Migraines: Everything You Need to Know
Migraines are a common condition that can have a huge impact on quality of life. But with the right treatments, they’re very manageable. We reveal all you need to know in this ultimate guide to migraines.
Published: Wednesday 02 September 2020
If you’re a migraine sufferer, it’s likely you’ve experienced something similar to this before: you feel a migraine coming on, the pain is almost unbearable, and people around you don’t seem to understand. “Isn’t it just a bad headache?” they might ask. “Can’t you just take some paracetamol?”
It’s true that headaches are one of the key characteristics of a migraine. But for non-migraine sufferers, it’s difficult to imagine how much pain an attack can cause. These aren’t ordinary headaches: migraine attacks can often cause severe pain alongside a host of other symptoms that, in combination, can be debilitating.
If you’ve recently started suffering migraines, you might be wondering where to start with treatment. Perhaps you’ve had migraines for a while, but normal painkillers don’t seem to be as effective recently. Thankfully, migraines are easily treatable with the right medication - even if over-the-counter painkillers don’t work.
In this guide, we’ll go over everything you need to know about migraines - what could cause them, possible triggers, signs and symptoms - and how to treat them effectively. So if you’re ready to take control of your migraines and keep living your best life, read on.
What is a migraine?
A migraine is a medical disorder characterised by recurring headaches that are moderate to severe. Typically, a migraine headache will present as a throbbing pain on one side of the head, but it can often be both.
Unlike typical headaches, migraines often present with additional symptoms that can interfere with daily life. These symptoms can either appear before, during or after the pain phase of a migraine.
If you’re struggling with migraines, it’s important to remember that you’re not alone. Migraines are common in the UK, with as many as one in five women and one in 15 men suffering from the condition. Migraines will usually begin in early adulthood, and vary significantly in frequency from person to person. One migraine sufferer might experience an attack every six months; another might get one every few days.
How long do migraines last?
The duration of a migraine varies from person to person, but they can last anywhere from a few hours to a few days.
What are the symptoms of a migraine?
Usually, the primary symptoms of a migraine will be a throbbing headache on one side of the head. These headaches can cause moderate to severe pain. However, migraines are different to headaches in that they often progress in four phases: prodrome, aura, attack and post-drome. Each phase has its own set of symptoms, and the earlier phases can give you warning signs that a migraine is around the corner.
This is the earliest phase of a migraine, and can present itself one to two days before the attack, or pain phase. Prodrome symptoms are usually small changes that tell you a migraine is on the way. These include:
- Food cravings
- Neck stiffness
- Frequent yawning
- Mood changes, from depression to euphoria
- Increased thirst and urination
This phase of a migraine can occur either before or during the pain phase. Auras are characterised by temporary symptoms of the nervous system. Usually, these symptoms will be visual in nature, but it’s possible to experience auditory disturbances, physical sensations and weakness as well. Aura symptoms usually build up over several minutes and last for up to an hour.
Aura symptoms include:
- Visual disturbances, such as flashes of light, bright spots or shapes
- Loss of vision
- Pins and needles in an arm or leg
- Weakness or numbness on one side of the body or face
- Trouble speaking
- Auditory disturbances, such as hearing noises or music
- Involuntary spasms or other movements
The attack phase, which is also commonly referred to as the pain phase, is where the migraine headache kicks in. If untreated, the attack phase can last anywhere from four to 72 hours. During this phase, symptoms include:
- A throbbing headache, usually on one side of the head, but sometimes on both
- Sensitivity to light, sound, and sometimes smell and touch
- Nausea and vomiting
Once the attack phase subsides, it’s common to feel drained and confused. Others can feel elated when a migraine passes. These feelings can last for up to a day, but it’s important to remember that sudden head movements can bring the pain back briefly.
What are the causes of a migraine?
The exact cause of migraines is still unknown. However, research suggests a number of factors can make you more likely to experience them, including genetics and environment. In addition, there is reason to believe that temporary changes to the brain stem, such as chemical imbalances, widening of the blood vessels and nerve changes, could also contribute.
Recent research into migraines has focused on whether serotonin - a chemical produced in the brain that affects mood and contributes to happiness - could play a role in the condition. In addition, it is suspected that certain neurotransmitters may contribute to the attack phase of migraines, including calcitonin gene-related peptide (CGRP).
While the root cause of migraine has yet to be determined, people who do suffer migraines often get them in response to certain stimuli. These factors, commonly referred to as “triggers”, vary from person to person but can include:
- Certain foods, particularly cheeses and foods with high salt content
- Skipping meals and fasting
- Sensory stimuli, including loud sounds, strong smells, sun glare and bright lights
- Medications, especially vasodilators and nitroglycerin
- Hormonal changes in women, specifically estrogen
- Physical exertion, including sexual activity
How can I get rid of a migraine?
There is currently no cure for migraines, but they can be managed effectively with the right treatments. It’s important to remember that you may not find the right treatment for you immediately - it’s possible you’ll have to try a few different combinations before finding the most effective one.
That said, most people find the most effective way to manage a migraine is not using painkillers, but simply sleeping or lying down in a dark, silent room. Migraines are often exacerbated by bright lights and loud noises, so removing these stimuli can help significantly when trying to manage pain and aura symptoms.
If, however, doing this doesn’t relieve your symptoms, supplementing rest with over-the-counter painkillers will often help you manage the pain effectively. Ibuprofen, paracetamol or aspirin can help relieve migraine pain, but it’s important to remember that they’re most effective if taken at the first signs of a migraine attack. In other words, it might be best to start taking painkillers when aura symptoms first appear. If you’re a migraine sufferer who does not experience aura, you should take painkillers as soon as you feel pain coming on, rather than when the pain is at its worst.
While over-the-counter treatments will be effective for many migraine sufferers, for others the symptoms might be so severe that regular painkillers don’t relieve them. In these instances, it’s important to see your GP so they can work out the best treatment for you. If your GP does decide that prescription medications are appropriate to treat your migraines, it’s quite likely they’ll offer you a type of medicine called a triptan.
What is a triptan?
Triptans are a family of medications used to treat migraines that do not respond to ordinary painkillers and rest. These treatments are said to work by binding to serotonin receptors in the brain’s blood vessels and nerve endings. This is then believed to block the release of inflammatory neuropeptides, which are protein-like molecules that neurons use to communicate with each other.
Commonly prescribed triptans include:
Triptans are a type of medication commonly referred to as an “abortive” treatment. While they’re effective at treating individual migraine headaches once they’ve started, they do not work as a preventative treatment. In addition, triptans are only effective at treating pain caused by migraines - they should not be used to relieve other forms of pain.
It’s important to remember that triptans are designed for temporary use only. Taking triptans for an extended period of time can cause overuse headaches These headaches can be very painful, so it’s vital that you take the medication exactly as prescribed by your GP or pharmacist.
What are the side effects of triptans?
Triptans are usually well-tolerated by people who take them. However, as with most other medications, they can cause certain side effects - though these are usually mild.
Common side effects include:
- Warm sensations
- Feelings of heaviness in the face, limbs or chest
Less common side effects include:
- Dry mouth
While triptans are usually very effective at ending a migraine, they may not work for some migraine sufferers. In these instances, your GP may prescribe anti-sickness medicines - also known as anti-emetics - instead.
What are anti-emetics?
Anti-emetics are a type of medicine used to treat nausea and vomiting. They’re usually prescribed to prevent motion sickness and reduce the side effects of opioid analgesics, general anaesthetics, and chemotherapy treatments for cancer. For migraine patients, however, anti-emetics can sometimes effectively stop migraine headaches when triptans haven’t been effective.
What are the side effects of anti-emetics?
Anti-emetics typically have very few side effects, but people who do get them typically report experiencing drowsiness and diarrhoea.
I’ve heard of ocular migraines - what are they?
Ocular migraines, also known as retinal migraines, are an eye condition characterised by brief attacks of blindness or visual disturbances like flashing lights in one eye. Though unsettling, these episodes are usually harmless and only last a short time. Retinal migraines are a separate and unrelated condition to headache-type migraines or migraines with aura.
What are the symptoms of ocular migraines?
The symptoms of ocular migraines include:
- Partial or total loss of vision in one eye - this typically lasts 10 to 20 minutes before vision gradually comes back
- Headache - this might happen before, during or after the vision attack
- Other visual disturbances, such as flashes of light, patterns of blank spots, blurring or dimming
What are the causes of ocular migraines?
Ocular migraines are caused by a sudden narrowing of the blood vessels to the eye. They can be triggered by:
- Bending over
- High altitude
- High blood pressure
- Excessive heat
- Oral contraceptive pill
- Low blood sugar
How are ocular migraines treated?
Ocular migraines typically don’t need prescribed treatments to be managed. Usually, treatment will involve managing any pain with over-the-counter painkillers and avoiding factors and stimuli that trigger attacks.
That said, you GP may choose to prescribe you medicine such as:
- Aspirin to reduce pain and inflammation
- Beta blockers, to relax blood vessels
- Calcium channel blockers, to prevent blood vessels constricting
- Tricyclic antidepressants, which can help prevent migraine
- Anti-epileptics which may also help prevent migraine
Authored by Harry Walker
Patient Care Specialist
After graduating with a degree in Journalism at City, University of London, Harry joined the Pharmica team as a Patient Care Specialist and content writer.
In addition to helping in the dispensary, Harry consults with our in-house pharmacists to produce engaging, informative and expert content for our patients.