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Migraine


Expert reviewer, Dr Jeremy Rees, Consultant Neurologist
Next review due July 2022

A migraine is usually a very bad headache, as well as other symptoms, that stops you carrying on as normal.

You may also feel sick (or be sick) and be extra sensitive to lights and sounds.

About migraine

Migraines affect around 15 in every 100 people in the UK. You can get migraines for the first time at any age, and they’re three times more common in women than in men.

Migraines can be so bad that you need to take time off work or school and even rest in bed. You may have a migraine attack once a week or only once every few years. Attacks usually get less troublesome as you get older.

There’s no cure for migraines. But there are ways to treat your symptoms, reduce your pain and stop your migraine attacks happening so often.

Types of migraine

There are several different types of migraine. The three main types are:

  • migraine with aura
  • migraine without aura
  • migraine aura without headache

Aura is a group of symptoms that can happen up to an hour before your migraine headache starts. For more information on migraine aura, see our section: Symptoms of migraine below.

You can get more than one type of migraine and can change between the different types.

Women may have menstrual migraine, with monthly attacks around the time of their periods. For more information on this, see our section: Causes of migraine below.

If you have migraine attacks on fewer than 15 days each month, this is called episodic migraine.

Chronic migraine is when you get headaches on at least 15 days a month over three months or more. And on eight of these 15 days each month, your headache has symptoms of a migraine.

Symptoms of migraine

A migraine is much more than just a bad headache. It has other symptoms too, even before your headache begins.

Prodrome stage

You may notice signs that a migraine is on its way, a few hours or even days before you have an attack. You may:

  • yawn a lot
  • get cravings for certain foods
  • have mood swings
  • notice changes in your usual sleep pattern

Migraine aura

If you have migraine with aura, you may have certain symptoms in the hour before your headache starts. Aura symptoms usually last for 15 to 30 minutes. These include:

  • seeing flickering lights, spots or zigzag lines in your vision
  • tingling in your hand, arm or face
  • finding it hard to speak clearly

Migraine attack

Migraine headaches can last between four hours and three days. Your headache may:

  • be at the front of your head or just on one side
  • be throbbing or pulsing
  • feel worse when you move around during everyday activities, particularly when you move your head
  • build up gradually over one or two hours

You often have other symptoms too, including:

  • feeling or being sick (nausea or vomiting)
  • sensitivity to light and sound
  • feeling lightheaded

Your symptoms may be so bad that they wake you from sleep. You may find it hard to concentrate and need to lie down in a dark room. You may also feel hot or cold and sweat a lot.

For the first 24 hours after a migraine attack, you may feel tired and weak and have aching muscles.

Diagnosis of migraine

Your GP will ask about your symptoms, whether you feel well between attacks and if you have a family history of migraine.

It may help if you keep a headache diary for at least eight weeks before you see your GP about migraine, unless your symptoms are very bad. Note down:

  • when you have headaches
  • where your headaches are and how they feel
  • how long your headaches last
  • how bad your headaches are
  • any other symptoms before, during and after the headache
  • any possible triggers, including what happened in the few days before your migraine attack
  • medicines you’ve already tried – and whether they worked or not

The Migraine Trust website has a helpful migraine diary template that you can use.

Your GP may examine you, especially your head, scalp, neck and eyes. They may also check your blood pressure.

There’s no specific test for migraine. But your GP may refer you for tests or to a specialist doctor, if they think something else could be causing your symptoms. This may be because you have more unusual symptoms, such as poor balance or double vision.

Treatment of migraine

If your symptoms aren’t too bad, you may be able to treat your migraine yourself with over-the-counter medicines and self-help measures. But if your migraine attacks are getting worse or becoming more frequent, you’ll need to see your GP. You shouldn’t take some migraine treatments too often, including over-the-counter painkillers, as this can trigger medication overuse headaches, which will make your headaches worse.

It can take a while to find the treatment that’s best for you. It may help to keep a diary, noting down your symptoms and how well different treatments work, including any side-effects.

Self-help for migraine

When you have a migraine, it’s best to rest or lie down in a quiet, dark room. If you can, try to get some sleep. Applying pressure or a hot or cold compress to your head may help. Keep yourself hydrated by drinking enough fluids, particularly if you’re getting sick.

If you know certain things trigger your migraines, try to avoid these as much as possible, as this may stop your migraine getting worse. For more advice on what can trigger a migraine, see our sections: Causes of migraine and Prevention of migraine below.

Some people find yoga, stress management or relaxation techniques can help to make their migraine attacks more bearable and less frequent.

Medicines for migraine

The best medicine for migraine depends on your symptoms, how bad they are and your medical history. A combination of medicines may work best – speak to your GP about which ones to take, and when. Your GP can prescribe suppositories (medicines you insert into your back passage) if you feel sick or find it hard to swallow tablets when you have a migraine.

Migraine medicines include the following.

  • Over-the-counter painkillers such as ibuprofen, aspirin or paracetamol. Take these as soon as you notice signs of a migraine attack. Avoid painkillers containing codeine because these can make you feel even more sick. Try soluble painkillers, which dissolve in water, or fast-acting tablets. If over-the-counter medicines don’t work, your GP may be able to prescribe stronger painkillers.
  • Anti-sickness (anti-emetic) tablets are often combined with painkillers and may be particularly helpful if you are sick or feel sick with your headache. You can buy over-the-counter migraine medicines containing paracetamol with an anti-sickness medicine – speak to your pharmacist before you take them. Your GP can prescribe stronger anti-sickness medicines.
  • Triptans are available on prescription as tablets, dissolvable wafers, nasal sprays or injections. If you can, it’s best to try and take these as soon as your headache starts, rather than when your aura begins. You can buy sumatriptan tablets from a pharmacy if you’ve already been diagnosed with migraine, but you’ll need to speak to your pharmacist first. You can’t have triptans if you have high blood pressure, kidney or heart problems, or have had a stroke

If you take painkillers on 15 or more days a month, or triptans on 10 or more days a month, you may find you get daily headaches. This is called medication overuse headache. If you’re getting migraines regularly, on two or more days a month, speak to your GP about preventative treatments – for more information, see our section: Prevention of migraine below.

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

Emergency treatment of migraine

If you have a very bad migraine for more than three days, contact your GP who will be able to advise if you need emergency treatment.

Emergency treatment may involve giving you oxygen or injected migraine medicines that act quickly. You may need a drip in a vein to give you more fluids, especially if you’ve been sick a lot.

Causes of migraine

Doctors don’t know exactly what causes a migraine. It may be due to inflammation in the brain that makes nerve fibres over-sensitive to normal brain activity. Aura symptoms may be caused by a problem with the brain’s normal electrical activity.

Migraines tend to run in families, and one rare type, called familial hemiplegic migraine, is linked to changes in certain genes.

Some people find that everyday things can trigger a migraine attack, though these vary from person to person. Common triggers include missed meals, bright or flickering lights, alcohol, too little or too much sleep, cheese and strenuous exercise. For more information, see our section: Prevention of migraine below.

Women’s oestrogen levels can affect their migraines. You may find your migraine attacks are worse around your periods – this is called menstrual migraine. Migraines often get better or even stop during pregnancy. But they may get worse during the menopause. Some women find that taking combined oral contraceptives makes their migraines worse, others find combined oral contraceptives make their migraines better.

Although not a direct cause of migraines, some other things which increase your risk of getting a migraine attack include:


Complications of migraine

In most people, migraines don’t cause any complications. But some people develop chronic migraine with headaches on more than 15 days every month. If your migraine lasts for more than 72 hours, you’re being very sick or feel too ill to drink any fluids, you may become dehydrated.

Speak to your GP if your migraine symptoms change in any way. If your headaches are getting worse, becoming more frequent or are linked to seizures (fits), your GP may want to refer you for further tests.

Migraine aura and stroke can have similar symptoms such as a very bad headache, weakness, changes in your vision and confusion. But migraine symptoms tend to come on slowly, while stroke symptoms are much more sudden. Having a migraine doesn’t cause a stroke. But migraine, especially migraine with aura, has been linked to a slightly higher risk of stroke. This risk is very low but may be slightly raised if you:

  • are female
  • smoke cigarettes
  • take the combined oral contraceptive pill

Migraine has also been linked to an increased risk of depression, bipolar disorder, anxiety disorder and panic disorder.

Prevention of migraine

You may be able to prevent migraine attacks by avoiding common triggers and using preventive treatments.

Avoiding triggers

Certain everyday things may trigger your migraine attacks, so keeping a headache diary may help you to identify these. Keeping healthy and making certain changes to your lifestyle may help to prevent migraine attacks.

These lifestyle changes may include:

  • reducing your stress levels
  • eating regular meals and small snacks between them
  • avoiding food or drinks that trigger your migraine (e.g. caffeine, cheese, chocolate and red wine)
  • sticking to a regular daytime routine and sleep pattern
  • avoiding loud noises
  • avoiding bright or flickering lights
  • not sitting in front of a computer screen for long periods of time – take regular breaks and make sure you’re seated comfortably
  • exercising regularly but not overdoing it, especially if you’re not used to exercise
  • drinking at least eight glasses of water a day because dehydration can be a trigger

Some people don’t find any specific triggers or need several triggers working together at the same time to bring on a migraine attack. But if there’s an obvious link, you can try to avoid or limit a specific trigger.

Preventive treatments

If you’re getting several migraine attacks a month or your symptoms are very bad, your GP may prescribe you a low dose of medicines such as beta-blockers, amitriptyline or anticonvulsants. You’ll need to take these for up to six months.

If you have chronic migraines, regular Botox injections given by a headache specialist – usually every 12 weeks may be a possible alternative.

There’s also a treatment called occipital nerve block, which involves having a local anaesthetic and steroids injected at the back of your head by a specialist. There isn’t much medical research to show this works, but some people find it very helpful.

Some people find cognitive behavioural therapy, physiotherapy or acupuncture help. These aren’t widely available on the NHS, so you may have to pay for them.

Some people find that taking 400mg of riboflavin a day may makes their migraines more bearable. Riboflavin is found in meat, dairy foods, green vegetables, whole grains, almonds, poultry and lean meat, and fortified breads and cereals. Speak to your pharmacist before taking any supplements or herbal remedies, as these may interact with your other medicines.

Frequently asked questions

  • Children with migraine often get more tummy pain, sickness and dizziness than a headache. The pain is usually over their whole head or in the middle of their head – adults tend to get pain on one side.

    Migraine attacks in children may be shorter than in adults but can still last for up to three days. Children may look ill during an attack, but usually seem completely fine between attacks.

    Young children may not be able to explain their symptoms very well, but you may notice changes in their behaviour, such as crying or irritability. They may cover their eyes or ears, ask you to close the curtains and want to lie down in a quiet, dark room.

    If your child has any signs of migraine or their migraine is getting more frequent, it’s important to speak to your GP. Seek urgent medical help if your child has had a migraine for three days or has a sudden, bad headache without migraine symptoms.

  • If your migraines are very bad, you won’t be able to drive safely. Some symptoms, such as problems with your vision, dizziness and poor concentration, can make you more likely to have an accident while you’re driving.

    If you get a migraine attack while you’re driving, pull over and stop as soon as you can. Always have your migraine medicine with you so that you can treat your symptoms straight away. But make sure your medicines don’t affect your ability to drive – check this with your GP or a pharmacist.

    The Driver and Vehicle Licensing Authority (DVLA) doesn’t ban people with migraines from driving, so you don’t always need to tell them about your migraines. This will depend on your symptoms, how bad they are and how often you have attacks, so discuss this with your GP.


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Related information

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    • Personal communication, Dr Jeremy Rees, Consultant Neurologist, April 2019
  • Reviewed by Michelle Harrison, Specialist Health Editor, Bupa UK Health Content Team, July 2019
    Expert Reviewer, Dr Jeremy Rees, Consultant Neurologist
    Next review due July 2022



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