Migraine

What is migraine?

Migraine is a neurological disorder producing recurrent attacks of moderate to severe headache, typically one sided and throbbing, with nausea and sensitivity to light and sound. It is not simply a bad headache. Overusing acute painkillers is a common and reversible cause of headaches becoming more frequent.

Causes

• Cortical spreading depression producing aura
• Activation of the trigeminovascular system with CGRP release
• Genetic predisposition
• Hormonal fluctuation, particularly falling oestrogen
• Triggers including missed meals, poor sleep and stress

Symptoms

• Throbbing headache, often on one side
• Nausea and sometimes vomiting
• Sensitivity to light, sound and smell
• Worsening with routine physical activity
• Visual aura with zigzag lines or blind spots
• Tingling or speech disturbance during aura
• Attacks lasting 4 to 72 hours

Risk factors

• Female sex
• Family history of migraine
• Age between 20 and 50
• Hormonal changes around menstruation
• High stress and irregular routines
• Overuse of acute headache medicines

Diagnosis

• Clinical diagnosis from the pattern of attacks
• Headache diary to identify frequency and triggers
• Neurological examination
• Imaging only when red flags or atypical features are present
• Assessment of acute medication frequency

Treatment

• Triptans taken early in the attack
• Simple analgesia and antiemetics
• Limiting acute treatment to fewer than 10 days per month
• Preventive medicines such as propranolol, amitriptyline or topiramate
• CGRP monoclonal antibodies for frequent migraine
• Regular sleep, meals, hydration and exercise
• Identifying and managing individual triggers

Self care

• Treat attacks early, when medication works best
• Keep regular sleep, meal and hydration patterns
• Track attacks in a diary to identify patterns
• Limit acute medication to fewer than 10 days a month
• Rest in a dark quiet room during an attack
• Manage stress and avoid sudden changes in caffeine
• Exercise regularly, which reduces frequency for many

When to see a doctor

Book an appointment if:

• Attacks more than four days a month
• Acute medication needed on more than 10 days a month
• Attacks not responding to current treatment
• Change in the pattern or character of your headaches
• Aura symptoms that are new or prolonged
• To discuss preventive treatment or contraception if you have aura

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Identify and manage personal triggers rather than avoiding everything
• Keep sleep, meals and hydration regular
• Limit acute medication to avoid overuse headache
• Take preventive medication consistently if prescribed
• Manage stress and neck tension
• Consider CGRP therapy if frequent attacks persist

Outlook

Migraine is a long term condition that usually fluctuates over a lifetime, often improving after midlife and, in women, after menopause. Modern preventive treatments including CGRP antibodies substantially reduce attack frequency for many people who previously had limited options. Medication overuse headache is common, reversible and frequently the reason treatment appears to stop working.

Related conditions

Common questions