Migraine without aura: the most common type, and how to manage it

Migraine is a condition that produces a set of symptoms known as a migraine attack. The NHS notes that some people get aura, a warning sign such as zigzag lines or tingling, and that many do not. In migraine without aura there is no such warning. The pain simply builds, sometimes preceded by milder early symptoms.

The Migraine Trust points out that people may get a mixture of attacks with and without aura. So the label describes a particular attack as much as a particular person, and someone may be advised by a GP using either term depending on what their recent attacks looked like.

NHS inform says migraine headache is usually moderate or severe and felt as throbbing pain on one side of the head, that some people have frequent attacks up to several times a week while others have them only occasionally, and that years can pass between attacks.

According to the Migraine Trust the headache is often on one side and often throbbing, it worsens with movement such as walking or climbing stairs, and it is severe enough to stop normal daily activities. It goes with nausea or vomiting and sensitivity to light (photophobia), sound (phonophobia) or smells.

The NHS describes symptoms that can appear before the headache, including feeling very tired and yawning a lot, craving certain foods or feeling thirsty, mood changes, a stiff neck and passing urine more often. These early symptoms can start hours or up to 2 days before the head pain and finish after the headache stops. NHS inform lists further features that some people have: sweating, poor concentration, feeling very hot or cold, tummy pain, diarrhoea and light-headedness, and says tiredness can linger for up to a week afterwards.

NHS inform lists hormonal changes, starting a period, anxiety, depression, stress, tiredness, poor posture, neck or shoulder tension, jet lag, fasting or low blood sugar, unaccustomed strenuous exercise, alcohol, caffeine, chocolate, citrus fruit, dehydration, bright lights, flickering screens, smoke, loud noise, strong smells and changes in the weather as possible triggers. It cautions that it can be hard to tell a trigger from an early symptom, since craving chocolate may be a sign an attack is starting rather than its cause.

The NHS says attacks that happen just before or during a period are called menstrual migraines and are often longer and more severe than attacks at other times. It adds that most people find attacks slowly get better with age, that in women migraine often improves after the menopause and that it sometimes improves in pregnancy.

A diary helps. NHS inform suggests noting the date, time, what you were doing when it started, how long it lasted, symptoms and any medicine taken, and, where relevant, the start of your period. This also helps a GP spot patterns and a link with painkiller use.

NHS inform says there is no specific test, and the diagnosis rests on a pattern of recurring headaches with the associated symptoms. The GP may ask whether the headaches are on one side, pulsating, severe enough to prevent daily activities, made worse by movement, and accompanied by nausea, vomiting and sensitivity to light and noise. They may examine your vision, coordination, reflexes and sensations to rule out other causes.

Referral to a neurologist is considered if the diagnosis is unclear or if significant attacks are not being controlled by current treatment. The NHS also advises seeing a GP if attacks are severe, getting worse or lasting longer than usual, happen more than once a week, are difficult to control, or regularly occur before or during your period.

The NHS says migraine cannot be cured but treatment can help control symptoms and prevent attacks, that you may need to try a combination, and that the right treatment depends on how severe your attacks are and how often they occur. For the attack itself it lists painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and anti-sickness medicines, with painkillers best taken as soon as the headache starts. The Migraine Trust makes the same point for migraine without aura: take treatment as soon as the head pain starts.

To prevent attacks the NHS lists medicines such as beta blockers, antidepressants and medicines for epilepsy, acupuncture, relaxation techniques and cognitive behavioural therapy, and vitamin B2. The Migraine Trust says preventive medicines are taken regularly and built up to an effective dose, and that some people need to try several or are referred to a headache specialist. Prescribing is for clinicians to decide; this page does not recommend any particular medicine.

Overuse is a real risk. The NHS says to try not to take painkillers for more than 2 days a week, and NHS inform says not to take them on more than 10 days a month in the long term, which may reflect different medicine types, so ask a clinician which limit applies to you. The Migraine Trust warns that taking certain acute treatments on too many days a month can cause medication overuse headache.

The Migraine Trust suggests sticking to a routine, waking at the same time each day, practising good sleep hygiene, eating regularly at similar times, avoiding hunger, staying hydrated, taking gentle exercise such as walking and keeping a healthy lifestyle. If alcohol or lack of sleep seem to bring on attacks, changes there might reduce how often they happen.

During an attack the NHS suggests sleeping or lying down in a darkened room. Between attacks it recommends staying well hydrated, limiting caffeine and alcohol, keeping to a healthy weight, regular meals, regular exercise, enough sleep and managing stress.

• Keep regular sleep and meal times.

• Drink enough fluid and limit caffeine and alcohol.

• Take gentle regular exercise.

• Keep a headache diary, including period dates and any painkillers taken.

• Rest in a darkened room during an attack.

The NHS says to call 999 if you or your child have a headache that came on suddenly and is extremely painful, problems speaking or remembering, loss of vision or blurred or double vision, drowsiness or confusion, a seizure, a very high temperature with symptoms of meningitis, weakness on one side of the body or face, or a recent head injury. It advises an urgent GP appointment or NHS 111 if an attack has lasted longer than 72 hours, or if you are pregnant or have just had a baby.

NHS inform adds that a sudden agonising headache with blinding pain, or a headache with fever, stiff neck, confusion, seizures, double vision and a rash, could signal a serious condition such as stroke or meningitis and needs urgent assessment.