Migraine

Published by Bupa's Health Information Team, April 2011

This factsheet is for people who have migraines, or who would like information about them.

Migraines are a type of severe headache that can have a major impact on quality of life. They are often accompanied by feeling sick, vomiting or increased sensitivity to light. Migraines are one of the most common types of headache in adults.

About migraine

Migraines affect one in seven adults in the UK, with women being three times more likely to get them than men. You can get migraines at any age but they are most common from adolescence up to the age of 50. About half of all people who get migraines have a family history of them.

Types of migraine

The most common types of migraine are migraine with aura (classic migraine) and migraine without aura (common migraine). Aura is like a set of warning symptoms that comes on just before your migraine. Less common types of migraine are abdominal migraine, hormonal migraine and hemiplegic migraine.

Symptoms of migraine

You may get a migraine at any time, when you wake up, during the day or at night. You may be able to sense when a migraine attack is about to start. This is different from aura, instead it’s a sensation that a migraine may be beginning. Irritability, lack of concentration, food cravings and tiredness can all warn you that you may be getting a migraine.

A third of people have aura with their migraine. Aura symptoms don’t tend to last for more than an hour and you usually get them before the general headache symptoms of a migraine start.

Common aura symptoms include:

• visual disturbances – such as flashing or flickering lights, zigzag lines, blurred vision, temporary blindness
• numbness or a tingling sensation – common in the hands, arm or face, similar to ‘pins and needles’
• slurred speech
• poor concentration
• problems with your co-ordination

Most people don’t get aura with their migraines. The general symptoms of migraines include:

• a headache that lasts anything from four up to 72 hours
• pulsating or throbbing pain, often just on one side of your head
• a headache that gets worse when you’re active or stops you from being active
• feeling sick or vomiting
• increased sensitivity to light and noise

Most people don’t need to see their GP when they get a migraine. However, it’s a good idea to see him or her if:

• your migraines become more frequent or get worse over time
• you’re over 50 and you have never had a migraine before
• you get aura symptoms lasting more than an hour

You won’t have any symptoms between attacks.

Complications of migraine

Occasionally, a migraine may last for more than 72 hours and doesn’t go away by itself. This type of migraine is known as status migrainosus. It’s important to see your GP if your migraine lasts longer than 72 hours.

If you get frequent migraines on more than 15 days a month for an average of three months out of the year, this is known as a chronic migraine. When describing an illness, the term chronic refers to how long a person has it, not to how serious a condition is. About one in 100 people have chronic migraine. If you have chronic migraine, you may need to take increasing amounts of medication to help control the attacks. Over time, this may lead to further headaches, known as medication-overuse headaches.

If you get frequent migraines, you may be at an increased risk of depression, anxiety, panic disorders and stroke.

Causes of migraine

It’s not fully understood what causes migraines, but it’s thought they may be caused by a chemical called serotonin. Low levels of serotonin cause changes to the blood vessels in your brain. It’s not known exactly what causes the serotonin levels to change.

You may find it useful to keep a diary to spot the triggers that cause your migraines or make them worse.

Common triggers include:

• stress
• change in sleep patterns
• poor posture or tension in your neck and shoulders
• certain food or drink – commonly chocolate, cheese, alcohol, caffeine
• loud noises
• bright or flickering lights
• certain smells
• strenuous exercise if you’re not used to it
• skipping meals
• not drinking enough fluid

Women may get migraines around the time of their periods, during pregnancy and menopause, or as a result of taking oral contraceptives or hormone replacement therapy (HRT). It’s possible that these hormonal changes may affect the frequency and severity of migraines.

Other less common triggers may include high blood pressure, smoking, toothache, eye strain or taking certain sleeping tablets.

Diagnosis of migraine

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

There isn’t a specific test that can diagnose migraines. Try to keep a diary of when you get migraines and possible triggers. This will help your GP to see if there is a pattern to your symptoms.

Treatment of migraine

Self-help

Keep a diary of your migraines. Record your symptoms, how bad they get, how long they last and what medication you use, if any. This can help you to spot things that may trigger or make your migraines worse.

It’s best to rest in a quiet, darkened room and sleep if you can. You may want to try using a cold compress, such as an ice pack or ice wrapped in a towel to ease your headache. Don’t apply ice directly to your skin as it can damage your skin. A hot compress, for example a hot water bottle may also help. You may want to try applying pressure to the pulse points on the side of your forehead or neck.

Medicines

Different types of medicine are used to treat migraines, depending on your symptoms and how severe your migraines get.

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 regularly use painkillers for 10 to 15 days a month, for more than three months to relieve your migraines.

Over-the-counter medicines
You may find that over-the-counter painkillers (such as aspirin, paracetamol and ibuprofen) help to relieve the symptoms of your migraines. Your body absorbs soluble painkillers that you dissolve in water more quickly and so they may be more effective.

Medicines containing anti-emetics (antisickness medicines) such as domperidone (eg Motilium) may stop you vomiting and feeling sick. This can help your body to absorb the painkillers more easily.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Triptans
If over-the-counter painkillers don’t help to ease your migraines, you may want to try other medicines called triptans (also known as 5HT agonists). You will need a prescription from your GP for most triptans and you may need to try more than one before you find the one that works best for you.

Triptans stop the effects of serotonin, which is thought to cause migraines. They are more effective if you take them as soon as your migraine starts. Triptans are available as tablets, dissolvable wafers, nasal sprays or injections.

Don’t take triptans if you:

• have high blood pressure
• have had a stroke
• have had a heart attack
• are pregnant or breastfeeding
• are taking certain medicines – for example ergotamines, lithium or some antidepressant medicines

Common side-effects of using triptans may include dizziness, feeling sick, vomiting, tiredness or sensations of tingling, heat, heaviness or pressure in any part of the body.

Other prescription medicines
If you can’t take triptans or over-the-counter painkillers don’t work for you, your GP may prescribe non-steroidal anti-inflammatory drugs (eg diclofenac, tolfenamic acid) or a combination of anti-sickness and painkillers (eg MigraMax or Migraleve).

Other treatments

Although the cause of migraines is unclear, stress and anxiety are thought to make migraines worse. Relaxation techniques can be useful in the management of stress and anxiety. There are CDs and books to help you relax. Yoga, meditation, muscle stretches and controlled breathing exercises are all useful relaxation techniques.

Another option is a talking treatment called cognitive behavioural therapy. You have sessions with a trained therapist who can help you challenge negative thoughts, feelings and behaviour to help reduce stress and anxiety that may cause or make your migraines worse.

You may wish to try acupuncture to help relieve some of your symptoms, but there is little evidence to show that it’s effective. Speak to your GP before trying acupuncture. If you do decide to try it, check that your therapist belongs to a recognised professional body.

If you’re pregnant

Many medicines for migraines aren’t suitable if you’re pregnant or breastfeeding. Speak to your GP before taking any medicines for your migraines (even if they were prescribed to you previously) as they may be harmful to your baby.

Prevention of migraine

It’s important to learn to spot the signs and triggers of your migraine to help prevent them. The easiest way of doing this is by keeping a diary about your migraines.

Keeping active may also prevent you from getting migraines. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.

It’s important that you include at least two weekly activities to build up muscle strength, such as exercising with weights. Try to spend as little time as possible being inactive.

Preventive medicines

If you get frequent or severe migraines, your GP may prescribe medicines to help prevent them. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.