What is a migraine?

The cause of migraines it not completely understood, but they are most common between the ages of 15 and 55, in people with a family history of migraine, are more common in women (about three out of four people who have migraines are women), and typically become less severe and less frequent with age.

It is known that there are certain common ‘triggers’ which seem to start migraine attacks in some susceptible people and although this varies widely from person to person the most commonly reported ones are:

• Lack of or too much sleep
• Skipped meals
• Bright lights, loud noises, or strong smells
• Hormone changes during the menstrual cycle
• Stress and anxiety, or relaxation after stress
• Alcohol (often red wine) and caffeine (too much or withdrawal)
• Foods that contain nitrates, monosodium glutamate and tyramine

How common are migraines?

Figures vary from country to country, but migraine is the most common form of disabling headache that sends patients to their doctors.

Are there different kinds of migraine?

Yes, there are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.

In a migraine with aura (sometimes called a classical migraine) a person might have sensory symptoms (the so-called “aura”) 10 to 30 minutes before an attack. These include seeing flashing lights, zigzag lines, or blind spots, having numbness or tingling in the face or hands, and a disturbed sense of smell, taste, or touch. Only around 20% of people who get migraine experience an aura and men have this form of migraine more often than women.

With a migraine without aura (sometimes called a common migraine) a person does not have an aura but has all the other features of an attack.

We should be clear – if you have severe symptoms, like not being able to move your arms or legs, or changes to your speech, then you should be reviewed by a doctor as an emergency as there can be other more serious causes of these symptoms. It may be less urgent to have a review if these are a part of your normal set of migraine symptoms, and you have previously been assessed by your doctor or hospital.

There are a few different types of subcategories of migraines, specifically relating to the presence of aura. People can have migraine with aura, migraine without aura (the most common), and migraine aura without a headache.

Other than the headache and the symptoms of aura, migraine sufferers can sometimes experience the following associated symptoms:

• Feeling sick or being sick
• Sensitivity to light and sound (this is why many sufferers will seek dark, quiet rooms to rest)
• Sweating
• Gastrointestinal disturbances (bloating, pain, diarrhea, constipation)

Migraine has no cure but can be managed. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called “abortive” or “acute” treatment) and prevention. Many people with migraine use both forms of treatment.

Acute treatment

Over-the-counter pain-relief drugs such as aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen relieve mild migraine pain for some people. If these drugs don’t work for you, your doctor might want you to try a prescription drug.

Triptans work by balancing the chemicals in the brain. These come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and injection. They should not be used if you have heart disease or high blood pressure.

Acute drugs for migraine work best when taken right away, when symptoms first begin, so always carry your migraine medicine with you in case of an attack.

Preventive treatment

This is a group of drugs that are used to prevent migraines from occurring. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Examples include antidepressants such as amitriptyline, anticonvulsants such as topiramate, beta -blockers such as propranolol, and calcium channel blockers such as verapamil. These drugs may not prevent all migraines, but they can help a lot and are usually considered if migraines do not respond to drugs for symptom relief, or are disabling.

There are many different treatments for a migraine attack. You may need to try several different treatments and combinations to find one that works for you.

How can I help myself?

Try to avoid any migraine triggers and get up and go to bed the same time every day. Eat healthy foods, do not skip meals, and take regular exercise. Keep alcohol and caffeine intake to a minimum and learn ways to reduce and cope with stress.

What are rebound migraines?

People who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you're caught in a rebound cycle.