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Migraine Information

What is a migraine?

Migraine is a complicated condition involving headache, which is often associated with unpleasant symptoms such as pain, sensitivity to light and noise, visual disturbances, dizziness, and feeling and/or being sick. Migraine attacks generally last 4–72 hours, and are recurring, Symptoms during an attack vary between individuals and between attacks for any one individual, but are absent between attacks.

Migraines are not all the same. They have been classified according to symptoms, and include:

• Migraine without aura, characterised by a throbbing headache, pain, nausea and vomiting, light sensitivity, and intolerance to movements of the head
• Migraine with aura, characterised by neurological symptoms (visual or other sensory disturbances) as the headache begins, in addition to the symptoms of migraine without aura
• Migraine with aura without headache, characterised by the absence of the headache but with the other symptoms of a migraine with aura

Generally, migraines are comprised of different phases, which may vary:

• Premonitory or prodromal phase (a warning, when some individuals experience unusual mood changes, tiredness, excitability, or have food cravings)
• Aura phase (if it develops)
• Predominant attack phase (severe headache and/or other symptoms)
• Resolution phase (relief of the headache)
• Recovery or postdromal phase (a ‘morning after’ feeling)

Do all people experience migraines?

Migraine is a very common condition, affecting about 1 in 5 women and 1 in 12 men. It has a heritable element, so often affects several family members. Migraines are experienced by individuals of all ages, including very young children, but usually begin in adolescence or early in adulthood. Most sufferers have at least one attack a month, but this varies considerably.

What causes migraine rather than a headache?

The exact cause of migraine remains unknown but its origins lie in the way our brain and nervous system handles the sensory information it receives, including from sight (light), sound (noise), and feeling (pain). The migraine begins following chemical changes in the brain, which cause the brain to perceive and thus react in an unusual way to that which is normal. For example, we experience visual disturbances, an increased sensitivity to light and sound, dizziness, or sensations such as prickling. Blood vessels in the brain also change in size; particularly they become wider during a migraine attack.

In contrast, what we call a headache (as opposed to a migraine headache) is generally caused by specific factors, including alcohol, stress/tension, health conditions, infection, and too frequent use of painkillers (also known as medication overuse headache).

Migraines can be brought on by many factors known as ‘triggers’, which vary between individuals. Triggers include:

• Diet: foods and their constituents, such as cheese, chocolate, red wine, caffeine, and additives; hunger and irregular meals; and thirst
• Psychological factors such as stress, depression, and anxiety
• Medicines and women’s hormonal changes
• Lifestyle: sleep, exercise, and environment

While it is very difficult to be certain of any one trigger, it is recommended that people who suffer migraine write their experiences in a ‘migraine diary’ to determine possible causes. These should report:

• Migraine factors such as time the migraine began and ended, and symptoms
• Every-day life factors around the time that the migraine occurred such as diet, exercise, emotions, medication, and menstruation

Migraine diagnosis and treatment

Migraine is usually diagnosed by the symptoms experienced during an attack and by the lack of symptoms when between attacks. Migraine is treated either when it starts (acute therapy) or before it starts (preventative or prophylactic therapy).

The aim of acute migraine therapy is to eliminate the symptoms. These medicines include painkillers, e.g., aspirin, paracetamol, and. Ibuprofen, medicines to stop you feeling or being sick, and migraine medicines called triptans or egotamine. Taken once the headache begins, triptans work in the same way as serotonin, a natural brain chemical, by narrowing the widened blood vessels in the brain.

Preventative therapies are usually taken by people who find their migraine does not respond to acute medications and/or significantly disrupts their work and social life. They aim to reduce the number, frequency, and severity of the attacks, and include medicines known as beta-blockers, antidepressants, anticonvulsants, methysergide, and Botox. These medicines tend to either affect chemicals in the brain or the ability of nerves to transmit pain.

Does a migraine warrant a doctor attention?

A doctor’s opinion is recommended to assess which medicine is most suitable for your migraines. Attention should be brought to frequent or severe migraines, even if they disappear after prescription or non-prescription medicines. In case of a more serious condition, contact your doctor if you experience sudden agonising pain, one-sided face or body paralysis, difficulty with speech, double vision, headache associated with a high temperature, or a rash.