migraine overview for patients

Overview

Migraine is a common brain and nervous system condition that causes intense, throbbing headaches, usually on one side of the head. It is much more than a bad headache. During a migraine attack, a person may also feel sick, vomit, and become very sensitive to light, sound, or smells. A migraine attack can last from a few hours to a few days and can interfere with everyday life.

Very common. Migraine is one of the top ten causes of disability globally. In the UK alone, it is estimated that about 1 in 7 people live with migraine.

Migraine can begin at any age, but it most often starts during the teenage years or early 20s. Women are about three times more likely than men to have migraines, partly because of hormonal changes. There is often a family history — if a parent has migraines, their children are more likely to have them too.

Symptoms

Common symptoms

• A throbbing or pulsating headache on one side of the head
• Nausea or vomiting
• Sensitivity to light, sound, and sometimes smell
• Feeling dizzy or very tired
• An 'aura' before the headache — such as seeing flashing lights, zigzag lines, or tingling in one arm

Symptoms in children

• Headache on both sides of the head rather than one side
• Pale skin, tummy pain, nausea or vomiting
• Needing to lie down in a quiet, dark room
• Attacks that may be shorter than in adults — sometimes under two hours

Symptoms in older adults

• Symptoms may be less typical, such as confusion, dizziness, or feeling faint without clear headache pain.
• New or worsening headaches later in life are not normal and should be assessed by a doctor.
• Older adults are more likely to have other health conditions, so medication choices need extra care.

Causes

Main causes

• Changes in how your brainstem and trigeminal nerve process pain
• Release of chemicals (such as CGRP) that cause inflammation and swelling of blood vessels in the brain
• A genetic (inherited) tendency — migraine often runs in families

Risk factors

• Family history of migraine
• Being female (especially changes around your menstrual cycle)
• Stress or anxiety
• Poor sleep or skipping meals
• Dehydration or drinking too much alcohol
• Certain foods — for some, chocolate, cheese, caffeine, or processed foods
• Strong sensory triggers: flickering lights, loud noise, strong smells

When to see a doctor

See a doctor urgently if:

• Go to your nearest emergency department or call your local emergency number if you have a sudden, severe 'thunderclap' headache
• Seek urgent care if your headache comes with trouble speaking, weakness or numbness on one side, stiff neck, high fever, or a seizure
• Call emergency services if your headache follows a fall or blow to the head

Book a routine appointment if:

• See your GP or healthcare provider if you have frequent headaches that stop you from doing daily activities
• Request an appointment if you need to take painkillers more than 1–2 days a week for headaches
• Make an appointment if your headache symptoms are changing or a new pattern starts after age 50
• Ask for a review if you are pregnant or hoping to become pregnant and you have migraines

Diagnosis

A doctor will diagnose migraine by listening to your story — your symptoms, how often attacks happen, what makes them better or worse, and whether you have a family history. There is no single blood test or scan to prove a migraine. The doctor will usually also perform a brief neurological examination to rule out other causes.

Tests that may be done

• Usually no tests are needed, especially if your symptoms match a typical migraine pattern
• In some cases, blood tests may be done to check for anaemia, thyroid problems, or inflammation
• Imaging tests such as a CT or MRI scan are only ordered when something in the examination is unusual — for example, new neurological signs

What to expect at your appointment

Your doctor may ask you to keep a headache diary for several weeks to spot patterns and triggers. You may be asked to describe what you feel during an attack, how long it lasts, and what makes it worse. If your migraines are complex or difficult to control, you might be referred to a neurologist (a brain and nerve specialist) or a headache clinic.

Treatment

Treatment for migraine is tailored to each person. The main goals are to stop an attack quickly, reduce the number of attacks, and help you get back to normal life as soon as possible. Treatment often combines self-care with medicines prescribed by a doctor. It may take a little while to find the approach that works best for you.

Self-care at home

• Rest in a dark, quiet room and close your eyes
• Apply a cold or warm compress to your forehead or the back of your neck
• Try to drink plenty of water and eat a small snack if you can
• Use relaxation techniques such as deep breathing or mindfulness
• Keep a headache diary so you can learn your early warning signs

Medical treatments

There are two kinds of medicines used for migraine. One kind is taken at the start of an attack to relieve the pain, and may include simple pain relief and anti-nausea medicines. The other kind is taken regularly to prevent attacks in the first place; this is recommended when migraines happen often or are severe. Your doctor can discuss which options are appropriate for you. Newer treatments that target specific nerve pathways are now available in specialist centres, but no specific medicine can be recommended without a personal consultation.

When is surgery considered?

Surgery is not a standard or first-choice treatment for migraine. In rare cases, specialist centres may offer procedures such as nerve blocks or neuromodulation devices, but these are only considered after other treatments have not worked and after thorough assessment.

Living with this condition

Living with migraine means learning to manage a condition that can be unpredictable. With a good treatment plan and head-savvy habits, you can reduce both the symptoms and the worry. Give yourself permission to rest when you need to, and be clear with family, friends, and employers about what you are going through. Communicate your needs — this is not a sign of weakness.

Lifestyle tips

• Stick to a regular sleep schedule, even on weekends
• Eat regular, balanced meals and avoid skipping meals
• Keep a water bottle with you to avoid dehydration
• Limit caffeine and alcohol
• Schedule regular physical activity and move throughout the day
• Learn to pace yourself and take breaks when stressed

Diet and exercise

A Mediterranean-style diet rich in vegetables, fruits, fish, and healthy fats may support brain health. Regular moderate exercise — like brisk walking, cycling, or swimming — can reduce the frequency of migraine attacks and improve your mood. But do not exercise during an acute migraine attack. If certain foods seem to trigger your attacks, keep a diary and discuss this with a doctor or dietitian. Avoid extreme diets, fasting, or cutting out whole food groups without professional advice.

Mental health and emotional wellbeing

Migraine can be exhausting and frustrating, and it is normal to feel anxious, low, or worried about when the next attack will strike. Recurrent headache can affect sleep, work, and relationships. It may help to talk with a counsellor or mental health professional. If you are feeling overwhelmed or having thoughts of self-harm, please reach out: call your local crisis support line or go to your nearest emergency department right away. You are important, and help is always available.

Prevention

It may not be possible to prevent every migraine attack, but many people can significantly reduce them. The first step is identifying your personal triggers — this is easier with a headache diary. Keeping regular routines for sleep, meals, and exercise, and managing stress, can also help. In addition, there are preventive medicines that your doctor might recommend if attacks are frequent or severe. These are not painkillers but medicines that you take daily (or as prescribed) to stop the migraine process starting.

Screening programmes

There is no routine screening test for migraine. It is not a cancer or infection, so there is nothing to screen for. However, a regular check-up with your doctor can help you manage risk factors for other conditions.

Complications

If left untreated

• Serious disability during attacks — being unable to work, study, or look after yourself
• An attack lasting more than 72 hours (status migrainosus), which requires urgent medical care
• Medication-overuse headache: taking painkillers too often can actually make headaches more frequent
• Larger impact on mental health, including anxiety and depression, if attacks are frequent and unmanaged

Long-term outlook

The outlook for people with migraine is usually positive with proper care. Migraine is a lifelong condition for many, but it is not dangerous. Most people are able to continue their lives with symptom-free periods between attacks. Today's treatments — medicines, lifestyle changes, and neural-targeting therapies — have transformed what is possible. Work together with your healthcare team to create a plan, and keep adjusting it until it works for you. Be patient with yourself: progress takes time.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.