Headache Migraine

Overview

A migraine is a common brain condition that causes repeated headaches. It is not just a bad headache — it is a real health problem with its own pattern of symptoms. A migraine attack often brings throbbing pain, usually on one side of the head, along with feeling sick, and being bothered by light or sound. Some people see flashing lights or zigzag lines before the pain starts. This is called an aura. Attacks can be very uncomfortable, but they are not a sign that something is dangerously wrong with your brain, and most people find ways to manage them well.

Very common. Around 1 in 7 adults around the world get migraines, and it is one of the top reasons people miss work or school. It is also one of the most under-treated health problems, because many people think they just have to put up with it.

Migraine can affect anyone, at any age. It often starts in the teenage years or early twenties. It is about three times more common in women than in men, partly because of changes in hormone levels. Children get migraine too, and their symptoms can look different from adults. Some people find attacks become less frequent after middle age, though this is not true for everyone.

Symptoms

Common symptoms

• Throbbing or pulsing pain, often on one side of the head, but sometimes on both sides
• Pain that gets worse when you move, bend over, or climb stairs
• Feeling sick or being sick
• Sensitivity to light, sound, or smells
• Aura — temporary changes such as flashing lights, blind spots, zigzag lines, tingling in the arm or face, or trouble finding words, which usually build up slowly and fade within an hour
• Feeling very tired, yawning a lot, or craving certain foods in the hours before an attack
• A 'hangover' feeling of tiredness and foggy thinking for a day or so after the attack

Symptoms in children

• Attacks may be shorter than in adults, sometimes lasting only 1 to 2 hours
• Tummy pain, feeling sick, or vomiting can be the main symptom, sometimes with little or no head pain
• Being pale, sweaty, dizzy, or very sleepy during an attack
• Young children may not say 'my head hurts' — they may just be clingy, grumpy, or quiet and want to lie down in a dark room
• Car sickness and repeated tummy aches can be linked to migraine in some children

Symptoms in older adults

• Migraine can start for the first time later in life, but a brand-new headache pattern after age 50 should always be checked by a doctor
• Aura without much head pain is more common in later life and can be mistaken for other problems, so it needs checking
• Other health conditions and medicines can cause headaches, so a review of your medicines is often useful
• Keeping a simple diary of when headaches happen helps your doctor see the pattern clearly

Causes

Main causes

• Migraine is mainly down to how your brain and nerves process signals. Certain nerve pathways become over-active, and this sets off inflammation and pain. It tends to run in families, so genes play a big part.
• For many people, attacks are set off by triggers. Common ones include stress or the let-down after stress, poor sleep, skipped meals, dehydration, alcohol, too much or too little caffeine, bright or flickering light, strong smells, and changes in the weather.
• Hormone changes matter for many women — attacks can cluster around monthly periods, and patterns often change during pregnancy and around the menopause.
• Everyday headaches such as tension-type headaches are very common too, and many people get more than one type. Frequent use of pain relievers can itself cause a daily headache, known as medication-overuse headache.

Risk factors

• A parent, brother, or sister with migraine
• Being female, especially during the reproductive years
• High stress levels or a very busy, irregular schedule
• Poor sleep, shift work, or travel across time zones
• Skipping meals or not drinking enough fluids
• Regular or heavy use of pain relief medicines
• Anxiety, depression, or a history of childhood tummy problems
• Being overweight, which is linked to more frequent attacks in some people

When to see a doctor

See a doctor urgently if:

• Any of the emergency warning signs listed above — call your local emergency number
• A headache that is clearly different from your usual pattern and will not settle with rest and your normal pain relief
• A headache that wakes you from sleep, or is worst first thing in the morning, most days
• Headache with a fever, a stiff neck, or a rash
• New weakness, numbness, speech trouble, or vision loss, even if it goes away

Book a routine appointment if:

• Headaches are happening often enough to affect work, school, sleep, or family life
• You are taking pain relief on most days, or more than about 10 days a month
• You want to talk about prevention treatment rather than treating each attack
• You are pregnant, planning a pregnancy, or breastfeeding and your headaches have changed
• You feel low, anxious, or overwhelmed by your headaches
• You are unsure whether your headaches are migraine or something else

Diagnosis

In most cases, a doctor can recognise migraine by talking with you about your headaches. There is no blood test or scan that proves migraine. Your doctor will ask about the pattern: where the pain is, what it feels like, how long it lasts, what other symptoms come with it, and what seems to set it off. Keeping a headache diary for a few weeks before your appointment is one of the most helpful things you can do.

Tests that may be done

• A physical and neurological examination — checking your eyes, reflexes, strength, sensation, and balance
• A headache diary you keep at home, noting dates, duration, symptoms, triggers, and what helped
• Blood tests are sometimes done to rule out other causes such as thyroid problems or anaemia
• A brain scan is not needed for typical migraine. It may be arranged if there are warning signs, an unusual pattern, or if the examination finds something that needs checking
• If you have aura, your doctor may ask about symptoms that can look like a stroke, so they can be sure of the diagnosis

What to expect at your appointment

Your first appointment will mostly be a conversation. Your doctor may ask you to keep a diary and come back in a few weeks, or they may suggest starting treatment straight away. Diagnosis often takes a little time and patience, and it is normal to try more than one approach before finding what works for you. Write down your questions beforehand and bring a list of any medicines you take, including ones you buy without a prescription.

Treatment

Treatment has two parts: easing attacks when they happen, and reducing how often they happen. Many people do well with a combination of both. Your doctor will help you find the right plan for your pattern of headaches.

Self-care at home

• At the first sign of an attack, stop what you are doing and rest in a quiet, dark room if you can
• Use simple pain relief early in the attack — ask your pharmacist which option is safe for you, given your other medicines and health conditions
• A cold pack on the forehead or back of the neck, or a warm pack on tense shoulders, helps some people
• Drink water and eat something if you have skipped a meal
• Keep a headache diary so you can spot patterns and triggers
• Try to go to bed and get up at similar times every day, including weekends
• Be careful with pain relief: using it on many days each month can make headaches worse rather than better. Ask your pharmacist or doctor for advice if this sounds like you

Medical treatments

Doctors treat migraine in two main ways. First, medicines to relieve an attack — these work best when taken early, and there are several options, including simple pain relievers you can buy and stronger ones available on prescription. Some people are helped by medicines that also ease sickness. Second, preventive treatment — a daily medicine taken to reduce how often attacks happen and how bad they are. These are usually suggested when attacks are frequent or hard to manage. Your doctor will explain the options, check they are safe alongside your other medicines, and review how things are going after a few weeks or months. Other approaches include specialist treatments given by a headache clinic, relaxation and breathing training, and talking therapy such as cognitive behavioural therapy, which can help with the stress and low mood that often go with frequent headaches.

When is surgery considered?

Surgery is not part of routine migraine treatment. In a very small number of people with a clear, specific trigger point in the face or neck, a specialist may discuss targeted procedures, but this is rare and only after other options have been tried.

Living with this condition

Living with migraine is about planning without letting it take over. Many people learn the early warning signs of an attack and act fast — resting, taking pain relief early, and getting into a quiet space. It also helps to tell the people around you — family, friends, and your workplace or school — so they understand what you need. Flexible working hours, a quiet place to rest, and short breaks during the day can make a real difference.

Lifestyle tips

• Keep regular sleep and wake times, and aim for enough sleep without long lie-ins
• Eat regular meals and drink water through the day
• Keep caffeine steady — sudden increases or cuts can trigger attacks
• Limit alcohol if you have noticed it sets off your headaches
• Take regular screen breaks and adjust lighting to avoid glare and flicker
• Build in short, regular relaxation or breathing exercises, especially during stressful periods
• Gentle, regular exercise such as walking, swimming, or cycling
• Be realistic about your schedule and say no when you need to

Diet and exercise

There is no special migraine diet that works for everyone, and strict elimination diets are usually not helpful. Instead, use your diary to see whether particular foods really do trigger your attacks — common suspects include aged cheese, cured meats, chocolate, and foods with added flavour enhancers, but many people have no food triggers at all. Regular meals matter more than avoiding specific foods. Gentle, steady exercise is one of the better-supported ways to reduce how often attacks happen. Start slowly, keep hydrated, and avoid very intense or very hot exercise if that has set off an attack before.

Mental health and emotional wellbeing

Migraine and mood are closely linked. Living with unpredictable pain is tiring, and it is very common to feel anxious, frustrated, or low — especially if attacks mean missing work, school, or time with people you love. This is not a sign of weakness, and it is not your fault. Talking therapies, such as cognitive behavioural therapy, can help you cope with pain and worry, and treating low mood often helps headaches too. If you are having thoughts of harming yourself or feeling you cannot go on, please reach out right away — contact your local crisis line, your doctor, or your local emergency number. You deserve support and you do not have to cope alone.

Prevention

Migraine cannot always be prevented, but most people can reduce how often attacks happen. The biggest gains usually come from steady routines — regular sleep, meals, hydration, and stress management — plus a preventive medicine if your doctor recommends one. Working out your own triggers with a diary is often the most useful step. It is also worth knowing that cutting back on frequent pain relief can reduce headaches caused by overuse.

Vaccines

There is no vaccine for migraine.

Screening programmes

There is no routine screening test for migraine. Instead, the key step is to see your doctor if headaches are frequent, changing, or affecting your life, so they can check the pattern and rule out other causes.

Complications

If left untreated

• Frequent attacks can lead to missed work, school, and time with family, which can affect income and confidence
• Using pain relief very often can cause medication-overuse headache, where headaches become more frequent and harder to treat
• Poor sleep, low mood, and anxiety often go hand in hand with frequent migraine
• A very long or severe attack (sometimes called status migrainosus) can occasionally need urgent medical care
• Rarely, aura can happen with stroke-like symptoms — if you get sudden weakness, speech trouble, or vision loss, seek emergency help straight away

Long-term outlook

The outlook is genuinely hopeful. Most people with migraine find a plan that works for them and see attacks become fewer and easier to manage over time. Treatments keep improving, and there is a lot you can do yourself with regular routines and a good diary. Many people find migraine becomes less troublesome with age. If your current plan is not working, it is worth going back to your doctor — there is usually something else to try.

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