Migraine

Authored by Dr Jacqueline Payne, 23 Nov 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Prof Cathy Jackson, 23 Nov 2017

Migraine causes attacks (episodes) of headaches, often making you feel sick (nausea) or causing you to be sick (vomit). Treatment options include avoiding possible triggers, painkillers, anti-inflammatory painkillers, anti-sickness medicines, and triptan medicines. A medicine to prevent migraine attacks is an option if the attacks are frequent or severe.

Migraine is a condition that causes attacks (episodes) of headaches. Other symptoms such as feeling sick (nausea) or being sick (vomiting) are also common. Between migraine attacks, the symptoms go completely.

Migraine is common. About 1 in 4 women and about 1 in 12 men develop migraine at some point in their lives. It most commonly first starts in childhood or as a young adult. Some people have frequent attacks - sometimes several a week. Others have attacks only now and then. Some people may go for years between attacks. In some people, the migraine attacks stop in later adult life. However, in some cases the attacks continue throughout life. Read about migraine symptoms.

There are two main types of migraine attack:

  • Migraine attack without aura - sometimes called common migraine.
  • Migraine attack with aura - sometimes called classic migraine.

Migraine without aura

This is the most common type of migraine. Symptoms include a headache, usually on one side of the head, feeling or being sick, and often a desire to get away from bright lights and loud noises.

Migraine with aura

About 1 in 4 people with migraine have migraine with aura. The symptoms are the same as those for migraine without aura, but also include a warning sign, called an aura, before the headache begins. The aura can be:

  • Visual - seeing bright lights, getting a large blind spot or things seeming to move about - for example, letters on a page bouncing or shaking.
  • Pins and needles and numbness - particularly in the hand moving to your arm and then your face.
  • Having difficulty talking.
  • Smelling something odd or craving certain foods can also be auras.

If you get a migraine with aura you may have one or more of these symptoms at the same time but they will usually go before the pain of the headache arrives.

Read more about migraine symptoms.

Less common types of migraine

There are various other types of migraine which are uncommon, and some more types which are rare. These include:

Menstrual migraine. The symptoms of each attack are the same as for common migraine or migraine with aura. However, the migraine attacks are associated with periods (menstruation). Menstrual migraine occurs when you have a migraine attack around most periods that starts at any time from two days before to three days after the first day of a period. It may be useful to keep a diary of your migraines to see whether you have menstrual migraine. There are two patterns:

  • Pure menstrual migraine occurs when migraine attacks happen only around periods and not at other times. This occurs in about 1 in 7 women who have menstrual migraine.
  • Menstrual-associated migraine occurs when migraine attacks happen around periods but also happen at other times too. About 6 in 10 women who have menstrual migraine have this type of pattern.

Symptoms of menstrual migraine usually improve if you become pregnant, because during pregnancy there is a constant high level of oestrogen. As you approach the menopause, menstrual migraine attacks may become more frequent because your level of oestrogen tends to go up and down at this time. Once past the menopause, you have a constant stable low level of oestrogen, and menstrual migraine attacks tend to reduce. Treatment of each migraine attack is the same as for any other type of migraine. However, there are treatments that may prevent menstrual migraines from occurring. Read about prevention of menstrual migraine.

Abdominal migraine. This mainly occurs in children.  Often, as they get older, they get a common type of migraine, either with or without aura, instead. It mainly causes tummy (abdomonal) pain. Read more about symptoms of abdominal migraine.

Ocular migraine. This is sometimes called retinal migraine, ophthalmic migraine or eye migraine. Read more about the symptoms of ocular migraine.

Hemiplegic migraine. This is rare. It causes temporary weakness of one side of the body. Read more about the symptoms of hemiplegic migraine.

Vestibular migraine may affect up to one in a hundred people. It causes recurring episodes of severe dizziness (vertigo) alongside other typical migraine symptoms and lasts between 5 minutes and 72 hours. Read more about the symptoms of vestibular migraine.

Basilar-type migraine. This is rare. The basilar artery is in the back of your head. It used to be thought that this type of migraine originated due to a problem with the basilar artery. It is now thought that this is not the case, but the exact cause is not known.

Symptoms typically include headache at the back of the head (rather than one-sided as in common migraine). They also tend to include strange aura symptoms such as:

  • Temporary loss of vision.
  • Double vision.
  • Dizziness.
  • Ringing in the ears.
  • Jerky eye movements.
  • Trouble hearing.
  • Slurred speech.

Unlike hemiplegic migraine, basilar-type migraine does not cause weakness. There is an increased risk of having a stroke with this type of migraine. Important note: see a doctor urgently if you develop the symptoms described for basilar-type migraine (particularly if they occur for the first time). There are other causes of these symptoms (such as a stroke) and these need to be ruled out before basilar-type migraine can be diagnosed.

Chronic migraine is thought to affect 1 in 50 people, who experience headaches on at least 15 days per month with other related migraine symptoms on at least eight days.

Migraine is usually diagnosed by the typical symptoms. There is no test to confirm migraine. A doctor can usually be confident that you have migraine if you have typical symptoms and by an examination which does not reveal any abnormality. However, some people with migraine have non-typical headaches. Therefore, sometimes tests are done to rule out other causes of headaches. Also, with some uncommon or rare types of migraine such as ocular migraine, tests are sometimes done to rule out other causes of these symptoms. (For example, temporary loss of vision can be due to various causes apart from ocular migraine.)

Remember, if you have migraine, you do not have symptoms between attacks. It is the episodic nature of the symptoms (that is, they come and then go) that is typical of migraine. A headache that does not go, or other symptoms that do not go, are not due to migraine.

Tension headaches are sometimes confused with migraine. These are the common headaches that most people have from time to time. See separate leaflet called Tension-type Headache for more details. Note: if you have migraine, you can also have tension headaches at different times to migraine attacks.

Cluster headaches may also be confused with migraine. Cluster headaches are attacks of severe one-sided pain in the head, usually centred in or around one eye or temple, which occur in groups or clusters. The pain is extremely severe and can be accompanied by eye watering, eyelid drooping and facial sweating on the affected side. Cluster headaches usually last 45-90 minutes. See separate leaflet called Cluster Headaches for more information.

If you take painkillers too often for any kind of headache you may develop medication-induced headache, sometimes also called an analgesic headache. You can read more about this type of headache in the treatment section of this leaflet.

The cause is not clear. A theory that used to be popular was that blood vessels in parts of the brain become narrower (go into spasm) which accounted for the aura. The blood vessels were then thought to open wide (dilate) soon afterwards, which accounted for the headache. However, this theory is not the whole story and, indeed, may not even be a main factor. It is now thought that some chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms. The exact changes in brain chemicals are not known. It is also not clear why people with migraine should develop these changes. However, something may trigger a change in activity of some brain chemicals to set off a migraine attack.

The cause or trigger to menstrual migraine (see above) is thought to be the fall of the level of oestrogen that occurs at this time in the cycle. Oestrogen is one of the chemicals (hormones) that control the menstrual cycle. The blood level of oestrogen falls just before a period. It is not a low level of oestrogen that is thought to be the trigger, but the drop in the level of oestrogen from one level to another.

Migraine is not classed as an inherited condition. However, it often occurs in several members of the same family. So, there is probably some genetic factor involved. Therefore, you are more likely to develop migraine if you have one or more close relatives who have migraine.

Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:

  • Diet. Dieting too fast, irregular meals, cheese, chocolate, red wines, citrus fruits, foods containing a food additive called tyramine and not drinking enough water (dehydration).
  • Environmental. Smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
  • Psychological. Depression, anxiety, anger, tiredness, stress, etc. Many people with migraine cope well with stress but have attacks when they relax, leading to so-called weekend migraine.
  • Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill. See separate leaflet called Migraine and see separate leaflet called Migraine and Combined Hormonal Contraception for more details.
  • Other. Periods (menstruation), shift work, different sleep patterns, and the menopause.

It may help to keep a migraine diary. Note down when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that may trigger your migraine attacks. See separate leaflet called Migraine Trigger Diary. This gives more details and includes a diary that you can print out and fill in.

There are various treatments for a migraine attack, from simple painkillers to migraine medication which is specifically for migraine, such as triptans.

There are also various treatments you can take to prevent migraine attacks, if you have frequent or severe attacks. It may not stop all attacks, but their number and severity are often reduced. Medicines to prevent migraine are taken every day. They are not painkillers and are different to those used to treat each migraine attack.

Read about treatment for migraine and treatments to prevent attacks.

Some points to note about migraine in children include the following:

  • Migraine is common in children. It affects about 1 in 10 children of school age.
  • Symptoms can be similar to those experienced by adults. However, sometimes symptoms are not typical. For example, compared with adults, attacks are often shorter, and pain may be on both sides of the head. Also, associated symptoms such as feeling sick (nausea) and being sick (vomiting) may not occur.
  • Abdominal migraine (described earlier) mainly affects children.
  • Common triggers in children include missing meals, lack of fluid in the body (dehydration), and irregular routines. So, if a child is troubled with migraine attacks, it is important to try to have regular routines, with set meals and bedtimes. Also, encourage children to have plenty to drink.
  • Many of the medicines used by adults are not licensed for children. Find out more about migraine medication for children.

The good news is that about 2 in 3 women with migraine have an improvement whilst pregnant or breast-feeding. However, about 1 in 20 women with migraine find that their migraine gets worse whilst pregnant.

The bad news is that many of the medicines used to treat migraine should not be taken by pregnant or breast-feeding women.

Learn more about migraine medication when pregnant or breast-feeding.

Further reading and references

Migraine Trigger Diary

Hi all, I decided to become a member and make a post here after reading the forums for quite a while, great site by the way. I am currently suffering with various symptoms and am in a bad way and...

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