Migraine

What is migraine?

Migraine is a condition of headache attacks, which are often associated with pain, feeling and/or being sick (nausea/vomiting), dizziness, sensitivity to light and noise, and eyesight changes. Migraine attacks vary in length and frequency but between attacks, there are no symptoms.

Getting treatment online

If you have previously been prescribed medication for your migraines then The Online Clinic can prescribe medication for you after you complete a short questionnaire on our website.

There are several types of migraine, which differ in characteristics, including:

• Migraine without aura: a throbbing headache at the front or side of the head (usually on one side), moderate to severe pain with nausea and vomiting, sensitivity to bright light, and worsened by head movements
• Migraine with aura: has the features of migraine without aura, but there is also a warning sign (known as aura) at the start of the headache. The aura may be visual (e.g., flashing lights, zig-zag lines, or partial loss of vision) or a sensation (e.g., numbness, a speech problem, or a smell)
• Migraine with aura without headache: has the feature of a migraine with aura but without the onset of headache

Furthermore, a migraine can be divided into four phases. First is the premonitory phase when you may feel depressed, tired and irritable or have food cravings; then comes (if it is to happen) the aura; then the headache; and finally, resolution when the headache disappears.

How common is migraine?

Migraine is one of the most common health conditions in the world. More women than men have migraine attacks, with migraine reported in approximately 1 in 5 women and 1 in 12 men. Migraine can begin at any age, but usually attacks begin in the teenage years. Over half of migraineurs (people with migraine) have one or more attacks a month, and more than 1 in 10 report one or more attacks a week.

What causes migraine?

Migraine is about how a person’s brain deals with sensory information, such as pain, light or sound. Migraineurs have a very sensitive nervous system, particularly to change. Chemical changes in the brain cause the attack to start, which leads to a chain of events that result in the brain responding abnormally to normal signals (e.g., light sensitivity, visual disturbances, dizziness, or numbness or tingling). Narrowing and opening of blood vessels in the brain may also play a role. Migraine often runs in families so you may have inherited genes linked to migraine.

Differences within the body can make individuals more prone to migraine but other ‘outside’ things are important in causing migraine attacks. Being unpredictable, migraine can be ‘triggered’ by numerous things, including:

• Foods, e.g., chocolate, cheese, red wine, citrus fruits
• Psychological factors, e.g., stress, anxiety, depression, tiredness
• Environment, e.g., high altitude or humidity, noise, flickering lights
• Foods containing caffeine, or food additives (e.g., tyramine)
• Sleep (too much or too little)
• Drugs, e.g., oral contraceptives, sleeping pills
• Lack of food or irregular meals
• Change in routine
• Hormonal changes in women
• Mild dehydration
• Exercise

But it’s not that simple, because it is not usually possible to say that this or that causes migraine. While trigger factors certainly play a role if you are predisposed to migraine, it may be useful to keep a migraine diary with details of your migraine (e.g., when it started/ended, and symptoms) and aspects about your daily life (e.g., what you ate/drank, medication, exercise, sleep, and menstrual cycle). You may be able to determine a pattern and avoid any culprits.

How is migraine diagnosed?

Your doctor will usually diagnose migraine from your symptoms and by their absence between attacks. No tests will confirm a diagnosis. However, if there is doubt, you may be referred to a migraine clinic or hospital neurology department, which specialise in the diagnosis and treatment of migraine.

What makes migraine different from headache?

Migraines are a type of headache but what we refer to as a headache can be the result of a whole variety of factors such as tension, alcohol, infection, and medical conditions. Headaches tend to resolve with the problem. ‘Medication overuse headache’ may also occur in those who frequently take painkillers for their headache –they enter a vicious ‘headache – painkiller’ cycle, whereby as the painkiller (taken for the headache) wears off, its absence causes another headache, and thus to further use of painkillers. In contrast, migraines recur, usually last 4–72 hours, and in most cases there is complete freedom from symptoms between attacks.

How is migraine treated?

There are two ways of treating migraine; treatment when the migraine begins and treatment to stop migraine happening. Once you have a migraine, there are painkillers (such as paracetamol and anti-inflammatory drugs, e.g. ibuprofen) that are taken early in the attack, anti-sickness medicines for the nausea/vomiting, and medicines called triptans, which stimulate production of a chemical in the brain (serotonin) and should be taken at the onset of the headache.

However, if these medicines do not work or you are taking many painkillers or your migraine attacks significantly affect your daily life, you may wish to consider a medicine to prevent the attacks. These medicines generally reduce the number and frequency of migraines but not always completely. They include certain beta-blockers, anticonvulsants, antidepressants, and even Botox. However, it is advisable to see what a migraine diary reveals before taking these medicines because they have side effects and may take a while to begin working. Your doctor will advise which medicine is best for your migraine attacks.

When should a doctor be contacted?

It is advisable to see your doctor if your migraines are severe or frequent, regardless of whether they resolve with medicines bought from the chemist. Seek immediate medical attention if you suffer sudden excruciating pain, paralysis down one side of your body or face, speech difficulties or headache with high temperature, double vision and rash, as these may indicate something more serious.