A migraine is an intermittent headache that may last anywhere from 2 minutes to several days. Migraineurs experience symptoms like nausea, vomiting, neck stiffness, sensitivity to light and sound, pounding, aching, and sometimes even feelings of numbness and tingling. Although migraines are technically classified as headaches, they are significantly different. Migraines are caused by changes in blood flow to the brain. They often occur in clusters, meaning that there will be a period of time when you feel fine followed by a period of time when your head hurts intensely. 

Migraines affect approximately 15% of women and 6% of men. As of 2016, about 30 million Americans suffer from migraines, making them the third leading cause of disability behind back problems and arthritis.

What are migraines?

Migraine is a very common condition characterised by a severe headache, as well as nausea, vomiting, and sensitivity to light or sound. Migraines are more common in women and typically begin in early adulthood. They are thought to affect one in every five women and one in every fifteen men. Migraines typically improve with age, though they can become worse in some cases.

Migraines are highly individual, with different people experiencing different symptoms and having varying effects on their way of life. For some people, they occur several times per week and last days at a time while others may experience them less frequently every few months. 

What causes migraines?

The exact medical cause of migraines is not known but it’s thought to be a result of temporary changes in brain chemicals, nerves and blood vessels. There are also many triggers that can bring on a migraine and these will vary from person to person so understanding what affects you is key. 

Trigger factors are external stimuli that cause changes in the brain that initiate a migraine.

Common triggers include:

• Emotional triggers: stress, anxiety, poor sleep, depression, and excitement.
• Physical triggers: tiredness, shift work, bad posture, tension, jet lag, low blood sugar, strenuous exercise.
• Dietary triggers: poor diet, irregular meals, not drinking enough water and caffeine.
• Environmental triggers: travelling, bright lights, smoking and weather changes. 
• Medicinal triggers: some oral contraceptive pills or menopause.

Since migraines can be triggered by so many different things, they can have a 

significant impact on your quality of life when you don’t know how to prevent them.

What are the symptoms of a migraine?

Migraines are associated with moderate to severe pain but can commonly include a whole range of other physical symptoms too.

Common migraine symptoms include: 

• Severe pain, throbbing and pulsating on one side of the head or entire forehead.
• Blurred vision and sensitivity to light.
• Nausea or vomiting.
• Sensitivity to sound.
• Pins and needles.
• Lack of energy.
• Mood changes.
• Temporary paralysis.
• Slurred speech.

What are the 4 phases of a migraine?

Understanding the phases of a migraine is essential for understanding the symptoms. They usually have four distinct phases, though not everyone experiences all of them.

1. Prodromal phase: in the few hours or days leading up to a migraine you may notice changes in mood, behaviour, energy levels or appetite.

2. Aura phase: the visual stage that occurs 5 minutes to 1 hour before the migraine attack. It is typically characterised by flashes of light or blind spots in the vision.

3. Headache phase (migraine attack): during the attack phase (which typically lasts a couple of hours to a few days) symptoms include light sensitivity, vomiting, a throbbing headache and more.

4. Resolution stage: the symptoms will begin to pass and you may experience tiredness for a number of days afterwards.

What treatment options are available for migraines?

Migraines cannot be cured, but they can become less severe or even disappear over time. Migraine treatment aims to relieve symptoms and, in some cases, prevent the onset of migraines if started early enough. Migraine treatment can range from over-the-counter pain relievers to prescription medications, depending on the severity of the symptoms.

Painkillers

If taken early enough, simple pain relievers such as paracetamol, ibuprofen, or aspirin can help relieve the throbbing headache associated with a migraine attack. You should take them as soon as symptoms appear; if you wait until you have a painful headache, it will be too late and the medication will be less effective. Soluble pain relievers are more quickly absorbed into your system and may be more effective at relieving migraine pain.

If simple pain relievers are ineffective, stronger codeine-containing pain relievers such as Solpadeine or Nurofen Plus may be more effective. When using pain relievers, use caution because overuse can be dangerous. Regular use of any pain reliever can cause headaches and aggravate migraines.

Triptans

If your GP has diagnosed you with migraines that cannot be controlled with over-the-counter pain relievers, you will be prescribed a Triptan. Triptans (also known as 5-HT1 agonists) are pain relievers that cause blood vessels in the brain to constrict. Triptans help to reverse this process and relieve migraine symptoms because some of the changes that occur in the brain to trigger a migraine attack are thought to involve blood vessel widening. They may also have an effect by stabilising some of the chemical changes in the brain that occur during a migraine attack.

Each Triptan works differently for each individual that’s why it’s important to find the most effective option for your needs. Try each Triptan on three separate occasions and if it’s still not effective, try something else or consider a higher strength. Available tablets include Sumatriptan (Imigran) 50mg & 100mg, Almogran (almotriptan) 12.5mg and Migard (frovatriptan) 2.5mg

Nasal spray or wafer melts

If tablets are unsuitable for you then nasal sprays such as Imigran (sumatriptan) 10mg & 20mg or wafer melts including Maxalt Melt (rizatriptan) 10mg could be a better option. Both are ideal for quick symptom relief and for those experiencing nausea. 

Anti-sickness treatments (anti-emetics)

If nausea or vomiting is a common symptom for you then anti-sickness treatments such as Buccastem can be taken to relieve the symptoms. If you know you are prone to nausea, take them as soon as possible during an attack. The earlier they are administered during a migraine attack, the more effective they are at treating nausea and sickness.

How are migraines diagnosed?

There is no specific method or test for diagnosing migraines. Your doctor will usually make a diagnosis based on the pattern and severity of your headaches, the occurrence of other associated symptoms, and your response to migraine treatments. 

It is beneficial to keep a migraine diary to keep an accurate record of your condition to aid in your diagnosis. Your migraine diary should include the following entries:

• The date and time of the migraine attack
• What were you doing at the time?
• If there were any obvious or potentially significant trigger factors
• Which migraine stages did you go through?
• What symptoms did you have?
• Whether you used any medication and how effective it was.

Based on this information a more accurate diagnosis and treatment plan can be created.

How can migraines be prevented?

Identifying and avoiding migraine triggers is the most important aspect of migraine prevention. A migraine diary will assist you in identifying triggers so that you can avoid them or make changes to your lifestyle, diet and more.

It’s always best to speak to a medical professional if your symptoms are very severe and have a major impact on your quality of life.