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DEFINITIVE GUIDE

Migraine symptoms, causes and treatment

Migraine headaches can affect people's mood and lifestyles when they occur frequently.

Migraines can occur at any age but they usually begin in young adults and peak between ages 30 to 40. About 90% of people who have migraines experience the first one before the age of 40.

Migraines are accompanied with additional symptoms such as nausea, vomiting, sensitivity to light, sound and smell, and can become aggravated with physical activity.

If you notice an increase in the frequency of migraines or a change in its characteristics, you should speak to your GP right away.

Written by Dr Abby Hyams and Professor Fayyaz Ahmed. Reviewed by Dr Saloni Kapoor. Last reviewed on 15/06/2020. Next review date 15/06/2023.

Fast facts

Do I have a migraine?

You may be experiencing a migraine if you feel a moderate to severe headache of a throbbing or pulsating type, that worsens with physical activity. Migraine can affect any part of the head and may be on one side or both sides, mainly across the forehead. It commonly affects one side only and is often behind your eye. You may also experience pain behind one ear or in your temple. Migraine, if left untreated, can last anywhere from 4 hours to up to 3 days. The pain can be so bad that it stops you from carrying out your usual activities. You may also experience other symptoms such as sensitivity to light and sound, nausea and vomiting.

What helps migraines?

There are a few steps you can take to ease migraines. To help your sensitivity to light and sound when you have a migraine, try dimming the lights or sleeping in a dark, quiet room until the migraine passes. Other methods of helping your migraine include taking medications, taking a warm shower or placing heat packs on the area of the head that is affected. If your migraines happen frequently, there are some lifestyle changes you can make to prevent this. There is also medication available to prevent migraines if they are coming so frequently that they are affecting your quality of life. You can speak to your doctor about this.

CHAPTER ONE

Migraine signs and symptoms

Migraines are moderate to severe headaches that, if untreated, can last anywhere from 4 to 72 hours. The pain is throbbing or pulsating on one side of the head or across the forehead, however, migraines can affect any part of the head.

You may be wondering what the difference is between a headache and a migraine. We have some useful information in this chapter to help you understand the signs and symptoms of a migraine. We can help with:

  • What does a migraine feel like?
  • What are the signs of a migraine headache?

What is a migraine?

A migraine is a common health condition that often begins in adolescence but is commonly found in people aged 30 to 40. The prevalence of migraines has been reported in 22% of women and 7% of men and 15% of the general population. A migraine is a moderate to severe throbbing or pulsating sensation usually felt on one side of the head but can be felt on both. Migraines can be disabling and are usually accompanied by other symptoms such as nausea, vomiting and sensitivity to light, sound and smell.

How long do migraines last?

A migraine can last a few hours to a few days, usually between 4 to 72 hours. For some, migraines can occur several times a week and for others, they can happen as infrequently as once a year.

Why do I keep getting migraines?

The exact cause of migraine is unknown, although you may have inherited migraine from your parents. There may not be one specific cause for your migraine if you are experiencing them daily. There may be triggers in your lifestyle such as stress and diet.

What are the symptoms of a migraine attack?

You can tell if you are experiencing a migraine headache if you feel moderate to severe throbbing on one side of your head. This pain is usually located in front of the head or behind the eyes or ears. However, migraines can affect any part of the head. Symptoms of migraines are different for different people, however, they can be accompanied by other symptoms such as:

  • Nausea
  • Vomiting
  • Sensitivity to light, sounds and smells
  • Poor concentration
  • Diarrhoea
  • Stomach pains
  • Scalp tenderness

How do I know that I am about to get migraines?

Migraines may affect people in different ways, depending on what kind of migraine they may be experiencing. However, there are a few symptoms that indicate your migraine is about to begin:

  • Fatigue or feeling tired
  • The need to pee more often
  • Craving certain sweet foods more than usual, like chocolate
  • Changes in mood
  • Constipation or diarrhoea
  • Sensitivity to light and sound
  • Changes in vision

What are the stages of migraine?

A migraine can progress through stages such as the prodrome, headache and postdrome phases, however, not everyone will experience each stage. The stages of a migraine:

Prodrome

In the prodrome stage, you may feel the warning symptoms. This can occur for a few hours or up to 2 days before the migraine. In this stage, you may feel symptoms such as:

  • A change in mood from euphoria to irritability or sadness
  • Muscle tension
  • Fatigue
  • Constipation
  • Food cravings
  • Increased thirst and urination

Aura

A third of migraine patients experience aura. The aura stage can occur just before the migraine headache starts or when you are experiencing a migraine. Visual aura is most common. These include:

  • Blind spots
  • Geometric patterns such as zig zag lines
  • Flashing lights
  • Hemianopia (loss of vision on one side)
  • Slurred speech

Headache

This is moderate to severe, throbbing or pulsating on one side of the head or across the forehead but can be anywhere in the head. You may experience nausea, vomiting, sensitivity to light sound or smell and the headache worsens with physical activity. If untreated the headache may last between 4 to 72 hours.

Headache termination

Your migraine headache may go away when you sleep or after taking pain relievers.

Postdrome

This is a period of time following a migraine in which you may not feel well. You may feel unwell after the migraine and you can experience fatigue and problems with thinking. This period may take up to 48 hours to improve or feel better.

CHAPTER TWO

Migraine causes and triggers

The exact cause of migraine is unknown. Researchers believe migraines may be due to genetic and environmental factors. Migraines can also be triggered by emotional, physical and lifestyle factors.

This chapter has some useful information to help you understand why you may be experiencing migraines. We can help with:

  • What are migraine triggers?
  • Can stress cause migraines?

What causes migraines?

Migraines can be caused by problems with the nerves and blood vessels in the brain. The exact cause of migraines is unknown. Some researchers from the International Headache Genetics Consortium have located genes which may indicate a risk of suffering from migraines. Migraines typically tend to run in families, however, this does not mean everyone will experience them.

Some researchers argue that everyone has a threshold of experiencing headache to provoking factors or triggers. Those with migraine have a low threshold and hence experience headache much more easily than those with a high threshold. For example, hangover headaches are experienced by more or less everyone as the trigger is very strong.

Migraines are usually associated with triggers. These triggers are factors that can set off migraines. They include lifestyle factors such as stress, meal and sleeping patterns, and certain dietary factors. These triggers may be different for different people.

Physical triggers

There are some physical factors that can increase your chances of experiencing a migraine. Some of these triggers include:

  • Tiredness
  • Lack of sleep
  • Irregular sleep patterns
  • Poor posture
  • Tension in the neck and shoulders
  • Strenuous exercises
  • Dental problems (teeth grinding or a toothache)
  • Low blood sugar (hypoglycemia)
  • Changes in hormones (menstrual cycles)
  • Jet lag
  • Eyestrain
  • Changes in routine (worse at weekends if routine is broken)

Emotional triggers

Some factors that trigger migraines are changes to your mood or mental wellbeing. Some emotional triggers include:

  • Anxiety
  • Stress
  • Anger
  • Worry
  • Excitement
  • Shock

Dietary triggers

There are lifestyle factors that can increase your chance of getting migraines. These lifestyle factors include the types of foods you eat. Some dietary triggers of migraine headaches are:

  • Alcohol (especially red wine and beer)
  • Caffeine
  • Lack of food or irregular meals
  • Dehydration
  • Chocolate
  • Aged cheese
  • Cured meats
  • Smoked fish
  • Yeast extract
  • Artificial sweeteners (aspartame)
  • Monosodium glutamate (MSG)
  • Tyramine and nitrates

Some researchers argue that migraine patients may have cravings for certain foods in the prodromal stage of their migraine such as cheese and chocolate, and these may not be the actual trigger.

Environmental triggers

External triggers may play a part in you experiencing a migraine and its severity. However, not all people living with migraines will be affected by these factors. Some environmental triggers can include:

  • Bright or flickering lights
  • Prolonged or frequent use of smartphone screens or computer screens
  • Loud noises
  • Intense smells
  • Smokey environments
  • Change in weather or climate (such as temperature, humidity or altitude change)
  • Extreme heat

Can medications cause migraines?

Some medications have side effects which can cause headaches. If you do suffer from migraine, they could trigger a migraine attack. Some medications that are known to cause headaches include hormonal birth control pills and nitrates (which are medicines used to treat chest pain).

The overuse of painkillers can also cause an analgesic overuse or medication overuse headache. This is more common in those who have migraines and not seen if the painkillers are taken for other conditions such as arthritis or back pain, unless they are migraine sufferers. The exact cause for these headaches remains unknown. Patients with migraine are advised to restrict the use of painkillers to no more than two days per week to avoid risk of developing this headache.

All painkillers can cause analgesic overuse headache and include:

  • Some painkillers such as aspirin, paracetamol, ibuprofen, and naproxen.
  • Opiates such as codeine phosphate, dihydrocodeine, and tramadol.
  • Combination medicines such as co-codamol, co dydramol, syndol, and kapake.
  • Triptans, such as sumatriptan and zolmitriptan, which are medicines that constrict blood vessels and reduce headache pain.

Opiates, triptans and combination analgesics are more likely to cause analgesic overuse headaches than simple painkillers.

CHAPTER THREE

Migraine aura

Migraines are mainly of two types i.e, migraine with and migraine without aura. A third of patients experience symptoms prior to onset of headaches called aura (migraine with aura). These are symptoms that may resemble symptoms of stroke and cause concern to patients as well as the treating clinician. The remaining two third have headaches (migraine without aura).

The most common form of aura is visual that may take the form of blind spots in your field of vision just before or during your migraine headache. This chapter has some useful information to help you understand more about migraines with aura. We can help with:

  • What does migraine aura look like?
  • Why do they occur?

What is a migraine with aura?

Migraine with aura is a type of migraine headache in which visual and/or sensorimotor or speech symptoms occur before or during a migraine headache. The most common aura symptom is visual changes that include blind spots, dizziness, flashing lights and seeing zig-zag lines in the field of vision. Other symptoms may include experiencing pins and needles or weakness in one or both arms and legs. These symptoms are warning signs that a migraine headache is about to start. There are some specific types of migraine associated with aura that include:

  • Migraine with aura—with a headache or without a headache
  • Migraine with brainstem aura
  • Hemiplegic migraine
  • Retinal migraine

What is a migraine without aura?

A migraine without aura was previously termed as a “common migraine”. This type of migraine does not include aura symptoms prior to headaches. Nearly two third of migraines are of this type.

People who experience migraines without aura may feel severe pain on one or both sides of the head as well as other common symptoms of a migraine such as nausea, vomiting and sensitivity to light and sound. Migraines without aura may in some cases be accompanied by anxiety, depression and fatigue several hours prior to the headache.

The common migraine symptoms are normally:

Headache lasting 4-72 hours (untreated or unsuccessfully treated). The onset of the headache is usually gradual, peaking after 2-12 hours, then gradually subsiding. Attacks often begin in the morning, possibly waking the person from sleep, but may begin at any time of day or night.

Headache has at least two of the following characteristics:

  • Unilateral location (one side of the head). It is usually one sided but may be bilateral (on both sides of the head) at the onset, or may start unilaterally and become generalised.
  • Usually frontotemporal (at the front of the head or around the sides).
  • Pulsating quality (usually in the temples).
  • Moderate or severe pain intensity.
  • Aggravated by, or causing avoidance of, routine physical activity.

During the headache at least one of the following is present:

  • Nausea and/or vomiting
  • Sensitivity to light and noise

Frequency of attacks is extremely variable. Some people may have several attacks a week, others may go for several months to years between attacks.

Other features that may occur during an attack include:

  • Loss of appetite
  • Blurred vision
  • Impaired concentration
  • Nasal stuffiness
  • Hunger
  • Bowel discomfort
  • Diarrhoea
  • Abdominal pain
  • Passing large volumes of urine and sweating

What is a migrainous aura?

These are a spectrum of symptoms experienced by a third of migraine sufferers that occur just before or during migraine headache. The exact cause of aura remains unknown, although certain changes in the posterior part of the brain (occipital lobe) may result in generating a wave (spreading depression) that moves forward like a rippling water wave and causes symptoms that resemble stroke. To know if you are experiencing migraine with aura, there are a few symptoms you can look out for. The most common are visual although there may be other symptoms that can signify aura:

Visual symptoms can include flickering lights, spots or lines, or loss of vision. These can come on and then disappear entirely in a short time, often between 5-60 minutes. Visual symptoms may include:

  • Blind spots, called scotomas
  • Coloured spots
  • Zigzag lines
  • Tunnel vision
  • Flashes of light
  • Stars or sparkles of light
  • Temporary vision loss
  • Shimmerings or specks of light

Sensory symptoms (e.g. tingling sensation or numbness) which start gradually and disappear slowly. These include:

  • Paraesthesia (tingling)
  • Numbness that often starts in the hand
  • Pins and needles in the arms and legs
  • Dizziness
  • Vertigo (spinning dizziness)

Speech or language symptoms may include:

  • Dysphasia (the loss of ability to speak)
  • Difficulty communicating (mumbled or slurred speech)

Other rare symptoms of a migraine aura include:

  • Memory changes
  • Feelings of fear
  • Confusion
  • Partial paralysis or fainting (rare)
Important

Migraine aura is unlike a stroke where symptoms come abruptly. Migraine aura starts gradually and progresses over a period of a few minutes.

How long does a migraine aura last?

Migraine aura symptoms usually appear over a 5–20 minute period and can last for up to 60 minutes or more.

How do you treat a migraine aura?

The methods of treating migraine with aura are similar to those used to treat a common migraine. These methods can include medication, the use of medical devices, lifestyle changes and home remedies.

When to see a doctor about my migraine aura?

If you are experiencing a migraine with aura, you should book a GP appointment as soon as possible to consult with your doctor on your symptoms. You should see a doctor immediately if your symptoms:

  • Start abruptly
  • Last longer than one hour or do not resolve completely
  • Only affect one eye
  • Are different from previously established aura symptoms (change in characteristics of aura)
  • Symptoms do not completely resolve with time
Important

If you have sudden neurological symptoms such as weakness on one side, loss of vision, slurred speech or lose the ability to speak you should call 999. These symptoms can be due to a migraine but can also be symptoms of more serious conditions such as a stroke.

CHAPTER FOUR

Unusual types of migraine

People can experience migraines in different ways. The two main types of migraines are migraines with aura and migraines without aura. The others are uncommon or even rare.

We have some useful information in this chapter to help you understand the different types of migraines and identify which you may be experiencing. We can help with:

  • What are the different types of migraines?
  • How do you know what type of migraine you have?

Acephalgic migraine

A migraine without head pain is also known as a silent or acephalgic migraine. With this type of migraine, you may not experience head pain, however, you may experience an aura, visual disturbances, nausea and other symptoms associated with a migraine. People who experience these migraines are likely to experience other types of migraines and they are set off by common migraine triggers.

Important

If you start having this as a new symptom over the age of 50 years old, you would need to see your GP for further investigations. The main reason to consult your GP is that such symptoms may well represent stroke and will need further investigation.

Hemiplegic migraine

It is a rare type of migraine that can feel similar to a stroke. It often runs in families. With this type of migraine, you may experience temporary weakness or paralysis on one side of the body. It may accompany other symptoms such as visual disturbances, the sensation of “pins and needles” and a loss of sensation in one side of the body. This type of migraine may not always include serious head pain. Hemiplegic migraine can be disabling but usually resolves within 24 hours.

Retinal migraine

A retinal migraine is another rare type of migraine aura with or without headache. Retinal migraine affects vision in one eye. It can cause you to lose vision temporarily or see flickering lights in one eye. This type of aura usually accompanies a migraine headache but usually lasts less than an hour. It typically affects women during their childbearing years and most people who experience this are under 40. It may also run in families.

If you are experiencing a retinal migraine, you should book a doctor's appointment as soon as possible as this can be an indication of a serious issue.

Chronic migraine

You may be suffering from a chronic migraine if you experience migraine for over half each month for three months in a row. The migraines may be with or without aura. The intensity and severity of the head pain you experience throughout this time can vary. You may also mistake the migraine headache for a sinus or tension headache.

Migraine with brainstem aura

Formerly known as basilar-type migraine, brainstem aura is a rare type of aura with symptoms on both arms or legs and symptoms related to your brainstem i.e., vertigo, slurred speech, tinnitus, double vision (diplopia).

Vestibular migraine

A vestibular migraine is a type of migraine caused by problems associated with the balance system. With this type of migraine, you may not always experience a headache but it can cause repeated dizziness (or vertigo). It is more common in females. Other symptoms of vestibular migraines include:

  • Sensitivity to sound
  • Nausea and vomiting
  • Balance problems and feeling unsteady
  • Disorientation or confusion
  • Extreme motion sensitivity

Abdominal migraine

Abdominal migraine is a type of migraine seen most commonly in children aged 5 to 9 years old but it can occur in adults as well. The main symptom of abdominal migraine is abdominal pain. This can occur in the middle of the abdomen. Other symptoms of this migraine include loss of appetite, nausea, vomiting and pallor. This type of migraine usually lasts anywhere from 2 to 72 hours. Children experiencing these migraines may grow out of it and start experiencing migraine headaches later in life.

If you or your child are experiencing abdominal pains, it is important to see a doctor as soon as possible as this can be the result of underlying gastrointestinal, urogenital or metabolic conditions.

Menstrual migraine

Many women experience a migraine around the approach and/or during the time of their menstrual period. Whilst many women report that menstruation is a migraine trigger, there is a specific condition known as ‘menstrual migraine’.

Menstrual migraine is associated with changing levels of hormones which occur 2-3 days before the start of a menstrual period and possibly during the first 3 days of the period. This type of migraine affects less than 10% of women. There are no tests available to confirm the diagnosis, so the only accurate way to tell if you have menstrual migraine is to keep a diary for at least three months recording both your migraine attacks and the days you menstruate. This will also help you to identify non-hormonal triggers that you can try to avoid during the most vulnerable times of your menstrual cycle. If you have migraine and heavy periods, taking an anti-inflammatory painkiller such as mefenamic acid could help. Mefenamic acid is an effective migraine preventive and is also considered to be helpful in reducing migraine associated with heavy and/or painful periods. A dose of 500 mg can be taken three to four times daily. It can be started 2 to 3 days before the expected start of your period. If your periods are not regular, it can be effective when started on the first day. It is usually only needed for the first two to three days of your period. If your periods are irregular your doctor may suggest other ways to try and maintain your oestrogen levels at a more stable rate such as a combined oral contraceptive pill to help with the headache symptoms.

CHAPTER FIVE

How to treat a migraine attack?

You may be wondering what is the best way to treat a migraine attack. There are different medications and methods for treating migraines available to you.

There is no cure for migraines but the most common way people treat migraines is by taking painkillers. It is helpful to keep a headache diary to record your symptoms and triggers in order for you to be treated in the most effective way.

To learn more about your treatment options and what may work best for you, this chapter has some helpful information. We can help with:

  • How do you get rid of a migraine headache?
  • How can I get relief from other migraine symptoms such as nausea and/or vomiting?

Painkillers for migraine headaches

Many people who experience migraine headaches find that over-the-counter painkillers can relieve their symptoms. However, if you choose to use painkillers it is important:

  • Not to overuse them as they can cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract. We commonly advise not to exceed painkiller intake to more than two days a week.
  • Ensure that the painkiller does not have codeine or other opiate analgesic as they increase the risk of medication overuse headaches.

Some painkillers you can try include:

  • Ibuprofen (Advil, Motrin IB, others)
  • Paracetamol
  • Aspirin

Triptans for migraines

Triptans are specific remedies for the treatment of acute migraine headache and some of them are available over the counter. Your GP may be able to prescribe triptans if the simple painkillers, given above, are not adequately working. These are available as pills, injections or nasal sprays. They work by narrowing blood vessels around the brain as the widening of blood vessels is believed to be part of the migraine process. Taking too many triptans can also lead to medication overuse headaches. Some triptans include:

  • Sumatriptan (Imitrex, Tosymra)
  • Rizatriptan (Maxalt)
  • Naratriptan (Naramig)
  • Zolmitriptan (Zomig)

Acute medication should be taken early while pain is mild. If you have aura, triptans should be taken at the start of the headache and not at the start of the aura (unless the aura and headache start simultaneously).

Important

Please note triptans may not be safe for those at risk of a stroke or heart attack.

Anti-sickness medicines

Anti-sickness medicines are also known as antiemetics and they can be used by those who experience nausea and vomiting with migraine headaches. They should be taken as soon as your migraine symptoms start. Your GP may prescribe these to you and advise you to take them alongside painkillers or triptans. These medicines can come with some side effects such as drowsiness and diarrhoea.

Combination medicines

It may be useful to take combination medicines which act as painkillers and anti-sickness medicines. You are able to purchase these medicines at your local pharmacy without needing a prescription from your doctor. However, these combination medicines may not have a high enough dose of painkillers or anti-sickness medicine to relieve your symptoms effectively. In this instance, you may want to take both medications separately.

Medical devices for migraines

There are some medical devices that may reduce the symptoms of migraines by affecting the brain in different ways. These medical devices include a Cefaly device and a single-pulse transcranial magnetic stimulation (sTMS).

A Cefaly is a device that can be worn as a headband around the head for 20 minutes a day. This device was designed for migraine prevention and some research has shown it to be promising in reducing migraine symptoms in some individuals.

A sTMS is a device that can be placed on the head which uses pulses of magnetic energy to reduce the severity and frequency of migraines. However, these can only be used under prescription and are not appropriate for everyone.

A specialist for migraines

You may be referred to a specialist if adequate treatment, as above, is not controlling your symptoms or the attacks are so frequent that they are seriously affecting the quality of your life. At times, a GP may be unsure about the diagnosis and may choose to refer you much earlier before offering you any treatment. The specialist can further investigate your symptoms and recommend treatment that is right for you.

Acupuncture for migraines

Some individuals have found acupuncture to be an effective remedy for migraines when medications are not working to ease their symptoms. For this treatment, you may have to pay for it privately as most GP surgeries do not offer acupuncture treatment for migraines.

CHAPTER SIX

Home remedies for migraines

If you are experiencing migraine symptoms for the first time, it may be a good idea to try home remedies and lifestyle changes to ease your symptoms. You should consult your doctor to confirm that the symptoms you are experiencing are due to migraine and not another cause.

Your migraine symptoms may be set off by triggers within your environment or lifestyle. To better understand how you can effectively ease your migraine naturally, this chapter has some helpful information. We can help with:

  • How do you treat migraines naturally?
  • What is the home remedy for migraine headaches?

Home remedies for migraine relief

If you’re looking for natural remedies to ease your migraines, there are many treatments you can try such as:

  • A hot or cold compress applied to the area of your head where the pain is most prominent.
  • A magnesium supplement. Magnesium is helpful for menstrual-related migraines and migraines with aura.
  • Lavender essential oil can be inhaled directly or applied diluted to the temples.
  • Drinking enough water as dehydration can trigger migraine headaches.
  • Peppermint oil or a menthol solution can be applied to the forehead and temples can be an effective remedy for migraine headaches.
  • Biofeedback is a relaxation method that teaches you to control autonomic reactions to stress. It can be helpful for migraines triggered muscle tension in stressful situations.
  • Try a relaxing form of exercise like yoga. It is thought to improve mood and release tension in migraine-trigger areas.
  • Mindfulness or meditation have been shown to be effective for migraines
  • Book a massage. A study showed that weekly massages can reduce the frequency of migraines and improve your sleep.
  • Acupressure is a practice where pressure is applied by hands and fingers to specific points on the body to ease pain and other symptoms. A study found that it can also be used to relieve nausea associated with migraines.

Lifestyle changes to treat migraines

To reduce the frequency of your migraines, there are some lifestyle changes you can make, such as:

  • Regular exercise that contributes to easing migraine symptoms such as yoga and tai chi and other mind/body exercises
  • Getting into a good sleep pattern of 7-9 hours of sleep a night can help reduce the frequency and severity of your migraine attacks.
  • Being aware of the foods you drink and eat can contribute to easing your migraine symptoms. Some foods that should be avoided include alcoholic drinks, caffeine, chocolate, matured cheese, processed foods and food additives and preservatives.
  • Stress management techniques such as meditation and biofeedback can also help you fight migraine symptoms.

When to see a doctor for your migraine

Migraine is a very common condition and is typically not a sign of a serious medical issue. You need to see a doctor for your migraine only if:

  • They are more frequent and/or severe
  • There is a change in the characteristic of your usual migraine
  • Migraine has started to affect your quality of life
  • You need to take painkillers more frequently than two days a week
  • Migraine has started to seriously impact on your quality of life

Migraine does not make you immune to any other serious headache condition. If you experience any of the following symptoms (red flags) you must contact your GP immediately:

  • If you experience an abrupt onset of very severe headache (first ever or worst ever)
  • Trouble with your speech, confusion, seizures, personality changes, or inappropriate behaviour
  • Weakness, dizziness, sudden loss of balance or falling, tingling or a feeling of paralysis
  • Blurred vision, double vision, or blind spots
  • Visual symptoms affecting only one eye
  • Headache symptoms after having contact with someone diagnosed with meningitis
  • Fever, shortness of breath, a stiff neck, or rash
  • Headache pain that wakes you up at night
  • Severe nausea and vomiting
  • Headaches that happen after a head injury or accident
  • A new headache that starts for the first time after the age of 50
  • Headaches triggered by coughing, bending, sexual activity or other intense physical activity
  • Decreased level of consciousness or drowsiness

Other common headaches

Other common headaches that are experienced frequently that are often confused with Migraine:

Ice pick headaches

Ice pick headaches are a form of headache which give a sudden, sharp or intense pain to one or both sides of the head. You can often feel these headaches in the temple, eye or side of your head. If you experience sharp pains in the area of your head just past your eye and above your ear, you may be having an ice pick headache. These headaches will usually last only 5 to 30 seconds, however, they can be quite painful.

Cluster headaches

Cluster headaches can be the most intense types of headache. Cluster headaches can cause pain to a large area of the head and are almost always on one side. If you are experiencing a burning pain around and above your eye, at your temple, and moving toward the back of your head, you may be having a cluster headache. These headaches are sometimes accompanied by other symptoms such as red, swollen eyes and a runny nose. It often occurs at the same time every day and many patients wake up in the early hours of the morning with the pain. The attacks usually cluster together into bouts which may last several weeks. It is more common in males where onset is usually between the ages of 20 to 40 years.

Attacks may be triggered by alcohol. Other possible triggers include strong smells such as paints and solvents, nitroglycerine, exercise, and elevated environmental temperature.

Cervicogenic headaches

Cervicogenic headaches are typically set off by pain in your neck or a lesion on the spine. You may feel that the pain is in the back of your head. By visiting a GP, you can pinpoint the location of the pain and decipher what type of headache you are experiencing. Cervicogenic headaches often require medication and sometimes physical therapy and other treatments. Mostly these pains are on one side of the head and neck.

Trigeminal Neuralgia

This is a short sharp stabbing pain very similar to ice pick headaches like an electric shock over the cheek or jaw. This can be precipitated by touching your face, eating, chewing, washing your face, brushing teeth or shaving.

CHAPTER SEVEN

How to prevent migraines?

You may want to take steps to prevent your migraines from occurring and speak to your GP about medications that can help you.

You may notice that your migraine prevention medication may reduce the frequency of your migraines but doesn’t stop them completely. This chapter has some useful information to help you understand the way in which you can prevent migraines. These include measures in your diet, lifestyle, measuring and monitoring your headaches days and may include intake of regular medications. We can help with:

  • How to prevent a migraine?
  • What can cause migraines to get worse?

Food choices for migraines

Your food choices may have an effect on the severity and frequency of your migraine. Fasting, skipping meals and not drinking enough water can trigger migraines. There are certain foods that can also contribute to migraines that you can avoid. Many patients have a combination of various triggers but certain patients can indicate precipitation of their migraine with foods, such as:

  • Chocolate
  • Alcohol (especially red wine and champagne)
  • Processed meats
  • Sweeteners
  • Cheese
  • Caffeine

Preventative migraine medications

There are several preventative medications you can take to help you have fewer migraines and reduce the severity of your migraine headaches. However, these medications can include side effects which you can talk to your GP about. Some preventative medications include:

  • Anti-seizure drugs can work to calm nerve cells in the brain.
  • Beta-blockers may work to prevent migraine headaches. They act to reduce the frequency and duration of migraine. These drugs are usually used to treat high blood pressure and heart disease. Some beta-blockers include Metoprolol (Lopressor, Toprol XL), Propranolol (Inderal, Innopran XL) and Timolol (Blocadren).
  • Antidepressants can affect the level of the brain chemical serotonin, which may be linked to migraines. Some antidepressants include amitriptyline and venlafaxine.
  • Candesartan is a blood pressure medication with anti-migraine effects and is often used when the first line medicines do not work.
  • Botox injections are often used as the preventive therapy in patients with chronic migraine after failure of three first line drugs. These are given as intramuscular injections every three months by a trained clinician with experience in headaches.
  • Ajovy (Fremanezumab) has recently been approved for the prevention of chronic migraine in patients in whom other medication has not worked.
  • Triptans are used to treat migraines when they’re occurring, but one type, frovatriptan (Frova Migard), may help prevent migraines that women get because of their menstrual cycle.

Exercises and stress management for migraines

Strenuous exercise like lifting heavy weights can cause migraines. However, there are some exercises that promote stress relief and reduce the occurrence of migraine headaches. Some of these exercises include yoga, light aerobics, or tai chi. Migraines can also occur after stressful situations. In order to prevent migraines happening, you can try different methods of relaxation such as meditation, yoga, and biofeedback.

Changing your environment for migraines

Migraine triggers are variable for different people. Some experience more migraine in hot weather while others complain more during cold temperatures. For some overcast conditions bring on migraine, while others get more migraines during bright sunshine.

A change in your surroundings may be what is needed to ease your migraines. While the environmental factors cannot always be changed, you can sometimes avoid those triggers. For example, if bright sunshine triggers migraine one can stay indoors during hot sunny weather.

Other environmental factors that can trigger your migraines are flashing or flickering lights, loud noises and strange smells. There are some steps you can take to avoid situations with a lot of sensory stimulation. You can avoid:

  • Driving at night
  • Being in movie theatres
  • Attending clubs or crowded venues
  • The glare from the sun
  • Staring at TV or computer screens without breaks

Keeping a headache diary

To prevent migraines, you should be aware of your migraine triggers and try to avoid them. Keep a headache diary close by and make a note of what happens prior to your migraine. You can make a note of:

  • The weather
  • What foods you eat or drink
  • Your exercise routine
  • Any strong feelings and emotions you may be having
  • What medications you may have taken
  • The frequency and severity of migraine symptoms
CHAPTER EIGHT

Migraines in pregnancy

Many women report improvement in their migraine during pregnancy, although for some migraines may get worse during pregnancy.

This chapter has some helpful information so you can understand pregnancy migraine causes and what you can take to help your migraine symptoms during pregnancy. We can help with:

  • When should I see a doctor?

What causes migraines during pregnancy?

Migraines during pregnancy can be the result of many factors related to pregnancy changes, such as:

  • Hormonal changes
  • Fatigue
  • Tension
  • Blood sugar drops
  • Physical or emotional stress
  • Nasal congestion
  • Overheating
  • Lack of sleep
  • Change in eating patterns
  • Dehydration

New-onset severe migraines are rare in pregnant women, and pre-existing migraine can often improve. Always make sure your GP or midwife checks your blood pressure and performs a urine test in addition to a nerve examination if you experience new onset headaches in pregnancy. This is to rule out development of issues such as pre-eclampsia and cerebral venous thrombosis (blood clots).

What can I take for a migraine when pregnant?

You may be concerned about which drugs are safe to take when you are pregnant and experiencing a migraine. Generally, paracetamol and triptans are safe and effective when taken in a limited way. However, please check with your GP before using any other medication. Typically, nausea medications prescribed to women are safe to use if you are pregnant and experiencing migraine symptoms. Please avoid NSAID and aspirin. Sometimes codeine may be given if the headaches are extremely severe but only if your doctor feels it is really required.appropriate.

Please speak to your GP for further information on what medications are safe to take during pregnancy.

Migraine remedies during pregnancy

There are some pregnancy-safe treatments for the onset of migraines:

  • Lie down in a dark and quiet room and place a cold or warm compress on your neck or forehead for two or three hours. This can help you relax and ease your migraine headache.
  • Talk to your doctor about alternative methods and relaxation exercises that are safe during pregnancy. Tension in your back, neck, and head can cause pressure leading to a migraine.

How to prevent migraines during pregnancy?

There are some steps you can take in order to prevent a migraine from occurring during pregnancy:

  • Keep a migraine journal to keep a record of what you ate, where you were and what you were doing just before you experience a pregnancy migraine. Once you have identified your migraine triggers you can start to avoid these to prevent your migraine.
  • Cut back on stress. Stress is one of the most common triggers of migraines and there are stress-relieving exercises and therapies that can help prevent your migraines such as acupuncture, biofeedback, massage, meditation and yoga.
  • Get enough sleep. It may be difficult to get enough sleep during pregnancy however fatigue can trigger migraines so it is important to get enough of it.
  • Get regular pregnancy-safe exercise. Some exercises that can help reduce the frequency and severity of your migraines include walking and swimming.

Does migraine affect babies during pregnancy?

Although migraines can cause you intense pain, they do not pose a risk to the growth of the baby. Migraines are common during pregnancy and in postpartum. Some women find that migraines decrease in frequency in the last few months of their pregnancy.

When should I be worried about migraines during pregnancy?

If you suspect you are having a migraine during pregnancy, you should see your doctor in order to get diagnosed and find the appropriate treatment that is safe for you and your child. You should also see a doctor if you are getting unexplained, persistent headaches especially if they are accompanied by a fever.

If you are pregnant and experiencing migraines as well as symptoms of dramatic weight gain and puffiness in your hands or face, you should call a doctor immediately. Women who have migraines in pregnancy may be at an increased risk of complications such as hypertension, pre eclampsia and vascular disorders.

Pregnancy migraine myth

It is a common thought that having migraines during pregnancy may indicate that you will give birth to a boy, however, there is not enough evidence to support this myth.

CHAPTER NINE

Complications with migraines

There is no complete cure for migraines, however, migraine symptoms can be treated with natural remedies, lifestyle changes and medications.

Typically, your migraines will not get worse over time, however, they may lead to more serious complications. This chapter has some useful information to help you understand the complications that may arise with migraines. We can help with:

  • What are the complications of migraine?
  • When should you be concerned about migraines?

Status Migrainosus

Status migrainosus, also known as an intractable migraine, is a rare and severe migraine headache. In this condition a patient, often with a previous history of migraine, suffers a continuous migraine. The pain typical of migraine is disabling and goes on longer than a usual migraine attack. The pain and nausea that comes with this type of migraine headache have led to people being hospitalised and needing high doses of migraine medication.

Migrainous Infarction

A migrainous infarction is a stroke that occurs during a migraine attack with aura symptoms. This type of stroke is very rare and the migraine headache with aura will last for longer than an hour. The aura may still be present when the headache disappears. When an aura lasts longer than an hour, this can signal damage to the brain and you should see a doctor immediately. Female patients, particularly those who smoke and take combined oral contraceptive pills, are at a high risk.

Persistent Aura Without Infarction

This type of complication associated with migraines occurs when an aura lasts for longer than a week after a migraine has ended. When you have a persistent aura without infarction, your aura doesn't go away, even after you experience the migraine headache. The aura lasts for more than a week but there is no bleeding in the brain. However, you should see your doctor immediately for a proper diagnosis.

Migralepsy

Migralepsy is another rare condition in which a migraine triggers an epileptic seizure. A migraine-triggered seizure can start with an aura and can occur up to an hour after the migraine. Seizures are typically associated with erratic electrical activity in the brain.

Stroke

Although migraines have not been shown to cause a stroke, if you experience migraine with aura you have a very slightly higher risk of stroke. A stroke can occur when you lose blood supply to your brain due to blood clots or fatty material in your arteries. People who experience migraines may have twice the risk of having a stroke, according to the NHS. The risk is more if you smoke or take combined oral contraceptive pills.

Mental health issues

Migraines may be associated with an increased risk of certain mental health disorders. According to a 2009 study, migraines can precede the occurrence of mental health issues such as:

  • Major depression
  • General anxiety disorder, GAD
  • Bipolar disorder
  • Panic disorder
  • Substance abuse disorders
  • Agoraphobia
  • Post-traumatic stress disorder, PTSD

If you feel you are experiencing the symptoms of any of these disorders, you should seek help from a mental health professional.

CHAPTER TEN

Get same day treatment with Medicspot

A private GP can help diagnose your symptoms and let you know what type of migraine you are suffering from. They will also be able to prescribe the right medication if needed and advise you on the best methods to relieve your migraine symptoms. We can help with:

  • Where is your nearest doctor surgery?
  • And how can Medicspot help?

How it works

Medicspot allows your GP to measure your blood pressure, offer personalised advice, and prescribe medication as needed.

Find your nearest clinic today.

CHAPTER ELEVEN

About the authors

Written by Dr Abby Hyams and Professor Fayyaz Ahmed. Reviewed by Dr Saloni Kapoor. Last reviewed on 15/06/2020. Next review date 15/06/2023.

Dr Abby Hyams

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because of the wide spectrum of people she encounters every day.

Professor Fayyaz Ahmed

Professor Fayyaz Ahmed is a Consultant Neurologist and Professor (Hon) in Clinical Neurology at Hull University Teaching Hospitals NHS Trust and Hull York Medical School. Professor Ahmed graduated from Dow Medical College Karachi, Pakistan in 1986. He moved on to the UK after his residency and received his neurology training at St James’s University Hospital, Leeds and Imperial College London.

He did his research on cerebral blood flow in migraine and clinical training in headache at the Princess Margaret Migraine Clinic, Charing Cross Hospital, London. He was appointed as Consultant Neurologist in Hull in 1996 where he established a dedicated headache clinic.

He did his MBA in Public Sector Management from University of Hull in 2010 and is currently the Educational Officer of the British Association for the Study of Headache (BASH) having served as a Secretary (2005-2008), Vice Chair (2009-2010) and Chair (2011-2013). He was Chair of Headache UK and Director of the European Headache and Migraine Trust International Congress (EHMTIC) and now serves as Trustee of the International Headache Society and Director of Migraine Trust International Symposium. He advises the Association of British Neurologist through advisory group membership and has co-authored the recent BASH guidelines for headache disorders.

Dr Saloni Kapoor

Dr Saloni Kapoor is an enthusiastic and dynamic GP with a varied portfolio. She studied at University College London Medical School and trained as a GP in London. She has a multitude of special interests to include cancer medicine, genitourinary medicine, women’s health, integrative medicine and medical education. Saloni strongly believes in the transformative power of technology and innovation to solve the health challenges of the future and for telemedicine to ensure universal, safe and high-quality access to care for all.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.