What is migraine?
Migraine is a neurological condition that presents as recurrent attacks of moderate or severe headache, often on one side of the head and throbbing in character. Attacks are usually accompanied by nausea and sensitivity to light and sound.
Migraine is one of the most common types of headache and is more frequent in women. Without treatment an attack usually lasts from 4 to 72 hours. Although migraine cannot be completely “cured”, the frequency and severity of attacks can be reduced considerably with correctly chosen treatment.
What are the causes and triggers of migraine?
Genetic factors are foremost among the main causes of migraine. If someone in your family has migraine, your risk of developing it is higher. During an attack, the activity of nerve cells in the brain and processes involving the blood vessels change.
Another important cause of migraine pain is hormonal change: in women, attacks may be more frequent and more severe around menstruation. Triggers vary from person to person.
- Stress, or the period of relaxation after stress
- Lack of sleep or oversleeping
- Long gaps between meals, not drinking enough water
- Alcohol, too much caffeine or suddenly stopping caffeine
- Bright light, strong smells, noise
- Changes in the weather
What are the symptoms of migraine?
The main symptom of migraine is a severe headache; it can be so intense that the person has to stop their daily activities. The pain is often felt in the forehead, temple, eye or behind the eye, sometimes spreads to the back of the head and gets worse with physical activity. An attack may pass through several phases.
- Warning phase — hours or even a day or two before the attack: tiredness, yawning, mood changes, reduced concentration, cravings for certain foods.
- Aura — in some patients, before the pain: temporary visual disturbances (lines of light, shimmering, blank spots in the field of vision), numbness or difficulty speaking; it usually lasts less than an hour.
- Headache phase — throbbing pain, nausea, vomiting, sensitivity to light, sound and smell.
- Post-attack phase — weakness, a “heavy head”, difficulty concentrating.
When is emergency help needed?
In the following situations call 103 without waiting or go to an emergency department.
- A sudden headache that is “the worst of my life”
- Headache together with weakness on one side of the body, speech or vision problems, or confusion — especially if it happens for the first time
- Headache together with a high temperature, neck stiffness or a rash
- Headache that develops after a head injury
- An aura that lasts longer than an hour, or an attack lasting more than 72 hours
Rarely, some patients may experience temporary weakness during an aura, but weakness, speech or vision problems occurring for the first time require urgent assessment to rule out serious causes such as stroke. Read more: Headache warning signs.
How is migraine diagnosed?
The diagnosis of migraine is mainly clinical: the doctor asks about the character and duration of the attacks, accompanying symptoms and family history, and carries out a detailed neurological examination. When the complaints are typical of migraine and the neurological examination is normal, additional imaging is often not needed. If the character of the headache has changed, if there are warning signs or if the diagnosis is in doubt, the doctor may order an MRI scan and other tests. A headache diary kept for one or two months before the appointment is very helpful for diagnosis.
How is migraine treated?
Treatment has two strands.
- Treating the attack — painkillers or migraine-specific medicines taken as early as possible once an attack starts.
- Preventive treatment — treatment taken regularly to reduce the number of attacks when they are frequent or seriously affect quality of life.
The doctor decides individually which medicine to use, at what dose and for how long. Taking painkillers on many days a month can itself cause “medication overuse headache”, so frequent self-medication should be avoided.
Everyday life with migraine
Lifestyle is an integral part of treatment; without it, medicines may not have the expected effect.
- Go to bed and get up at the same time every day.
- Do not leave long gaps between meals, and drink enough water.
- Take regular, moderate physical activity.
- Use rest and relaxation techniques to manage stress.
- Record your own triggers in a diary.
Frequently asked questions
Is migraine dangerous?
Migraine itself is usually not life-threatening, but it has a serious impact on quality of life. A new headache, or one whose character has changed, should be assessed by a doctor.
Is migraine hereditary?
There is a genetic predisposition to migraine and there is often someone else in the family with migraine, but this does not mean it will definitely be passed on.
Is every headache a migraine?
No. Tension-type headache is more common and requires different treatment. The type of headache is determined by the doctor.
Do children get migraine?
Yes, migraine can also begin in childhood and adolescence. In children attacks may be shorter, the pain is often felt on both sides of the head, and sometimes abdominal pain and vomiting are the most prominent features. Recurrent headaches in a child should be assessed by a doctor.
What can I do during a migraine attack?
If possible, lie down in a quiet, dark room, drink water and take the medicine recommended by your doctor at the start of the attack. If attacks recur frequently, talk to your doctor about preventive treatment.