A migraine is often recognised by its characteristic throbbing pain on one (more common) or both sides of the head. It can last from between hours to days and may be triggered by different events in different people. In general, women are three times more likely to develop migraines than men. While onset may occur at any time in life, it is most common to first experience migraines in adolescence or early adulthood.

Symptoms

A migraine event may occur as a straightforward attack, or may present in stages. These are:

• prodrome – subtle changes that begin a day or two before a migraine, such as constipation, increased thirst and urination, more frequent yawning, food cravings, stiffness in neck and mood changes
• aura – these may occur before or during a migraine and include visual disturbances such as seeing flashes of light, blind spots or various patterns, pins and needles sensation in limbs, dizziness, difficulty speaking, numbness/weakness in face or side of body, temporary vision loss
• headache/attack – this is the main event that could last from between 4 to 72 hours and is characterised by a throbbing or pulsing pain on one (more common) or both sides of the head, often accompanied by sensitivity to light and sound (sometimes also smell and touch), nausea, vomiting
• post-drome/resolution – involves feeling drained, confused or sometimes elated for about a day after the migraine stops

Complications

Complications associated with migraine are few and may include:

• a relatively low increased risk of ischaemic stroke (believed to be twice as likely)
• a very low increased risk of mental health issues such as depression, anxiety, panic and bipolar disorders

Additionally, long-term and excessive use of painkillers to mitigate frequent migraines could also lead to medication-overuse headaches, where the painkiller subsequently causes headaches rather than counteract the migraine.

Causes

It is not entirely clear what causes migraines, but likelihood appears to be higher if there is a family history of migraines and if the individual is a female (three times more likely). The condition is believed to be associated with temporary abnormal brain activity which imbalances chemicals and/or affects nerve impulses and blood vessels in the brain.

There are several factors that can trigger attacks in people with migraines. These may include:

• hormonal triggers such as changes before or during menstruation (referred to as ‘pure menstrual migraine’), during the menopause and sometimes during pregnancy
• physical triggers such as poor-quality sleep, jet lag, shift work, tiredness, strenuous physical exertion, hypoglycaemia (low blood sugar), neck/shoulder tension
• emotional triggers such as stress, shock, excitement, depression, tension, anxiety
• environmental triggers such as bright/flickering lights or screens, loud noises, strong smells, smoking/smoke, poor ventilation, changes in climate (e.g. temperature, humidity)
• dietary triggers such as irregular meals, dehydration, alcohol, caffeine, foods containing tyramine (e.g. fermented, aged, cured, pickled, smoked food items) or other case-specific foods (e.g. citrus, chocolate)
• medicinal triggers such as the contraceptive pill, hormone replacement therapy (HRT), some sleeping tablets, excessive use of painkillers for migraines

Diagnosis

Experiencing frequent or periodic headaches is the most common means by which a migraine might be suspected or determined. This may be accompanied by nausea, sickness or some of the other symptoms mentioned above, and usually impairs basic everyday activity. There are no specific methods for diagnosing a migraine. Discussing such symptoms with your GP would help to affirm the occurrence of a migraine.

Prevention

It often helps to maintain a ‘migraine diary’ where the sufferer makes note of different factors that they might have been exposed to (see triggers discussed above), duration of attack, any pre-attack warning signs and symptoms experienced. This would help to observe if there are any patterns or activities that can be avoided in order to prevent future attacks. Making note of medication taken and their effect on the attack would also help to understand the best ways to treat and deal with each individual’s migraine attacks.

In addition, it may also help to maintain a healthy lifestyle that includes frequent exercise, regular meal times, a sleep routine, staying hydrated, avoiding excessive alcohol and caffeine and practising relaxation techniques.

Treatment

Treatment for migraine may be aimed at relief or at prevention. Again, different practices or medications may work for different individuals, depending on their symptoms and response to treatment. As such, measures that may be implemented include:

• sleeping or lying down in a cool, quiet, dark room
• placing a cool cloth or ice pack on the forehead or nape of the neck
• taking painkillers (works best if taken at the onset of an attack or when pre-attack warning signs are observed as this allows more time for absorption of the medicine into circulation before the attack climaxes)
• taking triptans (which cause blood vessels around the brain to narrow, thereby potentially reversing the changes that are believed to result in a migraine) – as recommended by a GP
• taking antidepressants (such as amitriptyline), anti-seizure drugs (such as topiramate) or blood pressure-lowering drugs (such as propranolol) which may help to prevent or control migraines – as recommended by a GP
• taking anti-emetic (anti-sickness) drugs to alleviate nausea or sickness
• undergoing acupuncture, particularly in instances where medication cannot be taken
• having botulinum toxin type A injections – in extreme cases where severe symptoms cannot be controlled by medication.

Cover illustration from Freepik