migraine when to seek care

Overview

A migraine is a type of headache that usually causes intense throbbing pain on one side of the head. It often comes with nausea, vomiting, and extreme sensitivity to light and sound. A migraine attack can last from a few hours to a few days, and some people have warning signs before it starts.

Yes. Migraine is a very common condition around the world. In the United Kingdom, around 1 in 7 people experience migraine at some point in their lives.

Migraine can affect anyone, but it is more common in women than men. It often starts in the teenage years or early adulthood, but children and older adults can also get migraines.

Symptoms

Common symptoms

• Throbbing or pulsing pain on one side of the head
• Moderate to severe pain that gets worse with physical activity
• Nausea or vomiting
• Sensitivity to light, sound, or smells
• Blurred vision or seeing flashing lights, zigzags, or spots (aura)
• Dizziness or feeling tired before or after the attack

Symptoms in children

• Pain may be on both sides of the head rather than one side
• Children may seem pale, tired, or irritable
• They may feel sick to their stomach or throw up
• They might want to go to a dark, quiet place to rest

Symptoms in older adults

• Migraine attacks may be less intense but can still be disruptive
• New or different headache symptoms in older adults should always be checked by a healthcare provider
• Older adults may have more dizziness or balance problems with a migraine
• Confusion or weakness is not typical for migraine and needs urgent medical review

Causes

Main causes

• The exact cause of migraine is not fully understood, but it likely involves changes in brain activity that affect nerve signals, blood flow, and chemical balances in the brain.
• Certain genes make some people more likely to develop migraines.
• Nerve pathways in the brain become unusually sensitive, releasing inflammatory substances that cause pain.

Risk factors

• Family history of migraine
• Female sex (hormonal changes during periods, pregnancy, or menopause can trigger attacks)
• Stress, anxiety, or depression
• Poor sleep or irregular sleep patterns
• Skipping meals or dehydration
• Certain foods, such as aged cheese, chocolate, caffeine, or alcohol (especially red wine)
• Bright lights, loud noises, or strong smells
• Weather changes or changes in air pressure

When to see a doctor

See a doctor urgently if:

• You have a new severe headache that comes on suddenly and quickly becomes very intense.
• Your headache is accompanied by weakness, numbness, confusion, trouble speaking, or vision loss.
• You have a headache and a stiff neck, high fever, or rash.
• You have a headache after a head injury.
• You are pregnant and develop a new type of headache or severe headaches.

Book a routine appointment if:

• You have frequent headaches (more than two per week) that affect your everyday activities.
• Your headaches are getting worse, or usual over-the-counter pain relief (as advised by a pharmacist) is not helping.
• You need more than two doses of pain medicine per week for your headaches.
• You have migraine symptoms that are interfering with work, school, or family life.
• You think you might be having migraines but have never been formally evaluated.

Diagnosis

A healthcare provider will ask about your symptoms, how often headaches happen, what makes them better or worse, and whether anyone in your family gets migraines. They will also do a physical exam and may check your nervous system. There is no single test for migraine; the diagnosis is based on your history and symptoms.

Tests that may be done

• Usually no tests are needed.
• If your symptoms are unusual or your provider suspects another cause, they may order a CT scan or MRI of your brain.
• Blood tests may be done to check for infections, blood vessel problems, or other conditions.
• In rare cases, a lumbar puncture (spinal tap) may be recommended if there is concern about bleeding or infection around the brain.

What to expect at your appointment

Your provider will likely ask you to keep a headache diary for a few weeks, noting when headaches happen, how long they last, possible triggers, and what helps. They may refer you to a neurologist (a doctor who specializes in brain and nerve conditions) if your migraines are complex, frequent, or hard to treat.

Treatment

Migraine treatment aims to stop an attack once it starts, and to reduce how often attacks happen. It often involves a combination of medicines, lifestyle changes, and avoiding triggers. Your healthcare provider will tailor a plan to your specific needs. Never take any medicine for migraine without first discussing it with a doctor or pharmacist, especially if you are pregnant, or have other health conditions.

Self-care at home

• Rest in a dark, quiet room when you feel an attack starting.
• Place a cool or cold cloth on your forehead or the back of your neck.
• Drink plenty of water to stay hydrated.
• Avoid bright screens and loud sounds.
• Try a regular sleep schedule: go to bed and wake up roughly the same time every day.
• Eat regular meals and do not skip meals.
• Use gentle relaxation techniques such as deep breathing or progressive muscle relaxation.

Medical treatments

Healthcare providers may prescribe medicines for migraine. Some are taken at the first sign of an attack, while others are taken regularly to prevent attacks. There are also devices and procedures that a specialist might suggest. Treatment options depend on your symptoms, your health history, and how often you get migraines. Your doctor will explain the benefits and risks of any treatment before you start.

When is surgery considered?

Surgery is not commonly used for migraine. Rarely, some procedures may be considered for very specific types of headaches or when all other treatments have not worked, but this is decided on an individual basis by a specialist.

Living with this condition

Living with migraine can be challenging, but many people learn to manage the condition well. Tracking your attacks in a diary helps you spot patterns and triggers. With the right treatment plan, most people can reduce the number of attacks and cope better with the ones that do happen.

Lifestyle tips

• Keep a regular sleep-wake schedule, even on weekends.
• Eat balanced meals at regular times and drink enough water.
• Limit caffeine and alcohol, as they can trigger attacks in some people.
• Manage stress with relaxation exercises, mindfulness, or talking to a counselor.
• Wear sunglasses if light is a trigger, and take breaks from screens.

Diet and exercise

Regular, gentle exercise like walking, swimming, or yoga can help reduce migraine frequency. But very high-intensity exercise or sudden exertion can sometimes trigger an attack, so build up slowly. Keep a food diary to see if certain foods are linked to your headaches, but don't cut out whole food groups without talking to a doctor.

Mental health and emotional wellbeing

Living with frequent migraines can cause anxiety, worry, and low mood, especially if attacks interfere with work or family life. It is normal to feel frustrated. Talk to your healthcare provider if you are struggling emotionally. Remember that having a migraine does not make you weak, and asking for support is a sign of strength.

Prevention

Migraine cannot always be completely prevented, but many attacks can be prevented or reduced by identifying triggers and following a healthy routine. If you have frequent or severe migraines, a healthcare provider may recommend preventive treatment—this does not always mean medicines; it can also include lifestyle changes and behavioral approaches.

Vaccines

There are no vaccines for migraine. However, staying up to date with routine vaccinations can help prevent illnesses that might trigger headaches or other complications.

Screening programmes

There is no routine screening test for migraine in the general population. However, if you have frequent or severe headaches, your healthcare provider may do a full evaluation to check for other causes and to develop a plan to reduce your attacks.

Complications

If left untreated

• Frequent pain and discomfort can reduce quality of life and cause missed work or school.
• Chronic migraine (more than 15 headache days per month) can develop if attacks are not well managed.
• Overusing pain medicines can cause medication-overuse headaches, making the problem worse.
• Untreated migraines may lead to avoidance of physical and social activities, contributing to depression or anxiety.
• In rare cases, certain migraine types (like migraine with brainstem aura or hemiplegic migraine) can cause temporary weakness or confusion, which requires medical review.
• Rarely, people who have migraine with aura may have a slightly increased risk of stroke, so it is important to manage cardiovascular risk factors and seek medical advice.

Long-term outlook

The outlook for migraine is generally very good. Many people find effective ways to manage their symptoms, and attacks often become less frequent and less severe with age. Even if migraines continue, most people are able to live full, active lives with the right treatment and support.

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