What is migraine?

So, what is migraine?

Migraine is a disorder of the brain where the nerves become over-stimulated and cause a cascade of chemicals to be released.

It’s not caused by a structural problem in the brain – using a computer as an analogy, this is a software rather than a hardware issue!

Migraine comes with an array of symptoms that can vary from one person to the next. Most adults with migraine will experience headache, with pain that is usually throbbing in nature, which can also be accompanied by nausea or vomiting along with increased sensitivity to light, noise, movement, or smell.

If you have headache attacks lasting hours or even days, with queasiness or a preference for rest (even if you could carry on), you are very likely to have migraine – but you will need to be seen by a medical professional for a diagnosis.

Migraine can be categorised as episodic (infrequent attacks) or chronic (more than 15 headache days each month).

While there is no simple cure for migraine, there are strategies and treatments that will help manage and control migraine and can often greatly reduce the severity and frequency of migraine attacks.

What does migraine feel like?

Migraine symptoms vary greatly, as you’ll discover from our range of factsheets. Some people, especially (but not only) children and young people, may find abdominal symptoms particularly troublesome. Others will have dizziness and visual or other sensory disturbances. And most, but not all, will experience headache.

For the majority who are affected by headache, migraine involves an intense, throbbing pain, which may be present on one side or both sides of the head. You’ll often experience sensitivity to light and sound too and may feel nauseous.

Who gets migraine?

Migraine is common. It affects around one in five women and one in 12 men.

It usually begins in early life, though diagnosis may be delayed until it becomes a problem, which is often when people begin working or during middle age.

Migraine usually gets less troublesome in older people, though it can begin at any age.

What are the different types of migraine?

Migraine can be episodic (around 90 per cent of cases) or chronic (10 per cent); it can involve aura (around 20 per cent) or feature no aura (80 per cent). Some people have migraine aura without headache.

People who have attacks of migraine are more prone to headache than people without migraine, but not all these headaches will be typical migraine attacks. Alcohol hangover headache, travel sickness, and vertigo are more often suffered by people with migraine.

Many headache experts think ‘tension headache’ is simply a featureless form of migraine.

What are the symptoms of a migraine attack?

There can be four stages, though not everyone experiences all stages:

1. The prodrome stage occurs hours or days before the headache. Swings in mood, such as irritability or anxiety, or cravings for foods such as cheese or chocolate, are due to changes which occur in this first phase. Yawning is a common feature and people are more sensitive to their surroundings (light, smells and noise).
2. Aura happens just before the headache and may last up to an hour, although typically 15 to 30 minutes. Aura can involve visual disturbances (90 per cent of auras) as well as numbness, dizziness, paralysis, speech difficulty and memory loss. Visual aura normally begins off-centre in both eyes and gradually enlarges with blackness, zigzags, lights or patterns that can affect half or all the vision. It can be helpful to cover or close one then the other eye to check if vision from both eyes is affected.
3. Pain or pressure in the head or neck is typically thumping or pulsing. It can affect any part of the head, including the face, sinuses or the neck. It can last hours or days, not minutes or weeks. If head pain is mild or absent, diagnosis can be difficult – for example, in cases of vestibular migraine, which predominantly involve vertigo and dizziness.
4. Recovery can take a day or two, during which time people feel generally unwell. A lot of people report ‘brain fog’, when it is harder to concentrate or simple tasks take longer to complete.

Is there a test for migraine? 

A diagnosis of migraine is based on the nature and time pattern of symptoms, not a test.

We are often asked if migraines show up on an MRI scan. A normal brain scan does not confirm a diagnosis of migraine. Around one in five healthy people (which includes people with migraine) may have an incidental abnormal finding on a brain scan, but only around 1 per cent of these may be potentially serious. Tests are not usually needed – although see the next section for exceptions.

Is migraine serious?

Many people with migraine are understandably concerned about attacks being a sign of an underlying condition. We’re often asked if migraine is ‘dangerous’ or ‘serious’.

Of course, migraine should be treated seriously since it can have a significant impact on one’s life. But it is rarely an indicator of something more concerning.

While a scan isn’t normally necessary, if there are other symptoms, such as epileptic attacks, paralysis, or a change in brain function, then those symptoms may independently warrant a brain scan.

There are three main situations where headache alone requires a brain scan.

1. So-called ‘thunderclap headache’, which comes on very rapidly, building in intensity in under few minutes to become the most painful headache imaginable
2. If you have developed new headaches and have had cancer of a type that can spread to the brain, then a brain scan is a wise precaution. These cancers include lung, breast, thyroid, kidney bowel cancers and melanoma.
3. If your pain is brought on by coughing, exercise, or change in posture, this can mean that the fluid around the brain and spine is partly blocked, which shows up on an MRI scan.

Migraine does not normally require a trip to A&E. But those experiencing the symptoms of a thunderclap headache, as outlined above, should go straight to the emergency department for a CT scan on the day that the headache begins. It can be a warning of bleeding in or around the brain.

It’s also common to find people are worried about brain tumours. You may have heard someone tell you they knew someone diagnosed with migraine who then died of a brain tumour. Migraine is a common disease, affecting one in seven people, so obviously one in seven people diagnosed with a brain tumour will have a history of migraine. It doesn’t mean the diagnosis of migraine was incorrect.

With 14 per cent of the UK population affected, more people have migraine than asthma, diabetes and epilepsy combined. It can be a disabling condition in its own right but, for the vast majority of people, it is not a signal of a more worrying condition.

What causes migraine?

The main causes of migraine are complex and involve the release of chemicals in the brain, leading to inflammation and oversensitivity. We often experience migraine along with excruciating pain. Pain is an alarm signal for the body, letting you know when something is wrong; migraine is like a faulty alarm activating in the brain software in response to various triggers.

Migraine with aura happens when the brain activation triggers a wave (called ‘depolarisation’) that spreads over the outer lining, or nerve cell layer, of the brain (the cortex). This wave causes symptoms such as the visual changes, numbness and tingling.

After this, neurochemicals are released and there are changes in the brain blood vessels and levels of inflammation, which result in reduced brain function, changes in the gut (which may lead to nausea, vomiting or diarrhoea), brain oversensitivity (which may make light seems too bright or noise too loud), and so on.

The underlying cause of migraine is not yet certain, but most experts think the neuronal malfunction results from a disorder in the ion channels on nerve membranes. This disorder is thought likely to be genetic (passed on in families), but the triggers of attacks are often your environment or lifestyle.

Headache specialists are often asked about what causes migraine in women – although the mechanism is the same across genders, women have a different balance of hormones which makes them more prone to attacks. You can learn more in the Women’s Health section of our Factsheets & resources page.

What are migraine triggers?

In many, but not all people, it’s possible to identify and avoid migraine triggers. Here are some common triggers that could be avoided to help you reduce the impact of migraine.

• Keep a regular routine

• • Irregular or skipped meals should be avoided. People with migraine should eat a fibre-containing breakfast within an hour of getting up, before leaving home for work or school.

• • Eat little and often

• • Some people think dehydration can trigger migraine

• • Try to have a regular body clock, going to sleep and waking up at the same time every day. On weekends or days off, stick to the same daily pattern as during the working week. Avoid shift work or try to stay on the same shift all the time.

• Manage stress

• • The release from stress at weekends is another reason for migraine. Try to keep stress levels relatively constant throughout the week and make change gradual.

• Stay fit

• • Keeping physically fit can make you more resistant to migraine (although for some people vigorous exercise can bring on an attack). Unaccustomed exercise can trigger migraine – try to exercise regularly and build up fitness gradually.

• Hormones

• • In women, falling oestrogen levels can trigger migraine at menstruation or after childbirth. The oestrogen-containing contraceptive pill should not be used by women who experience aura due to the increased risk of blood clots.

• Medication overuse

• • One of the commonest causes of worsening migraine is taking too many painkillers. Check out our Factsheets and resources section to find out more information.

• Weather

• • Changes in the weather can trigger migraine, although they can’t be avoided!

• Holidays and travel

• • Travel is a common migraine trigger. Many of the triggers listed here overlap and coincide when going on holiday, making migraine attacks more likely.

• Foods

• • Some people think that foods such as cheese, chocolate, citrus fruits and those containing tyramine can trigger migraine. Headache specialists say this is much less common than previously thought. Many of these foods may be craved during the prodrome stage, following a drop in blood sugar levels, rather than being triggers.

• Other common causes

• • Anything that causes headache can trigger migraine attacks in those who are susceptible, with Covid-19 infection, head injuries and alcohol consumption common triggers.

What can I do to help myself?

Many people manage well without seeing a headache specialist. You may find listening to our Heads Up podcast gives you useful tips, or you can review helpful books like Managing Your Migraine, by National Migraine Centre clinician Dr Katy Munro. The next step could be to speak with your local pharmacist or your GP.

You may also be able to reduce the impact of headache by improving your self-management regime – try these tips. But remember, migraine is not your fault!

• Keep a diary

• • The more you’re bothered by migraine, the more important it is to keep a record of headache attacks and other migraine symptoms. You should include possible triggers (such as your menstrual cycle or shiftwork patterns) as well as the details of any treatments, together with your response to each.

• Migraine medication

• • What are the treatments for migraine? Drugs can be very effective at controlling migraine symptoms – but not all painkillers are equal. Try to take painkillers which are known to work in migraine and take them quickly.

• • First line migraine medicine treatments include the aspirin and ibuprofen family (known as NSAIDs), which work better than paracetamol. Codeine and opioids are best avoided.

• • A family of migraine specific painkillers known as triptans also often work well, probably by reversing the changes in the brain that cause migraine. There are seven different triptans: if one doesn’t work, ask to try a different one.

• • The most important thing is to act quickly. During a migraine attack, there is a window of opportunity before the stomach stops working effectively (called gastric stasis), after which any drugs you take will not be absorbed properly. To help your stomach absorb the medicines better, you may be advised to by a clinician to take a larger dose of the painkiller (such as 900mg of aspirin or 600mg of ibuprofen) and try to choose a soluble form which you can dissolve. Adding an anti-sickness drug, such as domperidone 10mg, not only stops you feeling sick but can also help the medication absorption by reversing gastric stasis.

• • If the drugs do not work individually, a clinician may advise taking them all together as soon as possible at the start of the attack can be effective. For example, by taking sumatriptan, ibuprofen and domperidone at the same time.

• • One of the most common reasons for worsening migraine is overuse of painkillers. If you take ordinary painkillers or triptans for more than eight to ten days, triptans more than eight to ten days, or codeine-related drugs even quite rarely, the headaches can start getting worse as a consequence. Recording this in your migraine diary will help you keep track. It’s a good idea to seek advice from your GP who can guide you through the different treatment options and, if necessary, refer you to a specialist migraine clinic for further help.

• • Do not take drugs that do not work. If your migraine attack is going from bad to worse, it is often important to stop taking acute treatments for a while. This is hard to do if you have a busy life. The single commonest reason for worsening migraine (moving from acute to chronic pain) is the overuse of acute treatments. This is often a problem that can particularly affect people who take combinations of codeine and paracetamol, though any acute migraine treatment can worsen your headaches.

• • If you get frequent or very severe attacks, or if the treatment for your attacks does not work well, you may need to use preventative drugs. These are medications you take every day with the aim of preventing or lessening attacks. No single preventative will work for everybody and the aim should be to reduce the number and severity of attacks rather than expecting them to stop altogether. Some of medications have side effects, such as drowsiness. It is often best to start with acute treatment and keep a migraine diary before considering preventatives.

• Triggers

• • For prevention, dealing with the triggers listed above is generally more effective than medication. Working with the help of your headache diary, get a better understanding of your triggers – and then do what you can to address them.

Will it get better?

In almost every case, yes! The vast majority of people find that migraine improves naturally with time. And although there is no cure, migraine can be controlled, treated and managed.

Think about triggers and how to avoid them, avoid traps such as medication overuse or the wrong sort of contraceptive pill, keep a diary, consider a preventative, consult your pharmacist and GP, or book a consultation with the National Migraine Centre.

Where can I get migraine treatment?

You can get migraine treatment from a pharmacy, your GP, a neurologist, hospital or specialist clinic. The best hospital for migraine – and the best specialist for migraine – is the one that gets you to the help you need, listens to you, personalises treatment and takes time to fully understand your migraine experience.

The doctors who treat migraine include neurologists and GP headache specialists.

You may be able to access NHS treatment through your GP, although not everyone will be eligible for specialist hospital clinics and wait times can be long. At the National Migraine Centre, we bring together many of the UK’s leading headache specialists, who provide extended video appointments from your own home, alongside quick access to consultations to discuss whether anti-CGRP medication or procedures could help you. As a charity, we operate on a not-for-profit basis. Book a consultation today.

Take control of your migraine

Book an appointment with the experts: review the best treatment options for you with a leading headache specialist. Beat the misery of migraine and get back to living. Book your consultation through the National Migraine Centre now.