seen in women when oestrogen drops before period onset or in pregnancy
    • Foods, drinks or skipping meals
      • Aged cheeses, foods that are processed or with additives
      • Alcohol or heavily caffeinated drinks
    • Physical or mental stress
    • Environmental factors like weather or pressure changes
    • Sleep changes
    • Sensory stimuli like bright lights, loud noises and offensive smells
    • Medications that affect hormones or blood pressure

How is Migraine Diagnosed?

  • Headache diary - helps to diagnose migraine and identify triggers
    • Write down all timings and symptoms experienced as well as dietary and medication information, activities the day of the migraine and anything else that may or may not seem important
    • Based on the information provided, the doctor may be able to determine whether you are suffering from headaches or migraines
  • Your doctor will need a detailed history of your health including family history
  • Certain scans, blood or spinal fluid tests may be necessary to rule out other more serious conditions

What is the treatment for Migraine?

  • First of all avoid any identified triggers or causes listed above if at all possible
  • Due to the complex nature of migraines, treatment is tailored to each patient based on their symptoms and what is effective for them
  • Migraine is associated with increased risk for other physical and psychiatric conditions so treatment is of great importance.
  • Medications
    • Although there is no cure, several therapies can help treat or prevent migraines
      1. Acute therapy (for when you are experiencing a migraine) works best when taken as soon as possible so keep on hand in case of an attack:
        • For mild pain relief:
          • Non steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
          • Paracetamol which is sometimes combined with other drugs like caffeine
        • For moderate to severe pain relief:
          • Triptans (5-HT1 agonists) constrict blood vessels and block pain pathways in the brain via serotonin. These can be very effective in some patients. It is worth trying a different triptan if you have failed one:
            • Imigran (sumatriptan) - the first triptan to be developed
            • Sumatriptan as a generic version of Imigran is the least expensive option
            • Maxalt Melt (rizatriptan) - ideal for those who find swallowing tablets difficult or have trouble keeping medications down during migraine
          • Ergots are less effective than triptans but useful for those who experience migraines with pain lasting more than 2 days:
            • Ergotamine with or without caffeine
            • Dihydroergotamine is more effective with fewer side effects than ergotamine
          • Medications for other symptoms such as nausea

2.   Preventative medication is taken on a regular basis to reduce the severity and frequency of migraines consequently preventing overuse of medication taken in acute attacks as rebound headaches can result if these are used too often.

      • For patients who have at least four attacks per month, with pain lasting over 12 hours or when medication does not help:
          • Certain blood pressure medications:
            • Beta blockers
            • Calcium channel blockers
          • Certain antidepressants and other 5-HT blockers
            • Tricyclic antidepressants
            • Antihistamines
          • Anti-seizure drugs
            • Valproate
            • Topiramate
          • NSAIDs

Because of potential side effects, the benefit of using preventative medications should be weighed up against the impact they may have on quality of life due to migraines.