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Migraine
Migraine

 


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Condition
Migraine
Class
Central nervous system
Description
Migraine is a severe form of recurring headache. Pain usually occurs on just one side of the head and is often accompanied by nausea, vomiting and an increased sensitivity to light or sound. Migraine attacks occur in episodes, sometimes with days, week or months between attacks. When migraine does occur, attacks can be extremely disabling, lasting between 4 and 72 hours, and severely interfering with the person's ability to carry on normal daily activities.

It is estimated that 1 out of every 7 people in the UK, about 9 million people, are affected by migraine. The condition normally affects people in their 30s or 40s, but it can also develop in children, teenagers and adolescents. Migraine affects twice as many women as men.
Causes
The exact cause of migraine is not known. Most scientists now consider migraine to be a neurological disease, meaning that it starts as the result of a change in nerve activity in a region of the brain called the cortex. Previously, some scientists considered migraine to be a vascular disease, meaning that it starts as a result of changes in the blood vessels in the brain, but this theory is now largely discounted.

Those scientists who support a neurological cause suggest that the change in nerve activity causes the release of chemicals in the brain that cause stimulation of other nerves, in particular a nerve called the trigeminal nerve that conveys the sensation of pain in the head and face. When activated, the trigeminal nerves release a chemical called serotonin (also known as 5HT) which causes changes in the blood vessels in the brain, first causing the blood vessels to narrow, later causing the blood vessels to widen. It is the extra pressure caused by the widening blood vessels that creates the throbbing migraine headache.

Whatever the cause, there are many so-called 'triggers' which start a chain of events that eventually cause the migraine attack. The most common triggers are emotional stress, physical stress, diet, environmental factors and hormonal changes. Trigger factors are not the same for everyone.
Symptoms
Migraine attacks tend to develop in stages. A day or so before the attack begins, some people start to feel 'strange', experiencing changes in mood, behaviour and a craving for certain foods. This stage is known as the prodromal stage and can act as an early warning of a migraine attack once a person begins to recognise the changes and associate them with migraine.

In 10-15% of migraine sufferers, the prodromal stage is followed by visual disturbances called an 'aura'. These visual disturbances take the form of flashing lights, zig-zags of images and blind spots in the field of vision. Speech may also be impaired and the person may experience a tingling sensation in the face and hands. These symptoms may last for up to an hour.

People who experience an aura are said to have classical migraine, and the symptoms probably occur as a result of the start of the neurological changes or the narrowing of the blood vessels that occur at the beginning of the migraine attack. Those people who have migraine without an aura are said to have common migraine.

With or without aura, the next stage is an intense throbbing headache, usually but not always, on one side of the head. The person may feel sick and be sick, unable to stand bright lights, loud noises or certain smells, and may have diarrhoea. The person affected may also feel pain in other parts of the body and have difficulty in speaking. Symptoms may last for a few hours or a few days.

The next stages are a gradual easing of the pain of the headache, followed by feelings of weakness and tiredness.
Treatment
Prevention
Migraine attacks may be prevented by the use of medicines. People who have more than two attacks each month, or who respond poorly to treatment, may benefit from taking drugs such as beta-blockers. Although beta-blockers are usually best known for their use in the treatment of high blood pressure or angina, certain beta-blockers such as metoprolol, nadolol, propranolol and timolol will reduce the number of migraine attacks if taken regularly. It is likely that these drugs work by acting on the blood vessels in the brain. Other drugs such as pizotifen, cyproheptadine and methysergide oppose the effects of serotonin and so prevent the blood vessels in the brain from widening. Adults who have three or more migraine attacks per month, or frequent migraine attacks that interfere with their daily life may be treated with a drug called topiramate.

Acute attacks
If a migraine attack does occur there are a number of medicines that can be used to relieve symptoms. Simple over-the-counter painkillers, such as aspirin or paracetamol, can be very effective if taken in the early stages of migraine. If these simple remedies do not bring significant relief a doctor may prescribe stronger painkillers or painkillers combined with anti-sickness ingredients such as domperidone, metoclopramide or buclizine.

A doctor may also consider prescribing drugs called 5HT agonists (sometimes known as triptans), which act directly to correct the serotonin imbalance in the brain during a migraine attack. These drugs are thought to act by constricting or narrowing the blood vessels in the brain that have been widened during the migraine attack. They may also act at the trigeminal nerve to prevent the release of chemicals that cause pain and widen the blood vessels. Triptans also help relieve nausea and reduce sensitivity to light and sounds. Triptans work at any stage during a migraine attack, but work best if given at the onset of an attack.

Where migraine is very difficult to treat, a doctor may decide to prescribe a drug called ergotamine. Ergotamine also causes a narrowing of the blood vessels to reduce migraine pain, but it needs to be used sparingly for a limited time as it may reduce the blood supply to the fingers and toes leading to gangrene.
When to see your pharmacist
Your pharmacist will be able to provide a number of pain killers such as paracetamol, aspirin or ibuprofen that will help relieve headache. For the short term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone, the pharmacist may recommend codeine or dihydrocodeine. However, it is important that these two medicines are taken for no more than 3 days as they may cause addiction. No pain killers should be taken regularly in the hope that they will stop migraine from occurring. Over-use of pain killers can be a cause of headache.

Combinations of some of these pain killers are also available with other medicines that help tackle the symptoms of nausea and vomiting.

If you have had migraine attacks before, then under certain circumstances, your pharmacist will be able to supply you with one of the triptans called sumatriptan. There are strict conditions that apply before sumatriptan can be supplied without a prescription and your pharmacist will need to speak with you to ensure that you meet these conditions. If you do not meet these conditions, or if your symptoms follow a particular pattern, your pharmacist will advise you to see your doctor.
When to see your doctor
If you suspect that you have migraine or if you suffer from disabling headaches on a regular basis, go to see your doctor. Acute treatments for migraine are not suitable for daily use so if you are using them for longer than the specified time you should see your doctor. If you are experiencing four or more migraines a month you should also see your doctor who may decide to prescribe other drugs to be taken every day to control attacks.

See your doctor urgently if you are over the age of 50 and develop your first severe headache, or if you have a severe headache associated with taking the oral contraceptive pill, or if there has been any sudden changes in the symptoms of your usual headaches. These may be the symptoms of other illnesses and your doctor will need to examine you.
Living with migraine
Try not to let migraine control your life. There is much that you can do that can put you in control of your headaches, rather their controlling you. While you may not be able to prevent migraine attacks completely you can reduce the number of times that they occur and you can reduce the severity of attacks if they do occur.

Be prepared. If you suffer from migraine, it is worth being ready for an attack by having a supply of treatments at home. The last thing that you will feel like doing with a migraine attack is to have to go out to buy medicines. Also, the earlier the treatments are taken at the start of the attack, the more effective that they are likely to be.

If you are able to identify the triggers that have been responsible for causing your migraine attacks in the past, it may be possible to reduce the risk of your having a migraine attack by avoiding these triggers. Keep a diary of when you get migraine attacks and try to remember what you were doing or what you ate before the onset of attacks. For example, if you have noticed that you get a migraine attack after eating certain foods, then avoid those foods. Equally, if you notice that migraine is associated with your monthly period, taking pain killers just before your period begins may help.

As many migraine headaches often occur as a result of tension or stress, learning to control stress or avoiding stressful situations can be a big help. Plan your day so you know what you want to do and when you want to do it. Do not try to do too much and do not worry if you do not manage to get everything finished. Organise your working environment. If something is in your way or if something is not working properly, move it or fix it. It is amazing how spending a short time resolving niggling problems will save so much time and make you feel so much better. Establish a regular sleep pattern, take breaks and holidays doing something different where you can switch off from the pressure of your work.

If you need to take pain killers or triptans, take them at the onset of a migraine attack. Delaying treatment may result in medications being less effective, with a greater likelihood of nausea developing and attacks lasting longer than they might do otherwise. However, do not get into the habit of taking pain killers regularly in the belief that they will prevent migraine attacks, they are more likely to increase your headaches. Never exceed the recommended dosage or the recommended length of treatment of medicines.

If you suffer from frequent attacks, talk to your doctor about medicines that can help prevent or reduce the number of attacks.
Advice to carers and partners
Try to be supportive if you are looking after or living with someone affected by migraine. There will be times when migraine attacks disrupt social, domestic and professional activities and prevent your doing what you had planned to do. Give help when it is needed, other times just give the person peace and quiet, time to relax and recover. Changing lifestyle and eating habits of the family can also help avoid trigger factors.
Useful Tips
  • Have a rest or lie down somewhere quiet avoiding bright/strong light
  • Eating something sometimes helps
  • Try to avoid triggers such as stress or getting angry
  • Do not take pain killers regularly and never exceed the recommended dose
Further information
Headache UK
This umbrella organisation of the five leading charities in the UK devoted to headache and migraine aims to achieve recognition of chronic headaches as a major public health problem. The group promotes understanding of the significant impact headaches can have on the lives of people with these chronic conditions and tries to ensure speedy diagnosis and quality management for people who live with chronic headaches.
www.headacheuk.org

Migraine Action
A registered charity that provides support and information to sufferers, friends, families and carers
Helpline: 0116 275 8317 (Mon - Fri 09.00 - 17.00)
www.migraine.org.uk


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