Migraine – how to manage it

Migraine is a common health condition that affects 1 adult in every 7 across the globe.

It usually feels like a very bad headache that throbs on 1 side of the head, and can come with other symptoms such as sensitivity to lights, noise, and smells, as well as nausea (feeling sick) or vomiting (being sick).

A migraine attack usually lasts from around 4 hours up to 3 days, and you may get symptoms before and after you have pain.

Find out more about causes, plus what can help to ease your migraine.

What are the symptoms?

With a migraine, you’ll usually have bad head pain that throbs on 1 side of your head. Although in 1 type, called a silent migraine, you don’t get a headache.

Some symptoms can appear around 24 hours before the pain kicks in, and linger after it goes away.

Aside from pain, other symptoms can include:

• fatigue and yawning
• changes in mood
• difficulty concentrating
• peeing more
• food cravings or thirst
• stiff neck
• sweating
• belly pain
• diarrhea
• feeling sick (nausea) or being sick (vomiting).

The type of migraine you have will also dictate what type of symptoms you feel. If you have migraine with aura, this means you have warning signs that you’re about to have a migraine. This may include:

• seeing flashes of light or seeing spots, shapes or zigzag lines in your vision
• a tingling feeling (pins and needles)
• difficulty speaking
• feeling weak or numb on 1 side.

Aura symptoms don’t usually last for longer than 1 hour.

Having a migraine attack can be draining, and you may feel tired for up to a week afterward.

When to get emergency help

You should get emergency medical care if you or someone else has:

a very painful and sudden headache
vision loss, blurred vision, or seeing double
a feeling of drowsiness or confusion
problems with speaking or memory
a seizure (fit)
a very high temperature and meningitis symptoms (can include a rash, fever, headache, and stiff neck)
weakness on 1 side of the body or is unable to move.

Go to an urgent care center if:

• your migraine has lasted longer than 72 hours
• your aura symptoms have lasted longer than an hour
• you are pregnant or have just given birth.

Causes of migraines and who gets them

We don’t yet know the actual cause of migraine, but experts believe that the condition is due to abnormal brain activity affecting nerve signals, chemicals, and blood vessels in the brain.

Why this happens to some people and not others is not fully known, but having an imbalance in brain chemicals such as serotonin, which help regulate your nervous system, is thought to be involved. Your genes are thought to play a role as migraine runs in families.

You’re also more likely to get a migraine if you are:

• female – 3 times more women live with migraine than men. Scientists are investigating the link with hormonal changes each month and through life stages like puberty and menopause
• in your 30s or 40s – they’re most likely to happen between the ages of 35 and 45, although they can happen at any age

Some factors are triggers, meaning they’re likely to set off a migraine in people who are prone to getting them. They can include:

• moods like stress and anxiety
• hormonal changes (such as menstrual cycle, menopause)
• being tired
• having neck or shoulder tension
• certain foods such as chocolate and cheese
• skipping meals
• alcohol and caffeine
• sleeping too much or too little
• lack of exercise
• sensory changes like bright or flashing lights or strong smells
• changes in weather or barometric pressure (pressure within the Earth’s atmosphere)
• some medication – such as vasodilators or oral contraceptives.

Keeping a diary to track symptoms and triggers can help you work out what your triggers are, so you can avoid them and help cut your risk of having an attack.

When to see a doctor and getting diagnosed

Go back to the section When to get emergency help, to find out which symptoms need immediate medical care.

Otherwise, if you’re regularly experiencing migraine symptoms, more than once a week, or they’re particularly bad, getting worse or last longer than usual, you should see a doctor.

Also make an appointment if you find it hard to control your migraines or, if you have periods, you are getting migraines before or during them.

Although there’s no specific test to diagnose migraines, your doctor should be able to identify them based on your symptoms and migraine pattern.

It helps to record information about your migraines in a diary to share with your doctor.

Note the date and time of your migraine and:

• What were you doing when you felt it start?
• What symptoms did you get?
• Does the pain throb? Is it on 1 side?
• Does it prevent you from going about day-to-day life?
• Did it come with sensitivity to light and noise or other symptoms like vomiting (being sick)?
• Did moving or activity make it worse?
• How long did the migraine last?

Your doctor might do a physical test and check your vision, reflexes, co-ordination, and sensations to help rule out other possible causes of your symptoms.

You may be referred to a brain and nervous system specialist (neurologist) for further tests if your diagnosis is not clear or your current migraine treatment is not working.

What’s the treatment?

Treatment can involve preventing attacks as well as relieving symptoms during a migraine attack. This can include:

• painkillers such as ibuprofen (check this is safe for you to take) and paracetamol (acetaminophen)
• triptans – to relieve symptoms by blocking pain pathways. They may not be safe to take if you’re at risk of stroke or heart attack
• anti-sickness medication – to help manage symptoms.

You may have to try a mix of treatments to find something that works for you.

Your doctor may also advise lifestyle changes to help you manage migraines.

Therapies such as acupuncture and trying relaxation techniques may help for severe migraines.

A new type of medicine called gepant may be offered to you if the above treatments aren’t helping or you’re not able to take them. Gepants work by blocking a chemical associated with migraine attacks.

If none of these methods work then you may be referred to a specialist for more tests and treatment.

Self-care for migraines

• avoid your triggers – keep your migraine diary up to date so you can pinpoint any changes
• keep hydrated by drinking plenty of fluids such as water
• limit your intake of caffeine and alcohol
• eat regular meals and don’t skip them
• get enough exercise
• make sure you get your sleep quota and have set wake and sleep times
• take steps to manage stress with relaxation techniques
• rest in a dark room during a migraine attack.

Where to find support

Migraine Trust (UK): migrainetrust.org
American Migraine Foundation: americanmigrainefoundation.org