Please note that this is an adult-focussed article. Very good information on the topic of headaches in children can be found on the NHS Choices website.
Migraines are the most prevalent long-term neurological condition in the UK, with up to 8 million people affected. It can be a very debilitating condition, and the most common type of headache that people see a doctor for. The cause is not fully understood. However, researchers have found migraines to run in families, with one study discovering that people with three or more close relatives with a seizure disorder were more than twice as likely to have a migraine with aura.
Migraines affect men and women disproportionately, with 18% of women being affected compared to 8% of men. There is no clear reason why more women suffer from migraines, but many women report that their menstrual cycle can trigger a migraine. This is known as a ‘menstrual migraine’ and is associated with the withdrawal of oestrogen as part of the menstrual cycle, and the release of prostaglandin (a hormone-like substance) during the first 48 hours of menstruation. A menstrual migraine affects around 10% of women.
The World Health Organization ranks migraines at number 19 for all diseases worldwide that cause disability, so knowing what to do when a migraine starts – as well as managing the symptoms – are really important. The below infographics detail three key areas of migraine management – detect, conquer, and prevent – and how you can take steps to deal with an attack.
Detecting the symptoms
Migraines are split into three types – migraine with aura, migraine without aura, and migraine aura without headache. Only 20-25% of people will ever experience a migraine with aura, and the aura may not be present for every episode. The symptoms for a migraine with aura and without aura are slightly different, so by identifying your symptoms, you will be better-equipped to deal with them.
A migraine aura typically lasts around an hour. The most common migraine aura involves visual disturbances, but many people also report sensory disturbances, and both can occur at the same time. Sensory disturbance is characterised by a loss of sensation or numbness, and tingling within the face that then extends into the arm. Aura symptoms are thought to occur as a result of electrochemical changes within the brain, which the immune system responds to by sending more immune response cells to the brain. When this happens, the brain’s blood vessels widen in order to accommodate these cells, which then results in a migraine aura.
For a migraine without aura, the defining feature is a severe and intense pain, which is present in 85% of attacks. Typically, the pain is only present in one part of the head – towards the front or side – and the pain is aggravated by physical activity. You may also feel nauseous and have difficulty concentrating.
47% of people mistake the pain associated with a migraine as a tension or sinus headache, but there are a few key differences. With tension and sinus headaches, you are very unlikely to experience sensitivity to light, and sinus headaches usually only occur due to a sinus infection. Migraine pain is limited to one side of the head, whereas a tension headache will affect both sides of the head.
Taking control of the attack
There are a few ways you can fight a migraine. A number of medications can be used to treat migraines, such as pain relievers, triptans (a class of medication used specifically for migraines) and anti-nausea tablets. Common pain relievers such as aspirin or non-steroidal anti-inflammatories (such as ibuprofen) can relieve some of the pain associated with a migraine, and anti-nausea tablets can be taken in combination with these.
For regular migraines that don’t respond to regular painkillers, your doctor may prescribe a triptan. A triptan is specifically formed to treat a migraine and works by narrowing the blood vessels in the head and also blocks the transmission of pain to the sensory nerves found in the face.
Along with medication, you may choose to lie in a dark room or apply an ice pack to your head. Lying in a dark room is effective because it won’t expose you to light, and allows you to get some rest. An ice pack works by numbing the pain and cooling the blood passing through the vessels – 77% of people who used cold therapy during a migraine found it to be effective.
Preventing future migraines
As the phrase goes – prevention is better than cure. For many migraine sufferers, trying to predict an attack can be difficult, but there are a few ways that you can lessen the impact migraines have on your life.
A migraine trigger is a specific factor that can increase your risk of having a migraine attack. Although a trigger does not cause a migraine in itself, they are known to activate processes that cause a migraine, so identifying your triggers is the best way to anticipate a future attack. Common triggers include stress, dehydration, alcohol, caffeine, food additives, and lack of sleep
Sources and further reading
NICE Clinical Knowledge Summaries -- Migraine
NHS factsheet – Migraine
The American Migraine Foundation
The World Health Organisation "How common are headaches?"
The Migraine Trust
The Migraine Research Foundation
The National Migraine Centre
NICE "Targeted neck cooling in the treatment of migraine"