Overview
Migraine is a headache disorder in which the brain becomes unusually sensitive and sets off attacks of pain with other symptoms. It is not caused by a weak body or by imagination.
Attacks often begin in the teenage years and are commonest in mid-adult life. Women are affected more often than men, and for many people attacks become milder with age.
Symptoms
The headache is usually moderate to severe, throbbing, often on one side or behind an eye, and worse with movement. Untreated, an attack lasts from about four hours to three days.
- Nausea, and sometimes vomiting
- Dislike of bright light, loud sound and strong smells
- Warning signs hours or a day before, such as tiredness, yawning, mood change, neck stiffness or food cravings
- Aura before the pain: zigzag lines, flashing lights, a blind spot, tingling, or trouble finding words, lasting up to an hour
- Exhaustion for a day after the pain settles
When to see a doctor
See a doctor within a few days if attacks are becoming more frequent or more severe, if pain relief is needed on more than two days in most weeks, if the usual pattern has changed, or if a migraine-like headache starts for the first time after the age of fifty.
Causes
The exact cause is not fully known. During an attack, nerves and blood vessels in the brain behave abnormally, and pain pathways switch on. Migraine often runs in families, so genes play a part.
Triggers do not cause migraine, but they set off an attack in someone who already has it: missed meals, too little or too much sleep, stress, periods, dehydration, bright light, strong smells, alcohol and too much caffeine.
Risk factors
- A parent, brother or sister with migraine
- Being a woman, particularly around the time of periods
- Anxiety or depression
- Irregular sleep, shift work or long gaps between meals
- Frequent use of pain relief for headache
Complications
Migraine is not dangerous in itself for most people, but frequent attacks cost days of work, school and family life. Taking pain relief too often can lead to a daily headache that settles only once the medicine is reduced under medical advice. An attack lasting more than three days, or aura symptoms that do not clear, needs review by a doctor.
Prevention
- Keeping regular sleep hours, including at weekends
- Eating at regular times and drinking enough water
- Being physically active most days, and cutting down caffeine slowly
- Keeping a headache diary to find personal triggers
- Limiting pain relief to no more than two days a week
- Asking about a daily preventive medicine when attacks are frequent
Diagnosis
Migraine is diagnosed from the story of the attacks and a normal examination. There is no blood test or scan that confirms it, and most people do not need imaging.
Tests are arranged when something does not fit: a sudden severe headache, a changed pattern, a first headache later in life, fever, or an abnormal examination. A diary of dates, symptoms and medicines taken is the most useful thing to bring.
Treatment
For an attack, treatment works best when taken early: rest in a dark quiet room, simple pain relief such as paracetamol or an anti-inflammatory, a medicine for nausea, and if these are not enough, a migraine-specific tablet from the triptan group prescribed by a doctor.
When attacks are frequent or disabling, a doctor may suggest a daily preventive medicine. Several groups are used, including some also used for , mood or epilepsy, and they take several weeks to show benefit.
Relaxation training and steady daily habits support the medicines. Migraine cannot be cured, but attacks can usually be made fewer and milder.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Migraine is just a bad headache, and strong people simply put up with it.”What is true?
Fact
Migraine is a disorder of the brain with its own pattern of attacks, nausea and sensitivity to light and sound. It is one of the leading causes of years lived with disability worldwide, and it responds to treatment.
Myth“Migraine comes from weak eyesight, so new spectacles will cure it.”What is true?
Fact
An eye test is worth having if vision is blurred, but migraine comes from changes in the nerves and blood vessels of the brain, not from the spectacle power. Glasses do not prevent attacks.
Myth“The safest plan is to take a painkiller every day so the headache never starts.”What is true?
Fact
Pain relief taken too often can turn migraine into a daily headache, known as medication overuse headache. Most guidance is to keep pain relief to no more than two days a week and to ask about a preventive medicine instead.
Myth“Migraine is only tension, so it will go away once life becomes less stressful.”What is true?
Fact
Stress, poor sleep, missed meals and hormonal changes are common triggers, but they are not the cause. Migraine tends to run in families, and avoiding triggers alone is often not enough.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How is a migraine different from an ordinary headache?
An ordinary tension headache usually feels like a tight band around the head and lets a person carry on. Migraine is often one-sided and throbbing, gets worse with movement, and comes with nausea and a dislike of light and sound. Migraine also arrives in attacks with clear starting and ending points.
Does migraine mean there is a tumour in the brain?
Almost never. Migraine has a typical pattern that repeats over months or years, and the examination between attacks is normal. Headache that is new, steadily worsening, worse in the morning, or comes with weakness, fits or personality change is different and should be seen by a doctor.
Can migraine be cured for good?
There is no cure at present. The aim is fewer and milder attacks, which is achievable for most people with a mix of trigger management, treatment taken early in an attack, and a preventive medicine when attacks are frequent. Many women find attacks ease after menopause.
Are migraines in pregnancy treated differently?
Yes. Several migraine medicines are not suitable in pregnancy, so treatment is chosen carefully and rest, hydration and regular meals matter more. Anyone who is pregnant or planning a pregnancy should tell the doctor before starting or continuing any migraine medicine.
