Migraine
A migraine is usually a severe headache felt as a throbbing pain at the front or side of the head.
Some people also have other symptoms, such as nausea, vomiting and increased sensitivity to light or sound.
Migraine is a common health condition, affecting around one in every five women and around one in every 15 men. They usually begin in early adulthood.
There are several types of migraine, including:
migraine with aura where there are warning signs before the migraine begins, such as seeing flashing lights
migraine without aura where the migraine occurs without warning signs
migraine aura without headache, also known as silent migraine where an aura or other migraine symptoms are experienced, but a headache does not develop
Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It is possible for years to pass between migraine attacks.
Symptoms of a migraine
The main symptom of a migraine is usually an intense headache that occurs at the front or on one side of the head.
The pain is usually a severe throbbing sensation that gets worse when you move and prevents you from carrying out normal activities.
In some cases, the pain can occur on both sides of your head and may affect your face or neck.
Additional symptoms
Other symptoms commonly associated with a migraine include:
nausea vomiting
increased sensitivity to light and sound, which is why many people with a migraine want to rest in a quiet, dark room
Some people also occasionally experience other symptoms including sweating, poor concentration, feeling very hot or very cold, abdominal (tummy) pain and diarrhoea.
Not everyone experiences these additional symptoms when they have a migraine and some people may experience them without having a headache.
The symptoms of a migraine usually last between four hours and three days, although you may feel very tired for up to a week afterwards.
Symptoms of aura
About one in three people with migraines have temporary warning symptoms, known as aura, before a migraine. These include:
visual problems, such as seeing flashing lights, zig-zag patterns or blind spots
numbness or a tingling sensation like pins and needles,which usually starts in one hand and moves up your arm before affecting your face, lips and tongue
feeling dizzy or off balance
difficulty speaking
loss of consciousness, although this is rare
Aura symptoms typically develop over the course of about five minutes and last for up to an hour. Some people may experience aura followed by only a mild headache or no headache at all.
When to seek medical advice
You should see your GP if you have frequent or severe migraine symptoms that cannot be managed with over the counter painkillers, such as paracetamol.
You should also make an appointment to see your GP if you have frequent migraines (on more than five days a month), even if they can be controlled with medication, as you may benefit from preventative treatment.
Call your doctor immediately if you or someone you are with experiences:
paralysis or weakness in one or both arms and/or one side of the face
slurred or garbled speech
a sudden agonising headache resulting in a blinding pain unlike anything experienced before
headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision, and a rash
These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.
Causes migraines
The exact cause of migraines is unknown, although they are thought to be the result of temporary changes in the chemicals and blood vessels in the brain.
Around half of all people who experience migraines also have a close relative with the condition, suggesting that genes may play a role.
Some people find migraine attacks are associated with certain triggers, which can include starting their period, stress, tiredness and certain foods or drinks.
Treating migraines
There is currently no cure for migraines, although a number of treatments are available to help ease the symptoms.
It may take time to work out which is the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.
If you find that you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.
Painkillers
Many people who have migraines find that over the counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms.
They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.
It is not advisable to wait until the headache worsens before taking painkillers because by this point it is often too late for the medication to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good alternative because they are absorbed quickly by your body.
If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus.
Cautions
When taking over the counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.
Children under 16 should not take aspirin unless it is under the guidance of a healthcare professional. Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver problems or kidney problems.
Taking any form of painkiller frequently can make migraines worse. This is sometimes called medication overuse headache or painkiller headache.
Speak to your GP if you find yourself needing to use painkillers repeatedly or if over the counter painkillers are not effective. Your GP may
prescribe stronger painkillers or recommend using painkillers along with triptans. If they suspect the
frequent use of painkillers may be contributing your headaches, they may recommended that you stop using them.
Triptans
If ordinary painkillers are not helping to relieve your migraine symptoms, you should make an appointment to see your GP. They may recommend taking painkillers in addition to a type of medication called a triptan and possibly anti-sickness medication.
Triptan medicines are not the same as painkillers. They are thought to work by reversing the changes in the brain that may cause migraines.
They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process.
Triptans are available as tablets, injections and nasal sprays.
Common side effects of triptans include warm-sensations, tightness, tingling, flushing, and feelings of heaviness in the face, limbs or chest. Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own.
Your GP will usually recommend having a follow-up appointment when you have finished your first course of treatment with triptans, so you can discuss whether they were effective and whether you had any side effects.
If the medication was helpful, treatment will usually be continued. If they were not effective or caused unpleasant side effects, your GP may try prescribing a different type.
Anti-sickness medicines
Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you dont experience nausea or vomiting. These are prescribed by your GP and can be taken alongside painkillers and triptans.
As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet, but are also available as a suppository.
Side effects of anti-emetics include drowsiness and diarrhoea.
Combination medicines
You can buy a number of combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which one is best for you, ask your pharmacist.
Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be high
enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each.
Treatment for pregnant and breastfeeding women
In general, migraine treatment with medicines should be limited as much as possible when you are pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is often recommended.
If medication is essential, then your GP may prescribe you a low-dose painkiller, such as paracetamol. In some cases, anti-inflammatory drugs or triptans may be prescribed. Speak to your GP or midwife before taking medication when you are pregnant or breastfeeding.
Preventing migraine
There are a number of ways you can reduce your chances of experiencing migraines.
Identifying and avoiding triggers
One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them.
You may find you tend to have a migraine after eating certain foods or when you are stressed and by avoiding this trigger, you can prevent a migraine.
Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you are taking is working.
In your migraine diary, try to record:
the date of the attack
the time of day the attack began
any warning signs
your symptoms (including the presence or absence of aura)
what medication you took
when the attack ended
Acupuncture
If medication is unsuitable, or it doesnt help to prevent migraines, you may want to consider acupuncture.
A course of up to 10 sessions over a five to eight week period may be beneficial.
Source: NHS Choices, UK
