A migraine is usually a moderate or severe headache felt as a throbbing pain on 1 side of the head.

Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood.

There are several types of migraine, including:

migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
migraine without aura – the most common type, where the migraine happens without the specific warning signs
migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop
Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally.

It's possible for years to pass between migraine attacks.

When to get medical advice
You should see a GP if you have frequent or severe migraine symptoms.

Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicines, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you're with experiences:

paralysis or weakness in 1 or both arms or 1 side of the face
slurred or garbled speech
a sudden agonising headache resulting in a severe pain unlike anything experienced before
headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash
These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

Causes of migraines
The exact cause of migraines is unknown, although they're thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain.

Around half of all people who experience migraines also have a close relative with the condition, suggesting that genes may play a role.

Some people find migraine attacks are associated with certain triggers, which can include:

starting their period
stress
tiredness
certain foods or drinks
Treating migraines
There's no cure for migraines, but a number of treatments are available to help reduce the symptoms.

These include:

painkillers – including over-the-counter medicines like paracetamol and ibuprofen
triptans – medicines that can help reverse the changes in the brain that may cause migraines
anti-emetics – medicines often used to help relieve people's feeling of sickness (nausea) or being sick
During an attack, many people find that sleeping or lying in a darkened room can also help.

Preventing migraines
If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks.

Medicines used to prevent migraines include the anti-seizure medicine topiramate and a medicine called propranolol that's usually used to treat high blood pressure.

It may take several weeks before your migraine symptoms begin to improve.

Outlook
Migraines can severely affect your quality of life and stop you carrying out your normal daily activities.

Some people find they need to stay in bed for days at a time.

But a number of effective treatments are available to reduce the symptoms and prevent further attacks.

Migraine attacks can sometimes get worse over time, but they tend to gradually improve over many years for most people.

Common symptoms of a migraine
The main symptom of a migraine is usually an intense headache on 1 side of the head.

The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you carrying out normal activities.

In some cases, the pain can occur on both sides of your head and may affect your face or neck.

Additional symptoms
Other symptoms commonly associated with a migraine include:

feeling sick
being sick
increased sensitivity to light and sound, which is why many people with a migraine want to rest in a quiet, dark room
Some people also occasionally experience other symptoms, including:

sweating
poor concentration,
feeling very hot or very cold
tummy (abdominal) pain
diarrhoea
Not everyone with a migraine experiences these additional symptoms and some people may experience them without having a headache.

The symptoms of a migraine usually last between 4 hours and 3 days, although you may feel very tired for up to a week afterwards.

Information:
If you have a high temperature or you do not feel well enough to do your normal activities, try to stay at home and avoid contact with other people until you feel better.

Symptoms of aura
About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine.

These include:

visual problems – such as seeing flashing lights, zig-zag patterns or blind spots
numbness or a tingling sensation like pins and needles – which usually starts in 1 hand and moves up your arm before affecting your face, lips and tongue
feeling dizzy or off balance
difficulty speaking
loss of consciousness – although this is unusual
Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour.

Some people may experience aura followed by only a mild headache or no headache at all.

When to get medical advice
You should see a GP if you have frequent or severe migraine symptoms that cannot be managed with occasional use of over-the-counter painkillers, such as paracetamol.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicine, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you're with experiences:

paralysis or weakness in 1 or both arms or 1 side of the face
slurred or garbled speech
a sudden agonising headache resulting in a severe pain unlike anything experienced before
headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash
These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

Stages of a migraine
Migraines often develop in distinct stages, although not everyone goes through all of these:

prodromal (pre-headache) stage – changes in mood, energy levels, behaviour and appetite that can occur several hours or days before an attack
aura – usually visual problems, such as flashes of light or blind spots, which can last for 5 minutes to an hour
headache stage – usually a pulsating or throbbing pain on 1 side of the head, often accompanied by feeling sick, vomiting or extreme sensitivity to bright light and loud sounds, which can last for 4 to 72 hours
resolution stage – when the headache and other symptoms gradually fade away, although you may feel tired for a few days afterwards

The exact cause of migraines is unknown, but they're thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

It's not clear what causes this change in brain activity, but it's possible that your genes make you more likely to experience migraines as a result of a specific trigger.

Migraine triggers
Many possible migraine triggers have been suggested, including hormonal, emotional, physical, dietary, environmental and medicinal factors.

These triggers are very individual, but it may help to keep a diary to see if you can identify a consistent trigger.

It can also sometimes be difficult to tell if something is really a trigger or if what you're experiencing is an early symptom of a migraine attack.

Hormonal changes
Some women experience migraines around the time of their period, possibly because of changes in the levels of hormones such as oestrogen around this time.

These type of migraines usually occur between 2 days before the start of your period to 3 days after.

Some women only experience migraines around this time, which is known as pure menstrual migraine.

But most women experience them at other times, too, and this is called menstrual-related migraine.

Many women find their migraines improve after the menopause, although the menopause can trigger migraines or make them worse in some women.

Emotional triggers:
stress
anxiety
tension
shock
depression
excitement
Physical triggers:
tiredness
poor-quality sleep
shift work
poor posture
neck or shoulder tension
jet lag
low blood sugar (hypoglycaemia)
strenuous exercise, if you're not used to it
Dietary triggers:
missed, delayed or irregular meals
dehydration
alcohol
caffeine products, such as tea and coffee
specific foods, such as chocolate and citrus fruit
foods containing the substance tyramine, which include cured meats, yeast extracts, pickled herrings, smoked fish (like smoked salmon), and certain cheeses (such as cheddar, stilton and camembert)
Also, foods that have been stored at room temperature, rather than being refrigerated or frozen, can have rising levels of tyramine.

Environmental triggers:
bright lights
flickering screens, such as a television or computer screen
smoking (or smoky rooms)
loud noises
changes in climate, such as changes in humidity or very cold temperatures
strong smells
a stuffy atmosphere
Medicines:
some types of sleeping tablets
the combined contraceptive pill
hormone replacement therapy (HRT), which is sometimes used to relieve symptoms associated with the menopause

There's no specific test to diagnose migraines. For an accurate diagnosis to be made, a GP must identify a pattern of recurring headaches along with the associated symptoms.

Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Seeing a GP
On your first visit, a GP may carry out a physical examination and check your vision, co-ordination, reflexes and sensations.

These will help rule out some other possible underlying causes of your symptoms.

They may ask if your headaches are:

on 1 side of the head
a pulsating pain
severe enough to prevent you carrying out daily activities
made worse by physical activity or moving about
accompanied by feeling and being sick
accompanied by sensitivity to light and noise
Migraine diary
To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks.

Note down details including:

the date
time
what you were doing when the migraine began
how long the attack lasted
what symptoms you experienced
what medicines you took (if any)
Regularly taking frequent doses of painkillers is an important reason why migraines can become difficult to treat. Doing so can cause a medication overuse headache.

Overuse headaches are usually caused by taking painkillers on a long-term basis and not because of exceeding, or just sticking to, the recommended dose.

It'll be very helpful to keep a record of what painkillers you take and how often you take them.

You should not take painkillers on more than 10 days every month in the long term.

It may also be helpful for women to make a note when they start their period, as this can help your GP identify potential triggers.

Referral to a specialist
A GP may decide to refer you to a neurologist, a specialist in conditions affecting the brain and nervous system, for further assessment and treatment if:

a diagnosis is unclear
you experience migraines on 15 days or more a month (chronic migraine)
treatment is not helping to control your symptoms

There's currently no cure for migraines, although a number of treatments are available to help ease the symptoms.

It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.

If you find you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

During an attack
Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack.

Others find that eating something helps, or they start to feel better once they have been sick.

Painkillers
Many people who have migraines find that over-the-counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms.

They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.

It's not advisable to wait until the headache worsens before taking painkillers, as it's often too late for the medicine to work.

Tablets you dissolve in a glass of water (soluble painkillers) are a good alternative because they're absorbed quickly by your body.

If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the bottom.

Cautions
When taking over-the-counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.

Children under 16 should not take aspirin unless it's under the guidance of a healthcare professional.

Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver problems or kidney problems.

Taking any form of painkiller frequently can make migraines worse. This is sometimes called a medication overuse headache or painkiller headache.

Speak to a GP if you find yourself needing to use painkillers repeatedly or over-the-counter painkillers are not effective.

They may prescribe stronger painkillers or recommend using painkillers along with triptans.

If they suspect the frequent use of painkillers may be contributing your headaches, they may recommended that you stop using them.

Triptans
If ordinary painkillers are not helping to relieve your migraine symptoms, you should make an appointment to see a GP.

They may recommend taking painkillers in addition to a type of medicine called a triptan, and possibly anti-sickness medicine.

Triptan medicines are a specific painkiller for migraine headaches. They're thought to work by reversing the changes in the brain that may cause migraine headaches.

They cause the blood vessels around the brain to narrow (contract). This reverses the widening of blood vessels that's believed to be part of the migraine process.

Triptans are available as tablets, injections and nasal sprays.

Common side effects of triptans include:

warm sensations
tightness
tingling
flushing
feelings of heaviness in the face, limbs or chest
Some people also experience feeling sick, a dry mouth and drowsiness.

These side effects are usually mild and improve on their own.

As with other painkillers, taking too many triptans can lead to a medication overuse headache.

Your GP will usually recommend having a follow-up appointment once you have finished your first course of treatment with triptans.

This is so you can discuss their effectiveness and whether you had any side effects.

If the medicine was helpful, treatment will usually be continued.

If they were not effective or caused unpleasant side effects, your GP may try prescribing a different type of triptan as how people respond to this medicine can be highly variable.

Anti-sickness medicines
Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you do not experience feeling or being sick.

These are prescribed by a GP, and can be taken alongside painkillers and triptans.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin.

They usually come in the form of a tablet, but are also available as a suppository.

Side effects of anti-emetics include drowsiness and diarrhoea.

Combination medicines
You can buy a number of combination medicines for migraine without a prescription at your local pharmacy.

These medicines contain both painkillers and anti-sickness medicines.

If you're not sure which one is best for you, ask your pharmacist.

It can also be very effective to combine a triptan with another painkiller, such as ibuprofen.

Many people find combination medicines convenient.

But the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms.

If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to easily control the doses of each.

Acupuncture
If medicines are unsuitable or do not help to prevent migraines, you can try acupuncture.

Some GP surgeries offer acupuncture, but most do not, so you may have to pay for it privately.

Evidence suggests a course of up to 10 sessions over a 5- to 8-week period may be beneficial.

Seeing a specialist
If the treatments above are not effectively controlling your migraines, your GP may refer you to a specialist migraine clinic for further investigation and treatment.

In addition to the medicines mentioned above, a specialist may recommend other treatments, such as transcranial magnetic stimulation.

Transcranial magnetic stimulation
In January 2014, the National Institute for Health and Care Excellence (NICE) approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.

TMS involves holding a small electrical device to your head that delivers magnetic pulses through your skin.

It's not clear exactly how TMS works in treating migraines, but studies have shown that using it at the start of a migraine can reduce its severity.

It can also be used in combination with the medicines mentioned above without interfering with them.

But TMS is not a cure for migraines and does not work for everyone.

The evidence for its effectiveness is not strong and is limited to people who have migraine with aura.

There's also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects.

These include:

slight dizziness
drowsiness and tiredness
a muscle tremor that can make it difficult to stand
irritability
NICE recommends that TMS should only be provided by headache specialists in specialist centres because of the uncertainty about the potential long-term side effects.

The specialist will keep a record of your experiences using the treatment.

Treatment for pregnant and breastfeeding women
In general, migraine treatment with medicines should be limited as much as possible when you're pregnant or breastfeeding.

Instead, trying to identify and avoid potential migraine triggers is often recommended.

If medicine is essential, your GP may prescribe you a low-dose painkiller, such as paracetamol.

In some cases, anti-inflammatory medicine or triptans may be prescribed.

Speak to a GP or your midwife before taking medicine when you're pregnant or breastfeeding.

Migraines are associated with a small increased risk of ischaemic strokes, and a very small increased risk of mental health problems.

Stroke
An ischaemic stroke happens when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries.

Studies have shown that people who experience migraines (particularly migraine with aura) have about twice the risk of having an ischaemic stroke at some point compared with people without migraines. But this risk is still small.

It's not clear why ischaemic strokes are linked to migraine.

Contraceptive pill
The risk of having an ischaemic stroke is increased by using the combined contraceptive pill.

Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill.

Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors such as high blood pressure or a family history of cardiovascular disease.

If you take the combined contraceptive pill and experience aura symptoms, talk to a GP about alternative forms of contraception.

Mental health problems
Migraine is associated with a very small increased risk of mental health problems, including:

depression
bipolar disorder
anxiety disorder
panic disorder

There are a number of ways you can reduce your chances of experiencing migraines.

Identifying and avoiding triggers
One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them.

You may find you tend to have a migraine after eating certain foods or when you're stressed, and by avoiding this trigger you can prevent a migraine.

Keeping a migraine diary can help you identify possible triggers and monitor how well any medicine you're taking is working.

In your migraine diary, try to record:

the date of the attack
the time of day the attack began
any warning signs
your symptoms (including the presence or absence of aura)
what medicine you took
when the attack ended
Medicines and supplements
Medicines are also available to help prevent migraines. These medicines are usually used if you have tried avoiding possible triggers but you're still experiencing migraines.

You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Topiramate
Topiramate is a type of medicine originally developed to prevent seizures in people with epilepsy, but is now much more commonly used in migraine.

It's been shown to help prevent migraines, and is usually taken every day in tablet form.

Topiramate should be used with caution in people with kidney or liver problems.

It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives.

GPs should discuss alternative methods of contraception for women who are prescribed topiramate.

Side effects of topiramate can include:

decreased appetite
feeling sick
being sick
constipation or diarrhoea
dizziness
drowsiness
problems sleeping
Propranolol
Propranolol is a medicine traditionally used to treat angina and high blood pressure, but it's also been shown to effectively prevent migraines.

It's usually taken every day in tablet form.

Propranolol is not suitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems.

It should be used with caution in people who have diabetes.

Side effects of propranolol can include:

cold hands and feet
pins and needles
problems sleeping
tiredness
Amitriptyline
Amitriptyline is a medicine originally designed to treat depression, but has also proved useful in helping prevent migraines.

It's usually taken every day in tablet form.

Amitriptyline can make you feel sleepy, so it's best to take it in the evening or before you go to bed.

Other side effects include:

constipation
dizziness
a dry mouth
difficulty peeing
a headache
It may take up to 6 weeks before you begin to feel the full benefit of the medicine.

Botulinum toxin type A
In June 2012, NICE recommended the use of a medicine called botulinum toxin type A by headache specialists to prevent headaches in some adults with long-term migraine.

Botulinum toxin type A is a type of nerve toxin that paralyses muscles.

It's not exactly clear why this treatment can be effective for migraine.

NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least 8 days of which are migraine) that has not responded to at least 3 previous preventative medical treatments.

Under the NICE guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck.

A new course of treatment can be given every 12 weeks.

Monoclonal antibodies
If you have frequent migraines and other treatments have not helped, medicines called monoclonal antibodies may be recommended.

Examples include fremanezumab, galcenezumab and erenumab.

These medicines are given as an injection, usually every month or every few months.

After a few months of treatment, you'll have a check-up to see how well the medicine is working and to decide whether to continue the treatment.

Preventing menstrual-related migraines
Menstrual-related migraines usually occur from 2 days before the start of your period to 3 days after.

As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.

Non-hormonal treatments
The non-hormonal treatments that are recommended are:

non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller
triptans – medicines that reverse the widening of blood vessels, which is thought to be a contributory factor in migraines
These medicines are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding.

Hormonal treatments
Hormonal treatments that may be recommended include:

combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring
progesterone-only contraceptives, such as progesterone-only pills, implants or injections
oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days
Hormonal contraceptives are not usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke.

Advice and support
There are a number of organisations that offer advice and support for people with migraines, including The Migraine Trust.

The Migraine Trust can be contacted on 0808 808 0066 (Monday to Friday, 10am to 2pm) or by emailing info@migrainetrust.org.

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