MIGRAINE TREATMENT

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Zomig Nasal Spray

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ABOUT MIGRAINE TREATMENT

What is a migraine?

A migraine is an inherited tendency to have headaches with sensory disturbance. These headaches are intense; described as throbbing recurring pain, usually on one side of the head. 

The pain is typically accompanied by other symptoms such as vomiting, nausea, light sensitivity, and sound sensitivity. Migraines are common, affecting around one in 15 men, and one in five women

Migraine pain can be severe, interfering with your daily life. However, there is a range of treatments for migraines, including migraine tablets for relief, preventative medication, and nasal sprays.


What causes a migraine?

The cause of migraines is not yet known, although it is understood that both environmental and genetic factors could be influential. It is thought to be caused by abnormal brain activity temporarily affecting nerve signals, chemicals, and blood vessels in the brain. This change in brain activity can be caused by your genes being more susceptible to certain triggers, which in turn causes a migraine attack. 

There are several potential migraine triggers, including: 

  • Stressful environments
  • Changes to sleep patterns (not getting enough sleep or sleeping too much)
  • Flashing or bright lights
  • Head or neck trauma
  • Strong smells
  • Intense physical activity
  • Loud noises
  • Certain medications
  • Changes to mealtimes or missed meals
  • Certain foods and food additives
  • Alcoholic drinks and caffeinated drinks
  • Changes in the weather
  • Oestrogen fluctuations

 

Some people are more susceptible to migraines than others; this can depend on their:

  • Age: as migraines often start in adolescence and peaking in your 30s; family history, if one of your family members have migraines
  • Gender: if you are a woman, you are more likely to get migraines
  • Hormonal changes: women with migraines can get headaches before or just after menstruation, in pregnancy, and during menopause

How long does a migraine last?

If left untreated, a migraine attack can last from four hours to three days, depending on your situation. 

The frequency of migraine attacks vary between people, some people may have them several times a week, and others a few years apart. Migraine attacks can stop in adult life, but in some cases, the attacks will continue throughout life. 


Migraine symptoms

There are four different phases of a migraine, and each has its own symptoms. Not everyone will go through these four phases during a migraine attack. 

In the prodrome stage one or two days before a migraine, you might have: 

  • Mood changes
  • Constipation
  • Fluid retention
  • Increased urination
  • A stiff neck
  • Food cravings
  • Yawn more than normal

 

In the aura stage, which occurs in some people before or during a migraine, you may experience:

  • Vision loss
  • Visual phenomena - such as light flashes, bright spots, and shapes
  • Pins and needles
  • Numbness on one side of the body
  • Weakness on one side of the body
  • Difficulty when speaking

 

In the attack stage, you could experience:

  • Pain on one or both sides of the head
  • Throbbing and pulsing
  • Nausea and vomiting
  • Light or sound sensitivity

 

In the postdrome stage, you might feel fatigued and confused for up to a day. You should see a doctor if you are getting frequent migraine symptoms. Try to keep a record of attacks, including their duration and how they were treated. You should seek immediate medical assistance if you experience: 

  • A sudden, severe headache
  • Headache after head trauma
  • Headache with fever
  • Seizures
  • Numbness or double vision
  • A chronic headache that gets worse after straining or coughing 

 

For more information on signs and symptoms of a migraine, please visit our guide ‘10 signs that you might be having a migraine’.


Migraine types

There are several different types of migraines. The main types of migraine include:

  • Hemiplegic migraine
  • Migraine with aura
  • Migraine without aura
  • Vestibular migraine

 

Hemiplegic migraine

This type of migraine can cause weakness on one side of the body during the aura stage. 

These aura symptoms typically subside within a day. While the symptoms of a hemiplegic migraine are similar to stroke symptoms, they do not cause lasting nerve damage. Due to the similarity with stroke symptoms, if you experience hemiplegic migraine symptoms, you should seek immediate medical assistance. 

 

Migraine with aura

A migraine with aura, sometimes referred to as a classical migraine, is a severe headache that is often followed by symptoms such as:

  • Ringing in the ears (Tinnitus)
  • Dizziness
  • Pins and needles and numbness 
  • Smelling something odd or craving certain foods
  • Light sensitivity
  • Vision phenomena
  • Having difficulty talking

 

Around one in three people who have migraines will experience these warning symptoms (an aura) before a migraine.

 

Migraine without auras

This is the most common type of migraine. When a migraine occurs, there are no specific warning signs. 

During the attack stage, people that experience a migraine without aura can feel all the normal symptoms of a migraine attack. This type of migraine has three stages; the prodrome stage, the attack stage, and the postdrome stage. 

While there is no aura, if you have this type of migraine you may experience symptoms such as:

  • Headache
  • Nausea or vomiting
  • Discomfort with bright lights and loud noises

 

Vestibular migraine

A vestibular migraine is related to a nervous system problem. It causes dizziness (vertigo) and is also known as migrainous vertigo and migraine-associated vertigo. People with vestibular migraines don’t always suffer headaches. 

The predominant symptom is dizziness lasting more than a few minutes. If you have vestibular migraines you may also have:

  • Balance problems
  • Feel confused
  • Have sensitivity to sound or have extreme sensitivity to motion

Migraine vs headache

A headache can cause an unpleasant feeling of pressure and aching. This pain can range from mild to severe and usually affects both sides of the head. They can last anywhere from 30 minutes up to a few days.  

A migraine is a more intense and severe throbbing pain that normally affects one side of the head, although it can affect both sides. This pain can make it difficult to carry out daily tasks. 

Headaches from a migraine are often accompanied by other symptoms such as nausea, vomiting, pain at the temples, visual phenomena, vision loss, light sensitivity, sound sensitivity, and pain behind one ear or eye.


Migraine relief

If you have been diagnosed with migraines, which usually involves a physical and neurological examination, along with a review of your medical history and symptoms, there is a variety of migraine medication that you could be given to relieve the pain. 

These medications are best taken as soon as the first sign of a migraine appears. They include:

  • Pain medication - such as non-steroidal anti-inflammatory drugs (NSAIDs) and migraine tablets for relief that combine aspirin and acetaminophen with caffeine 
  • Triptans - including prescription migraine tablets such as 
  • Anti-nausea medications

 

There are also home care measures that you can take to help ease migraine symptoms, including:

  • A consistent sleeping and eating routine
  • Drinking plenty of fluids
  • Exercising regularly and relaxation techniques
  • Making changes to your diet, eliminating foods and substances known to trigger a migraine
  • Preventative therapy - taking prescription medications, such as antidepressants, blood pressure medication, or anti-epileptic treatment 

 

The appropriate treatment strategy will be determined by the severity and frequency of the migraine attacks, and other medical conditions. 

This will be explored by our team of trained pharmacists following a short consultation to determine your full medical history and symptoms. They will then be able to advise as to the correct course of action.


Can you prevent a migraine?

A migraine may be prevented if preventative methods are used, or lifestyle changes are made. Preventative methods include:

  • Making changes to your diet, eliminating foods and substances known to trigger a migraine
  • Preventative therapy - taking prescription medications, such as antidepressants, blood pressure medications, or antiepileptic medication
  • Taking steps to reduce stress

 

These methods can help reduce the frequency, severity, and length of the migraine attack.

 

Preventative migraine treatment

You can treat migraines with preventative migraine medication that decreases their severity, frequency, and duration. Depending on your circumstances, medical professionals may advise that you take preventative medications if your headaches are severe, frequent or long-lasting, and haven’t responded well to treatment for relief. 

Preventative migraine medication includes:

  • Medications for lowering blood pressure, like beta-blockers and calcium channel blockers
  • Anti-seizure medication
  • Tricyclic antidepressants
  • Botox injections, administered every 12 weeks, that can block neurotransmitters carrying pain signals from the brain
  • CGRP monoclonal antibodies, which are newer drugs for migraine treatment that are administered periodically by injection

How is a migraine diagnosed?

Currently, there is no specific test to diagnose migraines. A GP will diagnose a migraine by examining the pattern of recurring headaches, medical history, and symptoms. The GP may carry out a physical examination to rule out any underlying causes of the symptoms presented.

It can be helpful to keep a ‘migraine diary’, noting the date, time, length of the migraine, the symptoms experienced and the medication taken (if any). The GP may feel it appropriate to refer you to a neurologist for further examination if the diagnosis is unclear, any treatment tried has not worked, or a migraine occurs 15 days or more per month.


When should I go to the doctor about my migraine?

  • You should seek the advice of a doctor in the following circumstances:


     

  • ​​Before seeking treatment for yourself, it is best to see a GP for a diagnosis​
  • If you are above 40 and you are experiencing headaches for the first time
  • When your headaches are occurring more often and lasting longer
  • If you are needing to use migraine relief tablets (such as triptans) more than 10 times a month
  • When headaches are changing (e.g. you are experiencing new symptoms)
  • When you have three or more headaches a week 
  • When you need pain relief daily or almost every day for your headache
  • If you are experiencing slurred speech
  • If you experience paralysis or weakness of one or both arms or on one side of the face
  • If you experience a headache accompanied by a high temperature, stiff neck, mental confusion, rash, double vision, or a seizure
  • A sudden headache-causing agonising pain

 

 

In the event of any of the above, it is best to call 111 to seek medical advice. If you experience any of the last four points, call 999. 


Additional resources

For more information on migraines or any of the treatment options that we have mentioned above, please take a look below:


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