Migraine headaches

It is widespread in the population with seriousness ranging from an annoyance to a life-threatening and or daily experience.

Usually migraine causes episodes of severe or moderate headache (which is often one-sided and pulsating) lasting from 4 to 72 hours, accompanied by stomach upsets, such as nausea and vomiting, and a heightened sensitivity to bright lights (photophobia) and noise. Approximately one third of people who experience migraine get a preceding aura, in which a patient senses a strange light or unpleasant smell.

Three quarters of adult migraine patients are female, although pre-pubertal migraine affects approximately equal numbers of boys and girls. This reveals the strong correlation to hormonal cycling and hormonal-related causes or triggers. Migraine famously disappears during pregnancy in a substantial number of sufferers.
The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same person:

The prodrome, which occurs hours or days before the headache.
The aura, which immediately precedes the headache.
The pain phase, also known as headache phase.
The postdrome.

 Prodrome phase
Prodromal symptoms occur in 40 to 60% of migraine sufferers. This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), constipation or diarrhoea, increased urination, and other vegetative symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to anticipate that a migraine attack is near.

 Aura phase
For the 20 to 30% of individuals who suffer migraine with aura that precedes or accompanies the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely.

Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights or forma­tions of dazzling zigzag lines (often arranged like the battlements of a castle) Some patients complain of blurred or shimmering or cloudy vision, as though they were look­ing through thick or smoked glass, or, in some cases, tunnel vision. The aura of migraine also consists of a feeling of pins-and-needles experienced in the hand and arm as well as in the nose-mouth area.

Other symptoms of the aura phase can include hearing or smell hallucinations, temporary dysphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch.

 Pain phase
The typical migraine headache is one-sided, throbbing, moderate to severe and can be aggravated by physical activity. Not all of these features are necessary. The pain may be on both sides at the onset or start on one side and become generalized, and usually alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 and 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraine sufferer experiences from one to three headaches a month. The head pain varies greatly in intensity. The pain of migraine is invariably accompanied by other features. Nausea occurs in almost 90 percent of patients, while vomiting occurs in about one third of patients. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhoea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized swelling of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.

 Postdrome phase
The patient may feel tired, "washed out", irritable, or listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. On some patients, a 5 to 6 hour nap may reduce the pain, but slight headaches may still occur when standing or sitting quickly. Normally these symptoms go away after a good night's rest.

The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed.

Migraine attacks may be triggered by:

Allergic reactions
Bright lights, loud noises, and certain odors or perfumes
Physical or emotional stress
Changes in sleep patterns
Smoking or exposure to smoke
Skipping meals
Alcohol or caffeine
Menstrual cycle fluctuations, birth control pills
Tension headaches
Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate or nitrates (preserved meats)
Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods.
Sometimes the migraine occurs with no apparent "cause". The trigger theory supposes that exposure to various environmental factors precipitates, or triggers, individual migraine episodes. Migraine patients have long been advised to try to identify personal headache triggers by looking for associations between their headaches and various suspected trigger factors and keeping a "headache diary" recording migraine incidents and diet to look for correlations in order to avoid trigger foods

Several studies have found some migraines are triggered by changes in weather. 

  The value of diet modification should not be overlooked. The simple task of starting a diet journal to help modify the intake of trigger foods like hot dogs, chocolate, cheese and ice cream could help alleviate symptoms

Migraine sufferers usually develop their own coping mechanisms for the pain of a migraine attack. Hot or cold water applied to the head, resting in a dark and silent room or ingesting caffeine at an appropriate time may be as helpful as medication for some patients.

For patients who have been diagnosed with recurring migraines, medications can be used to treat the attack, and may be more effective if taken early, losing effectiveness once the attack has begun. Treating the attack at the onset can often stop it before it becomes serious, and can reduce the frequency of subsequent attacks.

Paracetamol or Non-steroidal anti-inflammatory drug (Nsaids)(ibuprofen or aspirin) are the first line of treatment in over-the-counter medication in combination with codeine. Codeine can cause drowsiness.

Paracetamol tablets are non-drowsy and easy to swallow.

Nurofen Plus tablets is an ibuprofen and codeine combination. For adults and children over 12 years. This is a very powerful combination, but it does cause drowsiness and so impairs the ability to drive or operate machinery. It also cannot be used by patients who are allergic to aspirin, patients with stomach ulcers or asthma. It has to be taken with or after food which is not always possible with migraine sufferers. 

Nurofen meltlets is ibuprofen (200mg) in a melt in the mouth formulation (good for if you are being or feeling sick) which doesn't cause drowsiness for those who need to drive or operate machinery. Cuprofen tablets is the less expensive equivalent of Nurofen. 

During a migraine attack, emptying of the stomach is slowed, resulting in nausea and a delay in absorbing medication. Caffeine has been shown to partially reverse this effect, and probably accounts for its benefit.  

Propain tablets for adults and children over 12 years contain paracetamol, codeine, an antihistamine and caffeine. Syndol tablets contain paracetamol, codeine, a muscle relaxant and caffeine for adults and children over 12 years.

 Anti-emetics by mouth may help relieve symtoms of nausea and help prevent vomiting. Vomiting can diminish the effectiveness of orally taken pain relief. 

Migraleve Pink tablets is a combination treatment which contains paracetamol/codeine for analgesia, with buclizine as the anti-sickness. The earlier these drugs are taken in the attack, the better their effect. For adults and children over 10 years.

Migraleve Yellow tablets is a combination treatment without the buclizine.

Migraleve Complete tablets contain pink and yellow tablets as above.

Buccastem M tablets is an anti-sickness medication which is dissolved under the top lip so it gets into the blood stream even if you are being sick. For adults over 18 years. Very effective to control sickness to allow you to hold down a dose of pain relief.

Motilium Tablets and Motilium Instants which dissolve in the mouth are both very effective for nausea. Choose the Instants for migraine induced sickness.

Avomine tablets is an anti-sickness medication which is suitable for adults and children over 5 years.

Sumatriptan (Imigran Recovery tablets) is a  selective serotonin receptor agonists and is excellent for severe migraines or those that do not respond to NSAIDs or other over-the-counter drugs. It has only recently been allowed for sale over the counter. It can stop a migraine very quickly but is expensive. For adults over 18 years.

Trigger avoidance
Patients can attempt to identify and avoid factors that promote or precipitate migraine episodes. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful. General dietary restriction has not been demonstrated to be an effective approach to treating migraine, and migraine is remarkably resistant to the placebo effect

Sleep is often a good solution if a migraine is not so severe as to prevent it, as when a person awakes the symptoms will have most likely subsided.

For your safety:

Migraine should always be diagnosed by a doctor. More serious medical problems can present as a severe headache. A severe headache with light sensitivity and/or neck stiffness and/or skin rash may need to be treated as a medical emergency.

Children should always be treated by your doctor.

If your migraine does not clear after 3 days consult your doctor.

If you take any other medication or suffer from medical conditions then please tell us when you fill in the questionnaire when purchasing or consult your doctor.

For much more information click Migraine or go to NHSDirect at www.nhs.uk. 

This page was last updated: Monday 25 September, 2017