Migraine

Migraine is a common health condition. It affects around 1 in 5 women and around 1 in 15 men. It usually begins in early adulthood.

A migraine headache is usually a moderate or severe headache felt as a throbbing pain on one side of the head.

Some people have frequent migraine headaches up to several times a week. Other people only have occasional migraine headaches. It’s possible for years to pass between migraine attacks.

Phone 999 if you or someone else experiences:

paralysis or weakness in one or both arms and/or one side of the face
slurred or garbled speech
a sudden agonising headache resulting in a blinding pain
headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, like a stroke or meningitis. You should be assessed by a doctor as soon as possible.

Speak to your GP practice if:

you have frequent or severe migraine symptoms

Read about migraine prevention and treatment

Types of migraine

There are different types of migraine, including:

migraine with aura – where there are warning signs before the migraine attack begins, like seeing flashing lights
migraine without aura – the most common type, where the migraine attack occurs without warning signs
migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, without a headache

Symptoms of migraine

The main symptom of migraine is usually an intense headache on one side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck.

The pain might get worse when you move and may stop you from carrying out normal activities.

Other symptoms associated with migraine include:

nausea
vomiting
increased sensitivity to light and sound – which is why many people with a migraine headache want to rest in a quiet, dark room
sweating
poor concentration
feeling very hot or very cold
abdominal (tummy) pain
diarrhoea
dizziness (light headedness)

Not everyone with migraine experiences all of these symptoms. Some people may experience them without having a headache.

The symptoms of a migraine attack usually last between 4 hours and 3 days. You may feel very tired for up to a week afterwards.

Symptoms of aura

About 1 in 3 people with migraine have temporary warning symptoms, known as aura, before a migraine. These include:

visual problems – like seeing flashing lights, zig-zag patterns or blind spots
numbness or a tingling sensation like pins and needles – which usually starts in one hand and moves up your arm before affecting your face, lips and tongue
difficulty speaking
feeling dizzy or off balance
loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. The aura might start before the headache or you might experience it at the same time as a headache. Some people may experience aura followed by only a mild headache or no headache at all.

Causes of migraine

The exact cause of migraine is unknown. It’s thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

Around half of all people who have migraine have a close relative with the condition. This suggests that genes may play a role.

Migraine triggers

It may help to keep a diary to see if you can identify a consistent trigger. It can be difficult to tell if something is a trigger or if what you’re experiencing is an early symptom of a migraine attack.

There might not always be a trigger for your headache.

Possible migraine triggers include:

hormonal changes
starting your period
emotional triggers like anxiety, depression and stress
physical triggers like tiredness, poor posture, neck or shoulder tension and jet lag
fasting or low blood sugar (hypoglycaemia)
strenuous exercise, if you’re not used to it
dietary triggers like alcohol, caffeine, chocolate or citrus fruit
dehydration
environmental triggers like bright lights, flickering screens, smoking or smoky rooms, loud noises, strong smells or changes in the weather

Medication can also trigger migraine attacks. For example medication like some types of sleeping tablets, the combined contraceptive pill or hormone replacement therapy (HRT). Speak to your GP if you start to experience migraine attacks after starting to take a new medication.

Some people crave chocolate before a migraine begins. This can be a sign that you’re about to have a migraine attack rather than the chocolate being the trigger for the migraine.

Diagnosing migraines

There’s no specific test to diagnose migraine. Your GP must identify a pattern of recurring headaches along with the associated symptoms.

Migraine headaches can be unpredictable, sometimes occurring without the other symptoms. Getting an accurate diagnosis can take time.

Your GP might do a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms.

Your GP may ask if your headaches are:

on one side of the head
a pulsating pain
severe enough to prevent you carrying out daily activities
made worse by physical activity or moving about
accompanied by nausea and vomiting
accompanied by sensitivity to light and noise

Migraine diary

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks.

Note down details including:

the date
time
what you were doing when the migraine attack began
how long the attack lasted
what symptoms you experienced
what medication you took (if any)

Taking too many painkillers can make migraine difficult to treat. This condition is called medication overuse headache.

Keep a record of what painkillers you take and how often you take them. You shouldn’t take painkillers on more than 10 days every month in the long-term.

It can be helpful to make a note when your start your period, if you have one. This can help your GP identify potential triggers.

Read more about keeping a migraine diary on The Migraine Trust website.

Referral to a specialist

Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). They’ll do further assessments and offer treatment if:

a diagnosis is unclear
you experience significant migraine headaches that aren’t being controlled by your current treatment

Read about the prevention and treatment of migraine

Complications of migraines

Migraine is linked to a small increased risk of other conditions like:

Contraceptive pill

The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill. Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill.

Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors like high blood pressure or a family history of cardiovascular disease.

Talk to your GP about alternative forms of contraception if you experience aura symptoms and are taking the combined contraceptive pill.