Migraine

Migraine is a common health condition. It affects around 1 in 5 women and around 1 in 15 men, and it usually begins in early adulthood.

A migraine headache is usually a moderate or severe headache, felt as a throbbing pain on one side of the head.

Some people get migraine headaches often, up to several times a week. Others only have them now and then. It's even possible for years to pass between one migraine attack and the next.

You or someone else has:

• paralysis or weakness in one or both arms and/or one side of the face
• slurred or garbled speech
• a sudden, agonising headache that brings blinding pain
• headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, like a stroke or meningitis. A doctor should assess you as soon as possible.

• you have frequent or severe migraine symptoms

Read about migraine prevention and treatment

Migraine comes in a few different types. These include:

• migraine with aura, where you get warning signs before the attack begins, such as seeing flashing lights
• migraine without aura, which is the most common type, where the attack comes on without any warning signs
• migraine aura without headache, also known as silent migraine, where you have an aura or other migraine symptoms but no headache

The main symptom of migraine is usually an intense headache on one side of the head. Sometimes the pain is on both sides, and it may spread to your face or neck.

The pain can get worse when you move, and it may stop you doing your normal activities.

Other symptoms that come with migraine include:

• nausea
• vomiting
• increased sensitivity to light and sound (which is why many people with a migraine headache want to rest in a quiet, dark room)
• sweating
• poor concentration
• feeling very hot or very cold
• abdominal (tummy) pain
• diarrhoea
• dizziness (light headedness)

Not everyone with migraine has all of these symptoms. Some people have them without any headache at all.

A migraine attack usually lasts between 4 hours and 3 days. Afterwards, you may feel very tired for up to a week.

About 1 in 3 people with migraine get temporary warning symptoms before an attack. These are called aura. They include:

• visual problems, like seeing flashing lights, zig-zag patterns or blind spots
• numbness or a tingling feeling like pins and needles, which usually starts in one hand and moves up your arm before it reaches your face, lips and tongue
• difficulty speaking
• feeling dizzy or off balance
• loss of consciousness, although this is unusual

Aura symptoms typically build up over about 5 minutes and last for up to an hour. You might get the aura before the headache starts, or at the same time as the headache. Some people have an aura followed by only a mild headache, or by no headache at all.

No one knows the exact cause of migraine. It's thought to come from abnormal brain activity that temporarily affects the nerve signals, chemicals and blood vessels in the brain.

Around half of all people who have migraine have a close relative with the condition, so genes may play a part.

Keeping a diary can help you spot a consistent trigger for your migraine. It isn't always easy, though, because it can be hard to tell whether something is a true trigger or just an early symptom of an attack starting. And sometimes there is no trigger at all for your headache.

Possible migraine triggers include:

• hormonal changes
• starting your period
• emotional triggers like anxiety, depression and stress
• physical triggers like tiredness, poor posture, neck or shoulder tension and jet lag
• fasting or low blood sugar (hypoglycaemia)
• strenuous exercise, if you're not used to it
• dietary triggers like alcohol, caffeine, chocolate or citrus fruit
• dehydration
• environmental triggers like bright lights, flickering screens, smoking or smoky rooms, loud noises, strong smells or changes in the weather

Medicine can also trigger migraine attacks. Some types of sleeping tablets, the combined contraceptive pill and hormone replacement therapy (HRT) are examples. If you start getting migraine attacks after you begin a new medicine, speak to your doctor.

Some people crave chocolate before a migraine begins. This can be a sign that an attack is about to start, rather than the chocolate being the trigger.

There's no specific test for migraine. Your doctor has to look for a pattern of headaches that keep coming back, together with the other symptoms that go with them.

Migraine headaches can be unpredictable, and sometimes they happen without those other symptoms. So getting an accurate diagnosis can take time.

Your doctor might examine you physically and check your vision, co-ordination, reflexes and sensations. This helps rule out other possible causes behind your symptoms.

Your doctor may also ask whether your headaches are:

• on one side of the head
• a pulsating pain
• severe enough to prevent you carrying out daily activities
• made worse by physical activity or moving about
• accompanied by nausea and vomiting
• accompanied by sensitivity to light and noise

A diary of your migraine attacks, kept for a few weeks, can help with the diagnosis. Note down details including:

• the date
• time
• what you were doing when the migraine attack began
• how long the attack lasted
• what symptoms you experienced
• what medicine you took (if any)

Taking too many painkillers can make migraine difficult to treat. This condition is called medication overuse headache.

Keep a record of which painkillers you take and how often you take them. In the long term, you shouldn't take painkillers on more than 10 days every month.

If you have periods, it can help to note down when yours starts. This can help your doctor identify potential triggers.

You can read more about keeping a migraine diary on The Migraine Trust website.

Your doctor may refer you to a neurologist, which is a specialist in conditions affecting the brain and nervous system. The neurologist will do further assessments and offer treatment if:

• a diagnosis is unclear
• you have significant migraine headaches that aren't being controlled by your current treatment

Read about the prevention and treatment of migraine

Migraine comes with a small increased risk of some other conditions, including:

• stroke
• depression
• bipolar disorder
• anxiety disorder
• panic disorder

The combined contraceptive pill raises the risk of ischaemic stroke. For this reason, doctors generally advise women who have migraine with aura not to use it.

Women who have migraine without aura can usually take the combined contraceptive pill safely. The exception is if they have other risk factors for stroke, such as high blood pressure or a family history of cardiovascular disease.

If you get aura symptoms while you're taking the combined contraceptive pill, talk to your doctor about other forms of contraception.