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Migraine

A migraine is usually a severe headache felt as a throbbing pain at the front or on one side of the head.
Some people also have other symptoms, such as nausea and sensitivity to light.
Migraine is a common health condition, affecting about 15% of adults in the UK.
There are several types of migraine, including:
Migraine with aura is when there is a warning sign, known as aura, before the migraine begins. About a third of people with migraine have this. Warning signs may include visual problems (such as flashing lights) and stiffness in the neck, shoulders or limbs.
Migraine without aura
Migraine without headache, also known as silent migraine, is when an aura or other migraine symptoms are experienced, but a headache does not develop.

 Symptoms of migraine

A migraine is usually an intense headache that occurs at the front or on one side of the head. However, the area of pain can change position during an attack.
The pain is usually a severe throbbing sensation that  gets worse when you move.
Symptoms accompanying a migraine

Other symptoms commonly associated with a migraine are:
nausea – you may feel queasy and sick; this may be followed by vomiting
increased sensitivity – you may have photophobia (sensitivity to light), phonophobia (sensitivity to sound) and/or osmophobia (sensitivity to smells), which is why many people with a migraine want to rest in a quiet, dark room
Other symptoms can also occur during a migraine. These include:
poor concentration
sweating
feeling very hot or very cold
abdominal pain (which can sometimes cause diarrhoea)
a frequent need to urinate
Not everyone experiences these symptoms when they have a migraine, and they do not usually all occur at once.
In some cases, you may experience these symptoms without having a headache.
The symptoms accompanying migraine can last anywhere between four hours and three days. They will usually disappear when the headache goes.
You may feel very tired for up to seven days after a migraine attack.
Symptoms of aura

About one third of people with migraines have warning symptoms, known as aura, before the migraine. These include:
visual problems – you may see flashing lights, zigzag patterns or blind spots
stiffness or a tingling sensation like pins and needles in your neck, shoulders or limbs
problems with co-ordination – you may feel disoriented or off balance
difficulty speaking
loss of consciousness – this only happens in very rare cases
Aura symptoms typically start between 15 minutes and one hour before the headache begins. Some people may experience aura with only a mild headache or no headache at all.

There are five stages to a migraine, although not everyone will experience all of these.
Who is affected by migraines?

Migraines affect one in four women and one in 12 men in the UK.
Hormones may be the reason why migraines affect more women than men. For example, some women find that migraine attacks are more frequent around the time of their period. However, this association has not been proven.
Migraines usually begin in young adults. About 9 in 10 have their first migraine before they are 40 years old. However, it is possible for migraines to begin later in life.
How often do they occur?

Everyone will experience migraines differently. Some people have attacks frequently, up to several times a week. Other people only have a migraine occasionally. It is possible for years to pass between migraine attacks.
Some people find that migraine attacks are associated with certain triggers, which can include stress and certain foods.

Causes of migraine

Migraines are thought to be caused by changes in the chemicals of the brain.
In particular, levels of a type of chemical called serotonin decrease during a migraine.
Low levels of serotonin can make the blood vessels in a part of your brain spasm (suddenly contract), which makes them narrower. This may cause the symptoms of aura. Soon after, the blood vessels dilate (widen), which is thought to cause the headache. The reason for the drop in serotonin is not yet fully understood.
Hormones

Some scientists believe that fluctuating levels of hormones are closely linked to the cause of migraines.
Some women who experience migraines say they are more likely to have an attack around the time of their period. This is known as a menstrual migraine. Just before women have their period, levels of the hormone oestrogen fall.
Women can have menstrual migraines from two days before to three days after the first day of their period. About 1 in 7 women who have migraines only have an attack around the time of their period. This is known as a pure menstrual migraine. Around 6 in 10 women with migraines have attacks at other times too.
Other migraine triggers

Many factors have been identified as triggers for a migraine. These triggers include emotional, physical, dietary, environmental and medicinal factors. They are outlined below.
Emotional triggers
These include:
stress
anxiety
tension
shock
depression
excitement
Physical triggers
Physical triggers include:
tiredness
poor quality of sleep
shift work
poor posture
neck or shoulder tension
travelling for a long period of time
low blood sugar
The menopause can also trigger migraines.
Dietary triggers
Dietary triggers include:
lack of food (dieting)
delayed or irregular meals (see below)
dehydration
alcohol
the food additive tyramine
caffeine products, such as tea and coffee
specific foods such as chocolate, citrus fruit and cheese
When you do not eat regular meals, your blood sugar levels fall. If you then eat a sugary snack, blood sugar levels shoot up. These ‘peaks and troughs’ could trigger migraine attacks.
Environmental triggers
Environmental triggers include:
bright lights
flickering screens, such as a television or computer screen
smoking (or smoky rooms)
loud noises
changes in climate, such as changes in humidity or very cold temperatures
strong smells
a stuffy atmosphere
Medicines
Some medicines can trigger migraines, including:
some types of sleeping tablets
the contraceptive pill
hormone replacement therapy (HRT), which is sometimes used to treat the menopause

Migraines can severely affect your quality of life. During and after a migraine, some people need to stay in bed for days at a time.
However, there are effective treatments, and methods that can help to prevent migraines. Most people find ways of managing their migraines so that there is little disruption to their lives.

 Treating migraine

There is currently no cure for migraines. However, a number of treatments can be used to ease the symptoms.
It may take time to work out which is the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.
If you find that you cannot manage your migraines using over-the-counter medicines, then your GP can help.
Painkillers

Many people who have migraines find that over-the-counter painkillers, such as paracetamol and aspirin, can help to reduce their symptoms.
When taking paracetamol or aspirin, always make sure you read the instructions on the packaging and follow the dosage recommendations. Children under 16 should not take aspirin unless it is under the guidance of a healthcare professional. Aspirin is also not recommended for adults who have, or have had in the past, stomach problems, such as a peptic ulcer, liver problems or kidney problems.
Some people find that the painkiller codeine makes migraine worse. This can be because it increases the nausea associated with the migraine.
Taking any form of painkiller frequently can make migraine worse. This is sometimes called ‘medication overuse headache’.
Painkillers are usually the first treatment for migraine. They tend to be more effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms.
Some people only take painkillers when their headache becomes very bad. However, this is not advisable because it is often too late for the painkiller to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good option because they are absorbed quickly by your body.
If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus (back passage).
If over-the-counter painkillers are not effective, your GP or specialist may prescribe you a stronger painkiller.
Triptan medicines

If ordinary painkillers are not helping to relieve your migraine symptoms, triptan medicines might be the next option. Some triptan medicines, such as sumatriptan, are available without prescription over the counter. Others require a prescription from your GP.
Triptan medicines are not the same as painkillers. They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process.
Triptans are available as tablets, injections and nasal sprays.
Triptan medicines only work for some people. If one type of triptan medicine does not seem to work, ask your GP about other types.
Anti-inflammatory medicines

Some people find that anti-inflammatory medicines such as ibuprofen are effective in treating the symptoms of migraine.
You can buy ibuprofen over the counter at a pharmacy, and it is available on prescription. However, do not take ibuprofen if you have, or have had in the past, stomach problems, such as a peptic ulcer, or if you have liver or kidney problems.
Diclofenac, naproxen and tolfenamic acid are anti-inflammatory medicines that are only available on prescription.
Anti-sickness medicines

Anti-sickness medicines can successfully treat migraine in some people, even if nausea is not a symptom. These are prescribed by your GP and can be taken alongside painkillers.
As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet, but are also available as a suppository.
Combination medicines

You can buy a number of combination medicines for migraine over the counter at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which one is best for you, ask your pharmacist.
Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms. If this is the case, you may prefer to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each.
Ask your GP or pharmacist if you are not sure which medication is most suitable for you.
Migraine clinics

If you are not responding to treatment or your migraines are not being well managed, your GP may refer you to a specialist migraine clinic for further investigation. Reasons for being referred include:
doubt over the diagnosis of migraine
a rarer form of migraine is suspected
other headaches besides migraine are present
treatment is not working well for you
your migraines or headaches are getting worse and/or more frequent
Treatment for pregnant women

In general, migraine treatment with medicines should be limited as much as possible when you are pregnant or breastfeeding.
If medication is essential, then your GP may prescribe you a low-dose painkiller, such as paracetamol. In some cases, anti-inflammatory drugs or triptans may be prescribed. Speak to your GP or midwife before taking medication in pregnancy.

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