Migraine Treatments

What is a migraine?

A migraine resembles a severe headache. It usually causes a throbbing pain on one side of the head and can include additional symptoms such as nausea, vomiting, feeling sensitive to light and sound and tiredness. 

What causes migraines?

The exact cause of migraines is not known but many people who experience them have a genetic disposition for migraines. It's thought that temporary changes to the chemicals and blood vessels in the brain result in a migraine occurring. There are several known triggers which include stress, changes to daily routine, caffeine, lack of sleep and dehydration. 

What are the different types of migraine?

The different types of migraines are: 

• Migraine without aura- this is the most common type of migraine. A severe headache may be accompanied by feelings of nausea, tiredness, dizziness and a sensitivity to light or sound 
• Migraine with aura- these migraines cause visual disturbances including seeing coloured spots, zig zag lines or coloured lights. They can also cause vertigo, pins and needles, weakness and temporary blindness. 
• Chronic migraine- if you have migraines more than 15 days out of a month
• Menstrual migraine- when migraines are triggered by your period 
• Ocular migraine- a migraine which affects your vision and causes temporary blindness 
• Hemiplegic migraine- this is a rare type which results in weakness down one side of the body
• Migraine aura without headache- experiencing the other symptoms of a migraine without the headache 

How to keep a migraine diary

Keeping a migraine diary can help to determine what might be triggering them and whether or not your treatment is sufficient. Recording when migraines occur, how long they last and the details of your surrounding environment helps to establish a pattern. Alongside this, keep note of any medication you've taken, what you've had to eat or drink, the quality of your sleep, any stressors in your life and exercise you've done. Women may want to record their menstrual cycle. 

What does a migraine feel like?

A migraine feels like an intense, painful headache. It's usually accompanied by feelings of nausea, tiredness, dizziness or vomiting. It can also affect your vision and cause spots of light, flashes of light or tunnel vision among others. You'll also feel sensitive to light and sound and will usually need to lie down until the migraine eases off.  

What are some migraine triggers?

Possible migraine triggers include: 

• Stress
• Disruption to your normal routine 
• Lack of sleep or oversleeping 
• Caffeine 
• Menstruation or menopause 
• Environmental factors such as noise, humidity, weather, bright lights 
• Screen time 
• Muscle tension 
• Not eating properly 
• Certain foods, such as sugary treats and cheese
• Alcohol 
• Dehydration 

Migraine vs headache

It can be difficult to differentiate between a headache and a migraine as they both cause pain. A headache will be less severe than a migraine, the pain being steady and it will clear easily with painkillers. A migraine usually occurs on one side and produces a throbbing pain. You'll also get other symptoms which include nausea, tiredness, dizziness and a worsening of the pain after movement or looking at bright lights. 

How are migraines diagnosed?

Keeping a migraine diary will help to establish an accurate diagnosis. Your GP will need to see a pattern in when your headaches occur and what symptoms you have experienced. They may also undertake an examination to check your vision and reflexes to rule out other possible causes. It usually takes time to get a diagnosis as migraines can be sporadic. 

What is an aura?

A migraine with aura is experienced by 10-30% of people who suffer from migraines. Aura is the visual disturbances which accompany the migraine. These can be experienced as: 

• Blind spots
• Seeing flashing lights 
• An appearance of sparkles or stars obscuring your vision 
• Zig zag lines
• Tunnel vision 
• Temporary loss of sight 
• Coloured spots 

In addition to the visual disturbances it can also cause the following symptoms: 

• A weakness down one side of the body
• Pins and needles 
• A feeling of numbness or tingling 
• Dizziness 
• Vertigo (a spinning feeling which affects your balance) 

Can foods cause migraines?

Certain foods can cause migraines. These commonly include: 

• Cheeses
• Red wine
• Processed meats
• Alcohol
• Caffeine 
• Bananas 
• Beans
• Chocolate 
• Nuts
• Dairy
• Onions
• Tomatoes 
• Citrus fruits
• Additives 

This is likely to be different for everyone. Keeping a food diary and recording when your migraines take place can help to distinguish if certain foods do trigger your migraines. 

How to treat migraines

During a migraine, the best thing to do is to lie down in a dark room. Take painkillers as soon as you feel a migraine coming on to allow them enough time to work. If over the counter painkillers do not work to ease your migraines then see your GP. They can prescribe you with a type of medication called Sumatriptan which is specifically designed to treat migraines. If you experience vomiting then an anti-emetic can be prescribed to ease sickness. Care should be taken with over the counter painkillers as overuse can result in developing painkiller headaches. 

How to prevent migraines

Identifying what your triggers are can help to manage your migraines as you can take steps to avoid them. This isn't always possible however. There are medications available to prevent migraines which include Topiramate, Propranolol and Botulinum toxin type A. If your migraines are caused by your menstrual cycle taking Anti-inflammatories, Triptans or the combined contraceptive pill can help.  

How to live with migraines

Migraines can be unpleasant and painful, having an impact on your work and daily life. With adequate management, you can learn to live with migraines. The first step to take is to identify your triggers and find a way to avoid them. If stress has an impact on your life, making changes to manage this is important. Establish which medications are effective for you and ensure you have access to them. Maintaining a good sleep pattern and eating habits will also have a positive effect on your migraines.  

What are some home treatments for migraines?

Resting in a darkened room is the best thing to do during a migraine attack. Placing an ice pack or cold flannel over your forehead or neck has a soothing effect. Gentle yoga can help you to relax and prevent tension and migraines. Ginger and lavender oil are natural supplements which can provide relief, as can a neck and shoulder massage to relieve muscle tension. Sip water slowly if you are feeling sick to ensure you stay hydrated.

Chronic migraine treatment

Chronic migraines need to be treated with a combination of medication and lifestyle changes. Keeping a migraine diary is important to identify what your triggers are to find ways to avoid them. Taking a combination of painkillers and preventative medications is also an effective way of managing chronic migraines. You may be referred by your GP to see a specialist. 

Are there any medications that can treat or prevent migraines?

Triptans are a type of medication designed to treat migraines. They work by easing the swelling in the blood vessels of the brain which cause migraines. preventative medications include Topiramate, Propranolol and Botulinum toxin type A.

What are the best painkillers for migraines?

The best painkillers to take in the first instance are over the counter remedies like Paracetamol, Aspirin and Ibuprofen. They are only really effective if you take them as soon as symptoms arise. Triptans are available on prescription and are specifically designed to treat migraines so these may be more effective in providing relief for some people.

Are migraines dangerous?

Migraines can feel unsettling and painful but they are not considered dangerous. However, if you experience migraines whilst taking the contraceptive pill, you should seek medical attention, as this can increase your risk of stroke.

What are cluster headaches?

A cluster headache is a sudden and severe sharp pain which often occurs around the eye. The pain can last between 15 minutes to 3 hours and they occur daily for several weeks at a time. Cluster headaches usually produce other symptoms which include:  

• A watery, red eye
• One swollen, droopy eyelid
• A smaller pupil in one eye
• Sweating in the face
• One blocked or runny nostril 

Is it safe to drive with a migraine?

You should not drive during a migraine attack. Even if you do not experience any visual impairment, the pain may interfere with your concentration and judgement. If you feel a migraine coming on while driving, stop until you feel well enough to continue.

Can migraines be related to the menstrual cycle?

Migraines can be triggered by your period, which are known as menstrual migraines. These can be treated with painkillers or anti-inflammatories. Hormonal Contraceptives may also provide relief

Does having migraines increase your risk of stroke?

It is very rare for a migraine to cause a stroke. Studies have shown that women over 35 who use the combined contraceptive pill and suffer from migraines may be more at risk of a stroke if they have high blood pressure or smoke. However, it is not recommended for women who fall into this group to take the contraceptive pill.

Can I take the contraceptive pill if I have migraines?

The contraceptive pill is not suitable for women who experience migraines with aura. This increases your risk of a stroke. If you have migraines without aura (visual disturbances) then consult your GP before taking the pill. 

Can I get time off work for a migraine?

A migraine can impair your ability to work as it leaves you sensitive to light and sound. You should discuss this with your employer, informing them that you suffer from migraines so that they can make reasonable adjustments. 

Can tinted glasses help prevent migraines?

There are special tinted glasses available, known as ‘migraine glasses’ which reduce the amount of light getting into the eye. These have been found to be helpful in reducing migraines in some people. 

Sources

• NICE > Migraine
• NHS > Migraine
• NHS Inform > Migraine
• NHS > Cluster Headaches
• BMJ Best Practice > Migraine Headaches in Adults
• Migraine Trust