Everything you need to know about migraines

It’s often said that migraines are ‘more than just a headache’ – yet if you’re not among the one in seven people who suffers from them, or their families, it’s very likely you’ll just tag migraine as a headache, albeit possibly a very bad one.

Migraines are believed to affect around eight million people in the UK and they can be extremely debilitating, in many cases damaging a person’s quality of life and causing 18 million sick days from work each year.

The Migraine Trust (migrainetrust.org) says migraine is more common than diabetes, epilepsy and asthma combined, and this Migraine Awareness Week (September 6-12), the charity is highlighting migraine triggers, which can include stress, poor sleep, alcohol, hunger, hormonal changes and the environment. It’s also a good opportunity to raise awareness of migraine symptoms, which include a painful headache, vision problems, sensitivity to light, sound and smells, plus nausea and vomiting.

What is a migraine?

Contrary to popular belief, a migraine is not just ‘a bad headache’. It’s an extremely painful collection of neurological symptoms, including a headache often characterised by a severe throbbing pain on one side of the head.

As well as pain, migraines are also associated with nausea, dizziness, sensitivity to light and noise, and changes in eyesight.

“Attacks vary in length and frequency from person to person, and in between attacks, there are no symptoms at all – which can make it very difficult to plan and prepare yourself for the next one,” says GP Dr Lizzie Kershaw-Yates, one of the medical team at The Online Clinic (theonlineclinic.co.uk).

She explains that there are are three different types of migraine, which vary in their characteristics:

Migraine without aura: “This is a throbbing headache at the front or at the side of the head, usually on one side. It can include moderate to severe pain, with nausea and vomiting, sensitivity to bright light and can be worsened by head movements.”

Migraine with aura: “This has all the same features of a migraine without aura but there is also a warning sign at the start of the headache. This could be visual – such as seeing flashing lights, or experiencing a partial loss of vision – or it could be a sensation, such as numbness, struggling with speech or a smell.”

Migraine with aura, without headache: “This type of migraine has the same features of a migraine with an aura, but without the onset of a headache.”

How common are migraines?

“Migraines are one of the most common health conditions in the world,” Dr Kershaw-Yates says. “It affects more women than men. On average, one in five women suffer from them, and one in 12 men.”

They usually begin in the teenage years, but can potentially start at any age. “Over half of migraine sufferers have one or more attacks a month, and more than one in 10 have one or more attacks a week,” adds Kershaw-Yates.

“Migraines are more common in females, particularly between the onset of menstruation and menopause. People with relatives, such as parents or siblings with migraine, will be more prone to suffer too,” explains Dr Ben Turner, a consultant neurologist at London Bridge Hospital (part of HCA Healthcare UK).

What’s causing my migraines?

“In neuroscience terms, migraine is a ‘disorder of central sensory processing’, or in non-medical terms, ‘incorrect signals within the brain’. In essence, the cause of migraine is the complexity of the brain – 86 billion neurons are bound to misfire at times,” says Turner. “The brain is a highly sophisticated computer and, like computers, it may inexplicably freeze and need reboots. On an individual level, the main risk factors for migraine are genetic – i.e. a family history – and lifestyle, lack of meals or sleep.”

People with migraines are believed to have a very sensitive nervous system which, for some reason, responds in a particular way, particularly when it comes to change.

“Migraines mean that someone’s brain is responding abnormally to normal signal and sensory information, such as pain, light or sound,” explains Kershaw-Yates. “The narrowing and opening of the blood vessels can also play a part in causing a migraine.”

You should watch out for any external triggers which might be causing your migraines. These aren’t necessarily the same for everyone, but can include foods such as chocolate, cheese, red wine or citrus fruits, psychological factors such as stress, anxiety, depression or tiredness, along with high altitude, humidity, noise or flickering lights. Food and drinks which contain caffeine or food additives, sleep (either too much or too little), drugs and dehydration can also be migraine triggers.

“The amount of factors which can cause migraines is huge, so it’s difficult to say exactly what causes them,” says Kershaw-Yates. “One thing that can help pinpoint your triggers is to keep a migraine diary. Write down when it started, ended and what your symptoms were, along with as many details about your daily life as you can, including medication, exercise, diet and sleep.” This can help you and your doctor work out what might be triggering your attacks.

How are migraines diagnosed?

“No tests can confirm you suffer from migraines – you can only be diagnosed by a doctor based on your symptoms,” says Kershaw-Yates. “If they are in any doubt, you might be referred to a migraine clinic or a neurology department, which specialise in the diagnosis and treatment of migraine.”

It’s important to get properly diagnosed, if you think you may be experiencing migraines, to ensure you get the right advice and treatment.

How are they treated?

“There are three pillars of treatment: lifestyle, treatment of individual attacks (acute management), and preventative treatments (prophylaxis),” explains Turner, who stresses that all of these can play an important role in managing migraine.

“Once a migraine begins, you can take painkillers, anti-sickness medicine, or a medicine called triptans which stimulate the production of a chemical in the brain (serotonin),” says Kershaw-Yates.

“Acute management is about taking medication early, such as soluble aspirin in a carbonated drink with caffeine,” says Turner. “Alternatives to aspirin are the triptan family of drugs, which are now available over-the-counter. Both these approaches should ease two-thirds of migraines – they don’t stop all attacks, but doses can be repeated if necessary. If nausea is a factor then using medication to treat this is important.

How to prevent migraines

There are a variety of medicines that can be tried to prevent migraine attacks. The different treatments include beta-blockers, anticonvulsants, antidepressants, and even Botox.

“Prophylactic treatment used to require taking a medication such as a beta blocker, antidepressant or anti-epileptic medication regularly for weeks or months,” says Turner. “More recently, a new group of drugs targeting the calcitonin gene related peptide pathway have shown good outcomes. On average, these preventative treatments reduce migraine attacks by 50%.”

Preventative lifestyle measures include routine, a regular diet – breakfast, lunch and evening meals – and avoiding low blood sugar, which is a biological stress and trigger.

“Whether individual foods act as trigger is less clear, but chocolate, caffeine and dairy are considered potential triggers, in addition to alcoholic drinks – although triggers tend to be unreliable and individual. It’s established that shift workers are more prone to migraine, so regular sleep patterns reduce the risk. Regular exercise is also protective,” says Turner.

You should always seek professional medical advice if you’re thinking about trying a new treatment method for your migraines, as most of them include side-effects. Plus, some over-the-counter painkillers might not always be the most suitable way of treating your migraine.

How psychologically damaging are migraines?

“Regular migraine sufferers are more prone to low mood and anxiety, not just because of the regular threat of incapacitating attacks, but it appears the changes in the brain before and after migraine also make individuals low in mood,” says Turner.

Should I contact my doctor?

Dr Kershaw-Yates says that you should speak to your doctor if your migraines are severe or frequent, or if they are getting in the way of your day-to-day life. “If you experience excruciating pain, paralysis down one side of the body or face, speech difficulties, double vision, or a rash – make sure you seek immediate medical attention ASAP, as this may be a sign of something more serious,” she adds.

Also, if you’re struggling to manage your migraines, do go back and see your GP again, or seek a specialist referral – there might be a lot more that can be done to help.

‘Give it up’ for migraine

The Migraine Trust is asking the friends and family of people with migraine to take part in its #GiveUpForMigraine campaign, by thinking of something they love doing that they’re prepared to give up for a month, and donate the money they save from not doing it to The Migraine Trust.

The idea is that sacrificing what they love will give people an insight into a key part of what living with migraine is like, as the condition is often triggered by things people enjoy doing, like drinking alcohol or coffee, and they have to give them up to try to prevent their migraines.

“A migraine attack is often triggered by something, and understanding what triggers your attacks can help you manage it,” explains Migraine Trust spokesperson, Una Farrell. “Triggers vary for different people – alcohol might be a trigger for one person, while hormonal changes might trigger monthly attacks for one woman but not another.”

Farrell says identifying a trigger isn’t always easy, and they can sometimes be wrongly identified. “For example, at the beginning of an attack, before the pain’s begun, you may experience a craving for sweet things,” she says. “If you eat some chocolate to satisfy this craving, and then get a headache, you may identify chocolate as one of your triggers. In fact, you were starting to get a migraine before you ate the chocolate.”

A good way to identify triggers, she says, is to keep a detailed diary of your activity, food and drink, changes to your mood and body, and external factors such as the weather and room temperature, to help you spot patterns and thus identify your real migraine triggers.

For further information, see migrainetrust.org/get-involved/fundraising/giveupformigraine.

You may also be interested in…

• 4 types of headache – symptoms, causes and how to treat them
• 5 signs that you may have a magnesium deficiency
• Female symptoms of a heart attack: how men and women experience heart attacks differently
• Gut health: how to deal with IBS in party season
• Prone to acid indigestion? Here are 5 summer heartburn triggers to avoid