Migraine

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What is a migraine?

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

What are the symptoms of a migraine?

The most common symptoms of a migraine attack include throbbing headache, sensitivity to light and noise, nausea (feeling sick), vomiting (being sick) and a lack of energy. Occasionally other symptoms can be experienced, such as: sweating, poor concentration, feeling very hot or very cold, abdominal (tummy) pain and diarrhoea. 

What causes migraines?

The exact cause of a migraine is not yet known, however 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. 

Triggers include:

  • Head or neck trauma
  • Stress, or relaxing after a stressful period
  • Too much or too little sleep
  • Changes in routine
  • Caffeine
  • Hormonal changes in women
  • Changes to mealtimes or missed meals
  • Certain food or drink
  • Loud noises
  • Bright or flickering lights
  • Strong smells
  • A smoky or stuffy atmosphere
  • Extremes of weather
  • Exercise 

Who gets migraines?

Migraines are very common. About 15 in every 100 people in the UK have at least one migraine attack every month. You can get migraines for the first time at any age. They most commonly start during childhood or adolescence. 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. 

What are the different types of migraines?

There are two main types of migraine attack:

  • Migraine attack without aura - sometimes called common migraine.
  • Migraine attach with aura - sometimes called classic migraine.

Migraine without aura
This is the most common type of migraine and will occur without warning signs. Symptoms include a headache, nausea or vomiting, discomfort with bright lights and loud noises. 

Migraine with aura
About 1 in 4 people with migraine have migraine with aura. The symptoms include those for migraine without aura, but also include a warning sign (an aura) before the migraine attack begins. The aura can be:

  • Visual - seeing bright lights, getting a large blind spot or things seeming to move about.
  • Pins and needles and numbness 
  • Having difficulty talking.
  • Smelling something odd or craving certain foods.

What is the difference between a migraine and a 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. A migraine is a more intense and severe throbbing pain which normally affects one side of the head. This pain can make it difficult to carry out daily tasks. A migraine will also have other associated symptoms such as: nausea, pain behind one eye or ear, pain in the temples, seeing spots of flashing lights, discomfort with light and noise, vomiting or temporary loss of vision.  

What are the treatments for migraine?

A migraine can either be treated with prevention methods (aimed at reducing the frequency and severity of migraines) or medication. 

Prevention methods include:

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

Medications include:

  • Anti-sickness medicines
  • For immediate relief - mild to moderate pain relievers, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen sodium, or ibuprofen or prescription painkillers. 
  • Triptans (migraine specific painkiller), available as tablets, injections and nasal sprays. 

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

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.

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, how long the migraine lasts, the symptoms experienced and the medication taken (if any). The GP may feel it appropriate to refer to a neurologist for further examination if the diagnosis is unclear, any treatment tried has not worked or migraines occur on 15 days or more per month.

When should I go to the doctor about my migraine?

  • ​​Before choosing a 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 an 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. 

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