Migraine is a condition causing repeated attacks of moderate to severe headache, often on one side and throbbing, usually with nausea and a strong dislike of light and sound.
Go to hospital immediately if you notice
- A sudden, severe headache that reaches maximum intensity within seconds — 'the worst headache of my life'
- Headache with fever and a stiff neck, or with a rash
- Headache with weakness, numbness, confusion or difficulty speaking
- Headache after a head injury
- A new, persistent headache starting after about age 50
- Headache that consistently wakes you from sleep or is worst on waking
- Any of these need urgent medical assessment — they are not typical migraine
Overview
Migraine is not simply a bad headache. It is a neurological condition in which the brain is unusually sensitive to changes, and attacks follow a recognisable pattern.
An attack typically lasts from four hours to three days if untreated. Between attacks, people are usually completely well.
About one in three people with migraine get an aura — a warning that comes before the pain, most often flickering zigzag lines, blind spots or shimmering in the vision, lasting up to an hour.
Migraine is very common, more so in women, and is one of the leading causes of days lost to disability worldwide. It is also frequently dismissed as 'just a headache', which delays treatment that works.
Symptoms of Migraine
- Throbbing or pulsing headache, often on one side, though it can be on both
- Pain that gets worse with movement, climbing stairs or bending
- Feeling sick, and sometimes vomiting
- Strong dislike of bright light and loud sound; many people need a dark, quiet room
- Sensitivity to smells
- Aura before the headache in some people — flickering lines, blind spots, or tingling spreading up an arm
- Feeling drained and foggy for a day or so afterwards
What causes it
- Changes in nerve signalling and blood vessels in the brain, in a person whose brain is genetically more sensitive
- It is not caused by 'weakness', 'gas' or eye strain, though eye problems can cause a different sort of headache
- Attacks are set off by triggers, which differ from person to person
Who is at higher risk
- A family history of migraine
- Being female — hormonal changes are a common trigger
- Skipping meals and going long periods without eating
- Too little or too much sleep, and irregular sleep timing
- Stress, and also the period of relief after stress
- Dehydration
- Bright or flickering light, and long screen sessions without breaks
- Some people find specific foods, alcohol or strong smells trigger attacks
Tests and diagnosis
These are the tests doctors commonly use. Which ones you need depends on your symptoms.
- Diagnosed from the pattern of your attacks — a scan is not normally needed
- Keeping a headache diary for a few weeks is genuinely useful: note the date, how long it lasted, what you had eaten and slept, and what medicine you took
- Brain imaging is reserved for people with warning signs or an unusual pattern
- Your doctor will also check whether painkiller overuse is contributing
Treatment
- Treat an attack early. Medicine taken at the first sign works considerably better than the same medicine taken hours later.
- Simple painkillers help many people. Specific migraine medicines called triptans are available on prescription for attacks that do not respond.
- Anti-sickness medicine is sometimes added, since nausea can prevent tablets being absorbed.
- A dark, quiet room, and sleep if you can manage it.
- If you have attacks frequently, preventive medicines taken daily can reduce how often they come. These are different from painkillers and are prescribed by a doctor.
- Beware of medication-overuse headache — see the question below.
Prevention
- Eat regularly; do not skip meals
- Keep sleep and waking times consistent, including at weekends
- Drink enough water through the day
- Identify your own triggers with a diary, rather than cutting out foods at random
- Take breaks from screens and manage glare
- Regular, gentle exercise means fewer attacks for many people
- Limit how often you take painkillers for headache
When should you see a doctor?
See a doctor if headaches are frequent, disabling, or need painkillers more than about twice a week. Seek urgent care for a sudden severe headache, a headache with fever and neck stiffness, or one with weakness, confusion or difficulty speaking.
Frequently Asked Questions
How is migraine different from a normal headache?
A tension headache is usually a steady, band-like tightness on both sides and lets you carry on with your day. Migraine is more often one-sided and throbbing, gets worse with movement, and comes with nausea and dislike of light and sound — usually forcing you to stop what you are doing.
Can taking too many painkillers cause headaches?
Yes, and it is common and often missed. Taking painkillers for headache on more than about ten to fifteen days a month can lead to medication-overuse headache, where the treatment itself keeps a near-daily headache going. Getting out of it requires a doctor's guidance.
Does migraine mean something is wrong in my brain?
No. Migraine is a disorder of how the brain processes signals, not a sign of damage or a tumour. Scans are normal in the great majority of people with typical migraine, which is why they are not routinely done.
Will migraine go away as I get older?
For many people attacks become less frequent and less severe with age. In women they often change around menopause. It varies a great deal between individuals.
Questions to ask your doctor about Migraine
Pick the three that matter most to you and write them down before your appointment. Consultations are short, and almost everyone forgets at least one.
- Is this migraine, and how do you know?
- Should I be taking something to prevent attacks, not just treat them?
- How many days a month is it safe to take painkillers?
- Could my current painkiller use be making the headaches worse?
- Do I need a scan, and if not, why not?
- What headache symptoms would mean going to hospital?