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A National Migraine Centre factsheet
There’s a widespread misconception that it is quite normal to have headaches from time to time. But head pain can be associated with conditions such as viral infections, head trauma, meningitis, high blood pressure and stroke, and so should never be simply dismissed, however mild it may be. A proper diagnosis can help to find the right treatment and prevent further headaches.
Migraine attacks involve an array of symptoms alongside the headache. The head pain can be so severe that you may have to stop what you’re doing, but sometimes it’s the other symptoms, such as visual disturbance, dizziness, nausea or abdominal pains, which are disabling.
For many of those affected, the first migraine attack usually happens during childhood. It’s rare for a first attack of migraine to happen after the age of 40, although there may be a gap of many years between attacks.
Many people try to struggle through an attack, thinking that little can be done. Certainly, in the past, it was considered something that you had to ‘live with’ and very little was known about the condition.
But as more research has been done and specialist migraine clinics like the National Migraine Centre have opened, there has been a rapid increase in our knowledge – although the picture is by no means complete. Nowadays, much more can be done to make migraine attacks less severe and occur less often.
Migraine is a complex genetic, neurological brain disorder and comes in various forms. In general, it is a recurring headache that lasts from four hours up to three days.
About 20 to 25 per cent of migraine patients have a warning ‘aura’ which happens before the headache starts. This aura lasts from a few minutes to up to an hour. You may notice flashing lights or zig-zag lines moving in front of your eyes, as well as black spots when you look at things.
My eyes go out of focus, nearly always the left one, with dazzling white lights. This lasts about half an hour before my eyes clear. Afterwards, I have this terrific headache that lasts about two days.
Difficulty talking or finding the right words, or sometime a feeling of weakness or numbness in some parts of the body, are also symptoms of the aura stage.
When the headache arrives, it may affect just one side of the head but can be all over. The pain is often throbbing and made worse by movement. You will probably feel nauseous and may even be sick. Most sufferers are also sensitive to light and sound.
The pain begins at the front and travels all over my head, making the back of my head feel very heavy. I have to stay as still as I can otherwise it gets worse. I can’t sit in a room with the lights or the TV. I feel very sick.
The headache usually lasts for two to three days but you may still feel washed out for a couple more days.
When I get a migraine, it makes me very ill and really puts me out of action for two to three days. The first day, I can feel one coming on and then the full-blown migraine emerges, and I feel wretched. As the second day progresses, the pain finally begins to lessen. The third day leaves me with a vague pain and feeling absolutely shattered but otherwise okay.
The term ‘migraine with aura’ (formerly known as ‘classical migraine’) is used when an aura is followed by a headache. The aura may occasionally happen on its own, without the headache.
Around 75 to 80 per cent of people have ‘migraine without aura’ (or ‘common migraine’) – for them, the headache is the first main symptom, followed by the sickness and any other symptoms.
Find out more on our What is migraine? page.
Even if you don’t have an aura before the headache, you may have noticed other feelings that make you aware an attack is starting. A migraine attack can actually be divided into four distinct stages, although you may not have all four phases. There are two stages that may be present before the headache begins.
Before the actual attack starts, you may sometimes notice that you feel very tired and yawn a lot more. Although before other attacks you may have had the opposite feelings, with lots of energy and a sense you can get all your work done in half the normal time. Some people find that they recognise the start of a migraine attack when they approach the housework with great enthusiasm!
You may also find you crave certain foods – often sweet.
These sorts of feelings are noticed by about two thirds of sufferers but you might only recognise them when after the attack. Relatives and friends may be more aware of these subtle changes in mood or behaviour than you are.
These symptoms usually start several hours or even a day before the attack.
As mentioned above, an aura before an attack is experienced by about 20 to 25 per cent of migraine sufferers and can last from a few minutes to up to an hour.
There may or may not be a gap between the end of the aura and the start of the headache phase.
The headache may stay in one place or shift to affect different parts of the head, even swapping sides.
The most common accompanying symptoms are nausea and a dislike of light and/or sound.
Some people become more sensitive to certain smells, and strong smells may even trigger an attack. Most people are off their food, but some are extra hungry in spite of the nausea.
After the headache has gone, feelings of lethargy and generally being ‘washed-out’ remain. It can take a couple of days to get over this.
Some people are luckier and find they have extra energy immediately after an attack, which may have something to do with the feeling of relief!
Most people have read that certain foods, such as cheese and chocolate, can trigger an attack. This could possibly be true for some people, but in general most experts think foods are less likely to be a trigger for a migraine than they are a craving in the prodromal phase. So, while you may find a headache often follows certain foods, that doesn’t mean they’re the cause.
Alcohol and caffeine are common triggers, but the relationship is not straightforward. If you drink a glass of wine on its own, you may be unlikely to have an attack. However, if you drink the same glass of wine on an empty stomach, alongside other possible triggers, like a stressful day at work or having consumed lots of caffeine, an attack is more likely.
Triggers should be considered together – the stress, coffee, lack of food and the glass of wine. You should think in terms of ‘migraine thresholds’: you might be able to tolerate one or two triggers in isolation, but it may only take one or two more to cause an attack.
Dealing with any of your triggers may help you have fewer attacks and is an important way of controlling migraine. Find out more about how you can get on top of potential triggers by reading our migraine triggers factsheet.
You can also read more about the role of food in our migraine and food factsheet.
Ask friends and relatives if they notice any changes in you before the migraine attack starts. Look out for any differences in mood or behaviour in the 24 hours before the headache.
Several triggers may be necessary which, when added together, can result in an attack as the migraine threshold is crossed.
Sometimes, the attack can be prevented by removing as many of these triggers as possible and keeping below the threshold.
Keeping a diary is an essential tool for managing your migraine. You can download a simple migraine diary here.
But to identify your triggers also involves recording them in a diary too. You can find out how to do this with our Migraine triggers factsheet.
After you have recorded several attacks in this way, you should have a better idea of your triggers. You can then divide the triggers into two groups – those which you can do something about (such as missing meals, drinking red wine) and those that are out of your control (such your menstrual cycle, the weather or travelling).
Try dealing with those triggers that are within your control. Cut out one at time: if you try to deal with too many all at once, you can’t be certain which are most relevant to you.
If you know that you have a particularly difficult period at work, be extra careful to make sure you don’t miss meals or have too many late nights. Many people find it difficult to relax, but an active hobby, playing sports, cycling to work or walking the dog, can all help to relieve stress.
Hormonal factors are usually additional to non-hormonal factors. Hormonal changes are difficult to control, but you can lower the chances of an attack by being especially careful to avoid other triggers in the week before your period. Eat small, frequent meals, avoid sugary snacks and alcohol, and get adequate sleep.
Your headache diary can help point out less obvious triggers. If you find that most of your attacks start late morning or late afternoon, it may be lack of food that is the problem and you can try eating a mid-morning or mid-afternoon snack. Attacks on waking may be due to sleeping in, neck problems or, again, it may be too long since food (try a late night snack).
During a migraine attack, some body systems are affected, and drugs are not so easily absorbed.
It’s important to take migraine treatment without delay as early as possible in a migraine attack. Simple treatments can then be more effective.
Drugs can be taken without delay if you have them with you. Ideally, keep a couple of biscuits and a small drink with you too, so that you are not taking the tablets on an empty stomach.
Treatment for migraine is either acute, which is taken when you sense an attack coming on, or preventative, taken regularly to avoid or reduce the impact of migraine.
Acute treatments, like aspirin, can often be purchased over the counter at pharmacies, while your GP, or a headache specialist at an NHS or private headache clinic, can advise on preventatives. Book a consultation through the National Migraine Centre to speak with an expert who can help identify the right medication for you.
Over-the-counter drugs bought at the pharmacy may be enough to stop at attack if taken early enough. Speak to your pharmacist for advice.
If they’re not effective, your GP may also prescribe an anti-sickness drug to be taken in addition, which can help the drugs to be absorbed. Your GP can also prescribe stronger acute drugs for migraine if necessary.
If you are having frequent attacks of migraine that interfere with your work or social life, your doctor may prescribe a short course of tablets to take every day to prevent the attacks.
Preventative drugs can help to break the cycle of frequent attacks and give you some breathing space.
There are many different drugs available from your doctor – a headache specialist at the National Migraine Centre can be helpful in identifying the right medication for you.
Alternative medicines for migraine might help, but evidence may be limited. Check out our factsheet on the subject – and always speak to your GP before beginning treatment, even with so-called ‘natural’ remedies.
Those with neck tension or back problems may be helped by simple hot or cold pads put on the back of the neck or where it hurts most. You may also benefit from a course of physical treatment, such as osteopathy or massage. Postural problems may be helped by the Alexander Technique.
If stress is a problem, you could try biofeedback or relaxation techniques.
Depression, stress or muscle tension may also result in daily headaches that feel like a tight band around your head.
If you are regularly taking painkillers or ergotamine, which are used for the treatment of headache, that may make the underlying problem worse, possibly resulting in daily headaches. Read our factsheet on medication overuse headaches.
Unlike a migraine attack, these types of headaches, though perhaps painful, often don’t stop you working.
Migraine attacks do not occur daily, and you shouldn’t have any migraine symptoms between attacks. However, it is possible to have more than one type of headache at the same time.
Though uncommon, headaches can sometimes be a symptom of an underlying medical problem. It’s very important to see a doctor to make sure of the correct diagnosis of your headache, particularly if you notice any changes in the pattern of headaches or the symptoms, even if a previous diagnosis of migraine has been made.
Book an appointment with the experts: leading headache specialist can make living with migraine more manageable. Beat the misery of migraine and get back to living. Book your consultation through the National Migraine Centre now.
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