Most people with a migraine get a moderate to severe headache, which can last for anything between four hours and three days. The headache can occur on one or both sides of your head and is a throbbing, pulsating or banging pain. Activity usually makes the pain worse, for example walking or climbing stairs. You may also feel sick or vomit during a migraine, and you may find you’re more sensitive to light and noise.
You might get aura symptoms that affect your vision or other senses. For example, you may temporarily see flickering lights, spots or lines, or you may lose areas of your vision. You may also get pins and needles, or conversely, may get numbness. Some people also have disturbed speech.
Some people have migraines once a year or less, whereas other people have them as often as several times a week.
One of the things that make a migraine different from other types of headache is that it has clear stages. Most people will have the following stages, although not all have an aura stage.
- Premonitory stage. You may feel tired, crave sweet foods, have mood changes, feel thirsty or have a stiff neck. These feelings can last up to 24 hours.
- Aura stage. About one in three people have aura symptoms (visual or sensory changes). These may last from a few minutes up to an hour.
- Main attack stage. This is when you will have a headache and other symptoms such as nausea. This stage can last anywhere from four hours up to three days.
- Resolution and recovery stage. This is when the migraine fades. This usually happens slowly, although a migraine can sometimes stop suddenly, if you vomit for example.
Most people don’t need to see their GP when they get a migraine. However, you should see your GP if:
- your migraines become more frequent or get worse over time
- you’re over 50 and you have never had a migraine before
- you have a child under the age of 10 that develops a migraine
- you get migraines with aura and are taking the combined oral contraceptive pill
- you get a headache when your posture changes
- you have had cancer or have HIV and are getting new headaches
You should get immediate medical advice if:
- you have a sudden and very severe headache
- you get aura symptoms that last for more than an hour or make it harder to move
Chronic migraine is when you get headaches on more than 15 days a month for at least three months. And on eight of these days you have a migraine. Chronic migraines can have a big effect on your life. If you have chronic migraine, you may feel the need to take increasing amounts of medicine to help control your symptoms. However, be careful, because over time this can lead to further headaches, called medication-overuse headaches. Your GP can provide advice on how to tackle this.
Things that cause a migraine to start are known as triggers. But,for many people a migraine starts without a clear trigger.
Triggers might include:
- stress, or relaxing after a stressful period
- changes in sleep patterns (too much or too little sleep) or jetlag
- changes to meal times or missed meals
- certain foods or drinks – for example alcoholic drinks or some cheeses
- loud noises or bright lights
- strenuous exercise if you’re not used to it
- periods (menstruation)
You may find it useful to keep a diary to spot the triggers that cause your migraines or make them worse. Some things that can make you more likely to get a migraine are:
Using medication for headaches too often can also lead to medication-overuse migraines. Women may also get migraines as a result of taking combined oral contraceptives or hormone replacement therapy (HRT).
There isn’t a specific test that can diagnose migraines. If you’re able to keep a diary of when you get migraines and possible triggers, this will help your GP to see if there’s a pattern to your symptoms. To help diagnose a migraine, your GP will ask you about your symptoms. For example, how often you experience them, how intense your headaches are, and when they occur. This is why it’s a good idea to keep a symptom diary. They will also examine you.
Diagnosis of migraine with aura can be made more easily than migraine without aura. If you don’t have aura, you’ll need to have five or more migraines before your GP can confidently diagnose migraine without aura.
If you get migraines, there are no treatments that will stop your migraines for good. However, some treatments can help you to control your symptoms and minimise their effects. Some treatments can help to prevent a migraine, whereas others work to stop a migraine. You may need to try a few different ones before you find what works for you. It can help to keep a record of your symptoms and how any treatments affect your migraines.
When you get a migraine, it’s best to rest in a quiet, darkened room. You may want to try using a cold compress, such as an ice pack, to ease your headache. A hot water bottle may also help, or a hot or cold shower. You can also try applying pressure to the pulse points on the side of your forehead or neck.
Different types of medicine are used to treat migraines, depending on your symptoms and how severe your migraines get. Your GP may suggest you take an over-the-counter painkiller, such as ibuprofen, sometimes with an anti-sickness tablet. You’ll want the painkillers to work quickly once a migraine has started. For this reason, you may want to take soluble painkillers, which dissolve in water, or fast-acting tablets. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
If over-the-counter medicines don’t help your migraines, your doctor may suggest taking medicines called triptans. Triptans are anti-migraine medicines. It’s thought that they work in a number of ways, such as narrowing the blood vessels in your brain to relieve swelling. Unlike some medicines, triptans work best when taken after your migraine fully starts. Triptans are available as tablets, dissolvable wafers, nasal sprays or injections. Unfortunately, up to half of all people who take triptans find their migraine symptoms come back within two days. If you use any type of painkiller for your migraine too frequently, it may become less effective and cause further headaches. You may get medication-overuse headaches if you use painkillers for 15 or more days a month. If you’re worried that you may have this type of headache, speak to your GP.
If you know what triggers your migraines, do your best to avoid these triggers. For example, it may help to change your sleeping patterns. If stress triggers your migraines, you may find that a stress management technique helps. Likewise, if your migraines are linked to a neck problem, physiotherapy on your neck may help reduce your migraines.
Some medicines such the beta-blocker propranolol, or the anticonvulsant topiramate may help to reduce the number of migraines you have.
If these don’t work, then a course of acupuncture or another type of anticonvulsant may be recommended. Some people find that the vitamin Riboflavin may reduce migraine severity and frequency.
Getting regular exercise may also prevent migraines. The recommended level of physical activity for adults is 150 minutes of moderate exercise over a week in bouts of 10 minutes or more. You can do this by getting 30 minutes of exercise at least five days a week.
There’s little proof that hypnotherapy or aromatherapy can ease the symptoms of migraine. If your migraines aren’t improving with treatment or there’s uncertainty about the diagnosis, your GP may refer you to a neurologist. This is a doctor who specialises in investigating, diagnosing and treating conditions of the nervous system.
Are the symptoms of migraine different in children?
Migraine symptoms for children are often similar to those in adults. However, children’s migraines don’t tend to last as long, usually improving within two to four hours.
About one in 10 school children get migraines. They can occur at any age. The symptoms of migraines for children are similar to those in adults; however, there are a few differences.
Children’s migraines last for a shorter time than in adults. Usually no longer than four hours. The headache is more likely to develop over the whole head in children, whereas it might be one sided in adults. Children are also less likely to have aura before a migraine.
Your child may feel sick or vomit. They may also have abdominal (tummy) pain rather than a headache. For some children, travel sickness is also a symptom of migraine.
It’s a good idea to keep a diary of your child’s migraines. Note how long they last, if anything triggers them, and what relieves them. This will help your doctor to assess them. Speak with your doctor or go to Accident and Emergency immediately if your child:
- has constant head pain
- has a sudden, severe headache with no other migraine symptoms
- has symptoms early in the morning
- is vomiting a lot, has vision or balance problems, is weak or lacks coordination
- has behaviour changes that accompany a headache
I get migraines – am I at risk of having a stroke?
If you’re a woman under 45 and you get migraines with aura, you may be more at risk of having a stroke. You’re particularly at risk if you smoke or if you take the combined oral contraceptive pill.
A stroke happens when the blood supply to part of your brain is cut off, causing damage to the brain cells. There are two main types of stroke – ischaemic and haemorrhagic. An ischaemic stroke is when the blood supply to the brain is blocked by a blood clot or a fatty deposit. A haemorrhagic stroke is bleeding in the brain caused by a burst blood vessel.
If you’re a woman under 45 and you get migraines with aura, you’re slightly more at risk than other women of having an ischaemic stroke. If you also smoke or take the combined oral contraceptive pill the risk is greater. However, the risk of having a stroke is still very small.
If you’ve started getting migraines with aura and also take the combined oral contraceptive pill, you will need to stop taking it. If you wish to continue to use a contraceptive pill, the progesterone-only pill may be an option for you.
If you get migraines and are worried about an increased risk of stroke, have a chat with your GP.
What hormonal changes affect migraines in women?
Women’s hormone levels can affect their migraines. You may notice that your migraines are triggered by the change in hormone levels just before your period. Or you may find that pregnancy, menopause or use of the combined oral contraceptive pill affect your migraines.
About half of women who have migraines say that they are linked to their periods (menstrual cycle). Women who have migraines usually have their first one around the time of puberty.
You may have migraines a couple of days before your period starts or finishes. Some women find that they only ever have migraines near the start of their period. If you become pregnant, your migraines may stop or get better during your pregnancy.
You may find your migraines get worse, and happen more often, when you go through the menopause. For some women, hormone replacement therapy (HRT) can help, but for others it can make migraines worse. If your migraines are hormone related, your GP may prescribe medicines that can help ease them. Some women find that oral contraceptives make their migraines worse, but for other women oral contraceptives can improve migraines. If you think your migraines may be triggered by the oral contraceptive, speak to your GP. They may suggest you try a different pill or alter the schedule you use to take it. If you’re taking the combined oral contraceptive pill and get migrines with aura, you should stop taking it. Taking the combined oral contraceptive pill if you have migraines with aura can increase your risk of having a stroke. You may be able to use a progesterone-only pill instead.
- Map of Medicine. Headache in adults. International View. London: Map of Medicine; 2013 (Issue 1)
- Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache 3rd ed (1st revision). British Association for the Study of Headache, 2010. www.migraineclinic.org.uk
- Migraine, what is it? Migraine Trust. www.migrainetrust.org, accessed 21 October 2014
- Physical activity guidelines for adults (16 to 64 years), Department of Health, July 2011, www.gov.uk
- Headaches: diagnosis and management of headaches in young people and adults. National Institute for Health and Care Excellence (NICE), September 2012. www.nice.org.uk
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Reviewed by Dylan Merkett, Bupa Health Content Team, December 2014.
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