Health condition · Clinically reviewed
Migraine, the guide that answers what to do next.
A neurological condition that ruins days, not a bad headache to be pushed through. Here is how it is diagnosed, treated - and when a headache is not a migraine.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, IHS or peer-reviewed sources you can see at the end.
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Updated for 2026
Reflects current UK guidance including the CGRP class of preventive treatments.
Key facts
Migraine at a glance.
The essentials, in plain English - what it is, how common it is, how attacks are diagnosed, and how they are treated in the UK today.
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What it is
A neurological disorder that produces attacks of moderate-to-severe headache, often with nausea, light and sound sensitivity.
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How common
Around 10 million people in the UK; three times more common in women than men.
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Attack duration
Typically 4-72 hours if untreated. Some go longer (status migrainosus).
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Aura
About 1 in 3 people get visual, sensory or speech symptoms just before or during an attack.
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Diagnosis
Clinical - based on the pattern of attacks. Imaging is only needed if red flags are present.
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Treatment
Acute (triptans, gepants) plus preventives when attacks are frequent (beta-blockers, topiramate, CGRP mAbs).
Why this guide matters
Small choices, whole days back.
Migraine treatment has changed in the last few years. The three points below shape everything else on this page.
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A diary changes treatment
Two months of notes on triggers and severity often make more difference than any single appointment.
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Treat early, treat properly
A full-dose triptan at first sign of pain works far better than paracetamol two hours in.
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Preventives have changed
CGRP monoclonal antibodies have made prevention worthwhile for many who had run out of options.
How the diagnosis is made
From first attacks to a clear plan.
The steps a UK GP will normally follow, in order - so you know what to expect and why.
Phase 1 · Recognising
Spotting the pattern and confirming the diagnosis
Phase 2 · Confirming
Red flags excluded and medication overuse ruled out
Phase 3 · Managing
Acute treatment and prevention if needed
- 01
Recognising
A pattern emerges
Recurrent headaches, often one-sided, throbbing, moderate-to-severe, worse with movement.
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Recognising
A headache diary
Two months of daily logs - triggers, timing, medication, severity - clarifies the diagnosis.
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Recognising
Clinical criteria
ICHD-3 (International Classification of Headache Disorders) confirms migraine with or without aura.
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Confirming
Red flags are excluded
Sudden thunderclap onset, neurological signs or new headache over 50 - imaging is arranged.
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Confirming
Medication overuse checked
Painkillers more than 10 days a month often make headaches worse - and need to stop.
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Managing
An acute treatment plan
A triptan or a gepant at the earliest sign, plus an anti-nausea drug if needed.
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Managing
Prevention if frequent
4+ attacks a month - a daily preventive drug or a CGRP monoclonal antibody.
Typical timeline: 4-8 weeks from first appointment to a settled plan.
Symptoms
What a migraine actually feels like.
More than a bad headache - a full-body event with warning signs, aura and an aftermath. Here is the shape of a typical attack.
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Throbbing, one-sided pain
Moderate-to-severe, often on one side, worse with movement.
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Visual aura
Flickering zig-zags, a shimmering blind spot, or lights - lasting 5-60 minutes.
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Nausea or vomiting
A hallmark of a proper migraine, not just a headache.
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Light and sound sensitivity
The need for a dark, quiet room during an attack.
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Prodrome (24 h before)
Yawning, mood change, food craving or tiredness the day before.
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Sensory or speech aura
Numbness or pins-and-needles marching along one side, sometimes speech difficulty.
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Neck stiffness
Very common in migraine - often mistaken for a “tension” headache.
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Red-flag headaches
Sudden severe onset, worst-ever, new after 50, fever with a stiff neck - urgent assessment.
Treatment
How migraine is treated in the UK.
Acute treatment to stop an attack, and preventive treatment when they are frequent - what each option does, and when it fits.
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Triptans (acute)
Sumatriptan or rizatriptan at the first sign of pain - the mainstay acute treatment.
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Gepants (acute)
Rimegepant and ubrogepant - newer acute options useful when triptans do not suit.
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Anti-nausea (acute)
Metoclopramide or domperidone helps both nausea and drug absorption.
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NSAIDs & paracetamol
Aspirin 900 mg or ibuprofen work for milder attacks, especially with an anti-emetic.
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Beta-blocker (prevention)
Propranolol - a first-line daily preventive when attacks are frequent.
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Topiramate (prevention)
An anticonvulsant used at low dose for migraine prevention.
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CGRP monoclonal antibodies
Erenumab, fremanezumab, galcanezumab - monthly or quarterly injections that prevent attacks.
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Lifestyle levers
Regular sleep, meals, hydration, exercise; managing caffeine and alcohol; identifying personal triggers.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, seek assessment - especially with any red-flag features.
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NICE. Headaches in over 12s: diagnosis and management (NG150).
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The Migraine Trust. Migraine information and support.
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International Headache Society. ICHD-3 diagnostic criteria.
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NHS. Migraine: overview.
Red flags
When a headache is not just a migraine.
Most headaches are benign. These are the patterns that need urgent assessment - do not push through them.
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Sudden thunderclap headache
Worst-ever, sudden-onset - possible subarachnoid haemorrhage. Call 999.
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Fever, stiff neck, rash
Possible meningitis - urgent assessment.
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New headache after 50
Deserves imaging to exclude other causes.
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Weakness, slurred speech
FAST signs during a headache - call 999. Some migraine mimics are strokes.
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Headache with visual loss
Especially in one eye - possible giant cell arteritis in older adults.
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Worse with cough or bending
Can indicate raised pressure inside the skull - see a GP.
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Increasing frequency
Escalating attacks - check for medication overuse and reconsider preventives.
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Pregnancy with new headache
Especially with high BP - urgent review to exclude pre-eclampsia.
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Aura lasting over an hour
Especially with weakness - seek same-day assessment.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day - the diary, the routines, the rescue plan and the trap of overuse.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes - kept up for months - do more than a heroic week that does not last.
- 01 Diary
Track before you treat
Two months of daily notes reveal patterns that a five-minute consultation cannot.
- 02 Consistency
Small routines, big difference
Regular sleep, meals and hydration remove the most common triggers.
- 03 Rescue plan
Treat early, treat properly
Full-dose triptan at first sign, in the right form - not paracetamol later.
- 04 Overuse
Painkillers can become the cause
Any acute drug used more than 10 days a month risks medication-overuse headache.
Frequently asked
Everything we get asked about migraine.
Quick answers on scans, triptans, CGRP antibodies, preventives, triggers and pregnancy.
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What makes a headache a migraine?
Recurrent moderate-to-severe attacks, often one-sided and throbbing, worse with movement, usually with nausea or light and sound sensitivity - lasting 4-72 hours.
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Do I need a brain scan?
Usually not. Migraine is a clinical diagnosis. Imaging is only needed if there are red-flag features - sudden onset, new after 50, neurological signs.
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What is aura?
A short-lived neurological warning before or during a migraine - most commonly zig-zag visual patterns, but can include numbness or speech changes. It lasts 5-60 minutes.
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Which triptan should I try?
Sumatriptan is the usual first choice. If it does not work or does not suit, others (rizatriptan, zolmitriptan, eletriptan) often do - it is worth trying more than one.
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What are gepants and CGRP antibodies?
Newer migraine drugs. Gepants (rimegepant, ubrogepant) are acute or on-demand tablets. CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) are monthly or quarterly injections for prevention.
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When should I take a preventive medication?
When you have 4 or more attacks a month, or when acute treatment is not enough. Preventives take 6-8 weeks to show effect.
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Can painkillers cause more headaches?
Yes - regular use of any painkiller more than 10 days a month can cause medication-overuse headache. It usually improves once the drug is stopped.
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What are the common triggers?
Skipped meals, poor sleep, dehydration, alcohol (especially red wine), stress or the come-down after stress, hormonal change and weather. A diary helps identify yours.
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Is migraine linked to stroke risk?
Migraine with aura carries a modestly higher stroke risk, especially in women who smoke or use combined oral contraception. Discuss contraception choice with your GP.
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Migraine during pregnancy?
Attacks often improve in pregnancy, especially the second and third trimesters. Some medicines are safe; others are not - review with your GP or midwife.