If you’ve suffered from a migraine before, you know just how debilitating it is. According to the World Health Organisation, migraines rank in the top 10 of disabling conditions, and can result in lost work days, lost productivity and high health care costs.
However, when your head is pounding, it can be difficult to know the difference between a regular headache and a migraine. The following information can you help you work out exactly what is going on inside your head.
So what causes a migraine? A migraine is usually a throbbing, intense headache felt on one side of the head. You might also feel sick, have increased sensitivity to sound or light. It can affect people of all ages. The cause of migraine is not known.
It used to be thought that during an attack, the blood vessels in the brain dilate and then draw together with stimulation of nerve endings near the affected blood vessels.
However, this does not now seem to be the whole reason and some researchers think it is increased activity in some of the chemicals in the brain that cause migraine.
But nobody really knows and the exact causes of migraine are still poorly understood.
Are migraines common?
Migraine is a fairly common condition. It affects about 1 in 5 women and 1 in 15 men in their lifetime.
Although it can come on later in life, this is unusual. About 90 per cent of migraine sufferers have their first attack before they are 40.
The onset of migraine in women often occurs around puberty – therefore linking migraine to hormonal triggers (see below).
Are migraines hereditary?
Migraine sufferers often have a predisposition within the family but it is not certain how large a role heredity plays.
Most people suffering from migraine are aware that different foods, such as cheese, chocolate, wine or citrus fruits, can cause the attacks. Other triggers can include exercise, anxiety, stress, bright lights, loud noise, the contraceptive pill and travel.
These particular causal factors vary from patient to patient. Some women experience attacks more frequently around the time of their menstrual periods. The drop in oestrogen just prior to the period is thought to trigger it.
Migraine sufferers should avoid factors such as alcohol, lack of sleep and foods that are known to cause attacks.
People often use the word ‘migraine’ to refer to headaches of many different types. So-called ‘classical’ migraine attacks have one or many of several features:
- Headaches that occur in bouts of between roughly 4 to 72 hours
- The headaches usually affect one side of the head at a time, although both sides may be affected in separate attacks
- The headaches are usually throbbing and worsened by normal physical activity
- Nausea and/or vomiting
- Preceding symptoms, called ‘aura’, that most often are visual, such as zigzag lines or flashing lights across or at the edges of the fields of vision
- Other symptoms can include sensitivity to light and sound, or non-visual aura such as a sensation of tingling in the body.
Only about 15 per cent of people experience visual aura before an attack. ‘Common migraine’ refers to the majority who have all the other symptoms but no aura.
Rarely some people with migraine experience transient loss of power of a limb with severe attacks, or temporary difficulty with speech.
In addition to an interview, the doctor should also perform a physical examination. If there is any doubt about the diagnosis, the doctor will refer the patient to an expert on diseases of the brain (neurologist).
The first-ever attack of migraine can look like many other conditions, including meningitis or even a stroke – so great care can be needed in making the initial diagnosis.
Once several attacks have occurred, however, the pattern becomes recognisable as migraine type headaches do not persist longer than 72 hours – headaches that last for longer without stopping are not migraines.
Depending on the circumstances, it may be necessary for the person to see a specialist (neurologist) to have investigations such as a brain scan.
Other tests, such as those for ‘allergies’ or which seek to identify triggers for the migraine, are of little help. Blood tests are normal in migraine.
The first line of treatment is always to try and identify trigger factors, which means keeping a careful record of events, mainly of foods that have preceded an attack. The doctor may often advise writing a headache diary to link up triggers and events.
Particular foods are identified as migraine triggers in about 20 per cent of sufferers. The large female preponderance within migraine sufferers points to the importance of hormonal factors, such as the menstrual cycle, which are not modifiable.
Women who get migraines with aura or severe migraines regularly should not take the combined contraceptive pill. It is thought there may be an increased risk of stroke or other cerebrovascular events.
If you are on the combined pill and get your first migraine you must discuss with your doctor urgently about how to change to another method.
People suffering a migraine should try to rest in a dark, quiet room. Make sure you are well hydrated.
Treatment of migraine is most effective if given at the start of an attack.
Treatments for sufferers aged under 18 may differ from older patients, so it’s important to discuss this with the pharmacist before buying any over the counter remedies.
Simple painkillers, such as paracetamol, aspirin or NSAIDs, such as ibuprofen, can be effective at relieving migraine and are usually the first treatment tried.
They are preferably taken in soluble or liquid form because these are absorbed by the body faster.
If nausea or vomiting are a problem, suppositories may be preferable. Alternatively, an antisickness medicine can be taken with the painkiller. Migraleve contains co-codamol (paracetamol and codeine) in combination with the antisickness medicine buclizine.
Alternatively, your doctor may prescribe the anti-sickness medicines domperidone or metoclopramide.
If simple painkillers and anti-sickness medicines consistently fail to relieve migraine attacks, the most popular modern remedies are the ‘triptan’ group of drugs. These medicines include sumatriptan (Imigran), rizatriptan (Maxalt) and zolmitriptan (Zomig), among others.
They are all prescription medicines, with the exception of sumatriptan, which can now be bought from pharmacies as Imigran recovery. These drugs cause the blood vessels around the brain to contract, therefore counteracting the dilatation that seems to part of the initial migraine process.
They come in various forms, including nasal sprays, injections and tablets that dissolve on the tongue, which can be useful if nausea and vomiting are a problem during the migraine.
If you do take a triptan it is advised to take it at the start of the headache itself, not the aura that comes first if you suffer with aura too. Simple analgesia can be started as soon as the aura develops.
Triptans are not suitable in the elderly or those with cardiovascular or cerebrovascular disease as they may affect blood flow and cause problems.
If the attacks are occurring more than once a week/lasting a long time/affecting your ability to function then preventive or ‘prophylactic’ treatment as doctors call it, may be recommended.
This usually involves taking precribed daily medication, so may not be appropriate for people who suffer only occasional migraines.
Examples of medicines that can be used in this way are: propranolol a beta blocker, pizotifen (Sanomigran), topiramate, amitriptyline and valproate (the latter two are not licensed for this purpose).
It’s worth noting that using any painkillers for headaches or migraines too often or for too long can actually make the headaches worse. This is called Medication Overuse Headache (MOH). If you find you’re getting frequent migraines and are often taking painkillers, it’s important to consult your doctor for advice.
Often further medications need to be tried and perhaps combined before the most effective treatment for each individual patient can be found.
There is emerging evidence that 400mg per day of Vitamin B2 (Riboflavin) can reduce the frequency of migraines in severe sufferers, discuss this with your GP or Consultant. NICE Guidelines also include acupuncture as an adjunct to other therapies.
Alternative therapies, such as homoeopathy are popular even if the evidence supporting their effectiveness is poor or absent.
Lifestyle and dietary advice are always important.
Last updated: 12-03-2020