What is a Migraine?

Migraine affects every aspect of a person’s life – education, work, mental health and relationships. According to Migraine Trust, around 43 million days are lost from education and work every year due to migraine.

The impact goes beyond education and work, though. Some 60% of people feel that migraine significantly impacts their relationships and 71% say there is a significant effect on mental health. Though migraines are most common between the ages of 30 and 40, they don’t just affect adults either. Research from Cedar Health found that one in ten school-aged children experience migraines.

In this article, we’ll go through everything you need to know about this debilitating medical problem.

For want of a better word, a migraine is a headache. However, anyone who has ever experienced a migraine will tell you that it’s much worse than that. A migraine is a severe pain that’s usually throbbing and focused on one side of your head.

When people experience migraines, they often have other symptoms too. They can be more sensitive to sound and light and might experience nausea and vomiting as well.

Women are more likely than men to suffer from migraines. Around 20% of women (one in five) experience migraines. However, for men, the condition only affects one in fifteen men.

Migraines usually begin when people are young adults. Some people have migraines often – as many as a few a week. Others might only experience migraines occasionally. Years could pass between attacks.

What are the signs and symptoms of a migraine?

The most obvious migraine symptom is an extremely intense headache. This is on one side of the person’s head. The pain is typically like a severe throbbing that is worse when the person moves. It is so severe that the person is unable to do their normal daily activities.

Sometimes, it is possible to experience pain on both sides of the head and it can also affect the neck and face.

Additional symptoms

Besides the headache, there are often other migraine symptoms.

These include:

Nausea.
Vomiting.
Being very sensitive to sound and light.
Sweating.
Feeling hot or feeling cold.
Being unable to concentrate.
Abdominal pain.
Diarrhoea.

Not all people will have additional symptoms accompanying the headache.

The migraine symptoms will normally last at least four hours and can go on up to 72 hours. It is common to feel tired for as long as a week after the migraine.

Migraine signs – aura

Around one-third of people who suffer from migraines will experience a ‘warning sign’ beforehand. This is called an aura.

A migraine aura could manifest itself in a number of ways.

The person might have:

Visual problems. These might be blind spots, zigzag patterns or flashing lights.
Tingling sensations or numbness. This might be pins and needles in a hand that moves up an arm to the tongue, lips and face.
Feeling unsteady on your feet or feeling dizzy.
Not being able to speak well.
Losing consciousness (this is not very common).

An aura usually develops in five minutes and might last up to one hour.

It’s also possible to have an aura followed by no headache or just a mild one.

Knowing when to call a doctor

A migraine can feel very intense and scary, especially if it’s one of the first ones you’ve had.

When a person experiences frequent, severe migraines that are not controlled by over-the-counter pain relief like paracetamol, they should seek advice from their GP.

If you have migraines more than five times a month – even if you can control these with medication – then you should seek advice from a GP. This is because you might be able to benefit from a preventative treatment.

The migraine stages

For many people, there are different stages to their migraine. Not everyone will experience all of the stages.

Here are the common stages of a migraine:

1. Pre-headache (prodromal) stage. You might experience a change in energy levels, mood, behaviour and even appetite. You might notice these changes a few hours before a migraine attack – or even a few days before.
2. Aura. As explained above, these are usually visual problems that last between five minutes and an hour.
3. Headache stage. This is usually a throbbing or pulsating pain on one side of the head. It might come with nausea, vomiting, and being sensitive to noise or light. The headache stage lasts between four and 72 hours.
4. Resolution stage. This is when migraine headaches (and any accompanying symptoms) fade. It is possible to feel tired for up to one week after.

What causes a migraine?

No one knows for sure what causes migraines. It is believed that they’re down to changes in the blood vessels, nerves and chemicals in the brain.

It is also believed that genetics play a role in whether or not a person might have migraines. This is because around 50% of people who have migraines also have close relatives who have them too.

Some people have migraine triggers.

Examples of common triggers include:

The menstrual cycle or other hormonal changes.
Tiredness.
Stress or other emotional triggers.
Certain drinks or foods.

Triggers are individual. People can help find their triggers by keeping a diary of their migraines.

The menstrual cycle or other hormonal changes

Some women have migraines during menstruation. This is likely due to the hormonal changes they experience.

When women have migraines linked to their menstrual cycle, they usually happen between two days before menstruation and three days after. These migraines are called pure menstrual migraines.

A lot of women experience migraines at other parts of their cycle, and these are called menstrual-related migraines.

Due to the hormonal nature of these migraines, many women will find they stop having migraines after the menopause, though the menopause itself can also trigger them or worsen them for some.

Emotional causes

Along with stress, other emotions can have an effect on a person’s migraines. They can be triggered by anxiety, depression, shock, tension and even excitement.

Physical causes

Some people will experience migraines when there has been a physical cause. For example, if they have a period of time without sleep or they have had poor-quality sleep, they might then get a migraine. This can be especially difficult for people who do shift work. Long-haul travel can also be an issue as jet lag can trigger migraines.

Other physical triggers include shoulder or neck tension, poor posture and strenuous exercise (when the person isn’t used to that degree of exercise).

Finally, having low blood sugar can trigger a migraine.

Dietary causes

There are lots of food and drink triggers of migraines and all individuals will be different. Missing meals, delaying meals or having irregular meals can trigger a migraine.

As well as meals (or missing meals), what you drink can affect your susceptibility to migraines. Dehydration is a huge trigger for many people and so it’s important to stay hydrated. Tea, coffee and other caffeinated drinks can also be a trigger for some people, as can alcohol.

Food-wise, some people find citrus fruits like lemons or chocolate products are a trigger. Many people have also found that foods containing tyramine trigger their migraines. Tyramine is found in yeast extracts, cured meats, smoked fish, pickled herrings and some cheeses like camembert, stilton and cheddar.

Room temperature foods (as opposed to refrigerated or frozen foods) usually have higher tyramine levels.

Causes in the environment

Some people find that they only get migraines in specific situations they find themselves in.

Here are some environmental migraine triggers:

Flickering screens (computer screens, phones, tablets or TVs).
Bright lights.
Loud noises or noisy environments.
Smoky environments (or smoking itself).
Strong smells.
Stuffy rooms.
Climate changes – humidity or temperature changes.

Medicinal triggers

Certain medicines can also trigger migraines in some people. This includes certain sleeping tablets and the combined contraceptive pill.

Women who take HRT (hormone replacement therapy) to relieve menopausal symptoms can also experience migraines.

How long can migraines last?

Migraines can last a few hours to a few days. They can seriously affect your life and prevent you from doing your usual activities. Some people stay in bed for three days when they have a migraine.

However, there are some effective treatments available that can prevent migraine attacks and reduce symptoms when an attack occurs.

Most people find their migraine attacks slowly improve over time. However, there are some people who find they get worse.

What are the different types of migraines?

There are several migraine experiences. These include:

Migraine with aura.
Migraine without aura (this is the most common type).
Migraine aura without headache. This is also known as a silent migraine.

There are also different types of migraine. These include:

Hemiplegic migraine.
Abdominal migraine.
Chronic migraine.
Status migrainosus.
Menstrual migraine.
Retinal migraine.
Basilar migraine.

Let’s look at each of these in more detail.

Hemiplegic migraine

These migraines affect a small number of people. They often present as a stroke and come with weakness or paralysis that affects one side. People might also have vision or speech disturbances during the migraine.

There are two types of hemiplegic migraine – FHM (familial hemiplegic migraine) and SHM (sporadic hemiplegic migraine).

FHM is an inherited condition while SHM is when there are no genetic links.

Abdominal migraine

Usually, it is children who are affected by abdominal migraines. Generally, symptoms will last between one hour and 72 hours. The person will typically experience flushing, nausea and vomiting.

When children have experienced abdominal migraines frequently, they might also have experienced delayed development, clumsiness and attention deficit problems.

Children who experience abdominal migraines with no headaches will usually experience more typical migraines as they become adults.

Chronic migraine

Chronic migraine, also known as transformed migraine, describes the condition in people who have migraines that are ongoing and repeated. When someone has chronic migraine, they will usually have symptoms every day or almost every day.

Chronic migraine typically begins in late adolescence and early adulthood.

Status migrainosus

This is a very rare and very serious variant of migraine. With this type of migraine, the patient is usually hospitalised because their migraines have lasted over 72 hours. Status migrainosus is often accompanied by nausea and vomiting, which means they need intravenous fluids to treat dehydration.

Menstrual migraine

We’ve discussed migraines and the menstrual cycle above as this is a trigger for many women.

It is predicted that between 7% and 14% of menstruating girls and women will suffer from menstrual migraines.

Menstrual migraines are usually more severe.

Retinal migraine

This is a rare type of migraine that causes visual disturbances like blindness in a specific area in the field of vision. The visual disturbances last a few minutes to an hour before the headache.

Basilar migraine

A basilar migraine is also known as a migraine with brainstem aura or Bickerstaff syndrome. With this type of migraine, the person will usually experience vertigo or dizziness before the migraine headache.

They may also experience slurred speech, ringing in the ears, loss of balance, fainting (syncope) and loss of consciousness. This is a common type of migraine in young women and adolescent girls, which means it is probably linked to hormonal changes.

Can a migraine be prevented?

Whether or not a migraine can be prevented depends on whether or not you know of any specific triggers. For example, if you know that cheese triggers your migraines, avoiding cheese will prevent attacks.

Without knowing your triggers, you can still reduce your risk of an attack by leading a healthy lifestyle. Drinking enough water, getting regular exercise and good sleep, eating a healthy diet and limiting your intake of alcohol and caffeine can all help.

You can try to work out triggers by creating a migraine diary. In the diary, you should note down the date and time of the attack, whether or not there were any warning signs, the symptoms, whether or not there was an aura, medicines taken, and when the attack ended.

There are also many medicines available that are known to prevent attacks. These include propranolol and topiramate. Propranolol is usually used for high blood pressure treatments or anxiety, while topiramate is usually prescribed as an anti-seizure medication.

Another preventative medicine is amitriptyline. This is usually used to treat depression, but it can also prevent migraines.

If migraines are related to the menstrual cycle, there are some treatments available too. These include non-hormonal treatments like NSAIDs (non-steroidal anti-inflammatory drugs) and triptans. Triptans reverse blood vessel widening, which is believed to cause migraines to some extent.

Hormonal treatments like contraceptives (combined or progesterone-only) are also used to prevent menstrual migraines.

How are migraines diagnosed?

There are no set diagnostic tests for migraines. For a diagnosis, GPs need to identify recurring headaches and symptoms on a case-by-case basis. This can take time due to the unpredictable nature of the condition.

A GP might make a referral to a specialist. This will be a neurologist who can assess further. This might happen for people with an unclear diagnosis or when treatment isn’t working. People who have chronic migraine and suffer for two weeks or more each month will also benefit from seeing a neurologist.

How are migraines treated?

There is no known cure for migraines but there are some effective treatments available to help relieve symptoms.

Treatments include:

Painkillers – Over-the-counter medication like ibuprofen and paracetamol.
Triptans – Mentioned above. These reverse blood vessel widening.
Anti-sickness (anti-emetic) medicine to reduce nausea and vomiting.

As well as these drugs, lots of people find relief by being in a darkened room and trying to sleep.

TMS – Transcranial magnetic stimulation

As recently as early 2014, NICE (the National Institute for Health and Care Excellence) approved TMS (transcranial magnetic stimulation) to treat and prevent migraines.

The treatment involves a small electrical device that is held to the head to deliver magnetic pulses through the skin.

It isn’t clear how this treatment works but researchers have proven that it can reduce the severity of a migraine if it is used at the start of an attack.

The device can be used alongside medicines and won’t interfere with them.

However, TMS isn’t a cure and won’t work for all sufferers. There isn’t strong evidence for how effective it is, and it is only limited to those who have migraines with an aura.

What’s more, the potential effects of the treatment over the long term are unknown. However, so far, users have reported only temporary and minor side effects like drowsiness, tiredness, slight dizziness, irritability and muscle tremors.

Treatment options during pregnancy and breastfeeding

Generally, medication for migraines should be avoided during pregnancy and breastfeeding. Instead, it is much more advisable to avoid potential triggers. If medicine is needed, it will usually only be acceptable to take a low dose of paracetamol. Sometimes, triptans or anti-inflammatory medications might be given.

In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding.

Migraine complications

Migraines have been associated with an increase in the risk of ischaemic strokes, albeit a very small increased risk. There is also a recognised increase in mental health problems. This is largely due to the negative impact the condition can have on a person’s life.

Stroke

An ischaemic stroke occurs when the brain’s blood supply has been blocked by fatty material in arteries or a blood clot.

Research has shown that migraine sufferers are twice as likely to have an ischaemic stroke compared to those who don’t have migraines. This is particularly true for people who experience migraine with aura. The risk is still very small, however. The reason behind the link isn’t known.

Mental health problems

Migraine is linked to an increase in mental health problems. These include bipolar disorder, depression, panic disorder and anxiety disorder.

Final thoughts on ‘what is a migraine?’

As we’ve discussed, a migraine is an extreme headache that is usually a throbbing pain on one side of the head. Migraines are debilitating when an attack occurs. Though there are treatments that can ease an attack or prevent one, there is no known cure.

Anyone regularly suffering from migraines is advised to contact their GP. You can also get advice and support from The Migraine Trust.

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