Migraine: symptoms, treatment, triggers and when to get help

The NHS says the main symptoms of a migraine attack are a throbbing headache, which can be severe, often on one side of the head and worse when you move around; feeling or being sick; and being very sensitive to light and sounds.

You may also get warning symptoms hours or up to 2 days before the head pain starts. Some people get aura, which are warning signs that a migraine attack is about to start.

• Early symptoms: feeling very tired and yawning, craving certain foods or feeling thirsty, mood changes, a stiff neck, peeing more.

• Aura: problems with sight such as zigzag lines or flashing lights, numbness or pins and needles, dizziness, difficulty speaking.

• Aura symptoms should not last longer than 1 hour, according to the NHS.

• Attacks that happen just before or during your period (menstrual migraine) are often longer and more severe, according to the NHS.

The NHS suggests there are things you can do yourself to manage migraine, with help and advice from a GP. During an attack, try sleeping or lying down in a darkened room. If you take painkillers, take them as soon as your headache starts.

Day to day, the NHS lists the following ways to ease or reduce migraine.

• Try to avoid things you know trigger your migraine attacks.

• Stay well hydrated, and limit how much caffeine and alcohol you drink.

• Eat meals at regular times.

• Keep to a healthy weight and take regular exercise.

• Get plenty of sleep.

• Try to manage your stress.

• Keep a migraine diary to work out your triggers.

The NHS says treatment depends on how severe your migraine is and how often you get attacks, and that you may have to try a combination before you find what works. To treat an attack it lists painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and medicines that stop you feeling or being sick.

NICE guideline CG150 recommends combination treatment with an oral triptan plus an NSAID, or an oral triptan plus paracetamol, for acute migraine. People who prefer a single drug can have an oral triptan, NSAID, aspirin 900 mg or paracetamol. For young people aged 12 to 17 NICE suggests considering a nasal triptan in preference to an oral one. An anti-sickness medicine can be added even if there is no nausea. NICE says not to offer ergots or opioids.

For prevention, NICE says to consider propranolol, topiramate or amitriptyline after discussing benefits and risks, and that acupuncture (up to 10 sessions over 5 to 8 weeks) can be considered if those do not work. The NHS also lists relaxation techniques, CBT and vitamin B2 as options, and says if treatments do not help you may be referred to a specialist.

The NHS says it is not known what causes migraine, but it happens when there are changes to nerves and blood vessels in the brain. You are more likely to get it if you have a close family member who has it.

Some people find certain triggers can bring on attacks. The NHS lists these, and suggests a migraine diary to work out your own.

• Having your period.

• Anxiety and depression.

• Stress and tiredness.

• Skipping meals or not eating regularly.

• Too much caffeine.

• Not getting enough regular exercise.

NICE CKS describes migraine as a common primary headache disorder with attacks of moderate or severe headache and symptoms such as sensitivity to light and sound, nausea and vomiting. The headache is typically on one side, pulsating, and lasts 4 to 72 hours. It can occur with or without aura.

NICE CKS says episodic migraine occurs on fewer than 15 days a month, and chronic migraine is headache on at least 15 days a month. It says migraine is two to three times more common in women than men and that prognosis usually improves with increasing age.

The NHS says migraine sometimes improves in pregnancy, and NICE CKS says most women notice an improvement in frequency and severity of attacks. In women, migraine often gets better after the menopause.

Paracetamol is the first-choice painkiller in pregnancy, taken for the shortest possible time, and the NHS says to avoid painkillers containing codeine and NSAIDs such as ibuprofen unless prescribed. NICE CKS says preventative treatment should not be started in primary care for pregnant or breastfeeding women.

The NHS says to ask for an urgent GP appointment or call 111 if you have a migraine attack and you are pregnant or have just had a baby. A severe headache in pregnancy can be a symptom of pre-eclampsia, so call your maternity unit, GP or 111 if you also have vision problems, pain below the ribs, vomiting or sudden swelling.

The NHS says attacks usually last between 4 hours and 3 days, with early symptoms such as tiredness starting hours or up to 2 days before the head pain and finishing after the headache stops. Aura should not last longer than 1 hour.

The NHS says to ask for an urgent GP appointment or call 111 if an attack lasts longer than 72 hours, or if aura symptoms last longer than 1 hour at a time. Some people have attacks several times a week, while others have them less often.

The NHS says that if you or your child has a headache with vision problems, a headache made worse by coughing, bending or exercise, or a headache with vomiting, you should ask for an urgent GP appointment or call 111, and to call 111 for advice for a child under 5. A child headache that is getting worse or wakes them at night should also be assessed urgently.

NICE CG150 describes migraine in young people aged 12 to 17 as often pulsating, throbbing or banging, and recommends considering a nasal triptan in preference to an oral triptan for acute treatment in this age group.

The NHS and NICE CKS point to eating habits rather than a single banned food. The NHS lists skipping meals or not eating regularly and too much caffeine as triggers, and advises eating meals at regular times, staying hydrated, and limiting caffeine and alcohol. NICE CKS lists specific foods, dehydration and missed meals among potential triggers and suggests a headache diary to identify them.

NICE says migraine is diagnosed from the headache features and history, and recommends a headache diary. Diagnosis of migraine with aura requires fully reversible neurological symptoms that develop gradually over at least 5 minutes and last 5 to 60 minutes. NICE CKS stresses that a thorough clinical assessment is essential because other causes of headache can be serious and present similarly.

NICE says to be alert to medication overuse headache in people whose headache has developed or worsened while taking triptans or combination painkillers on 10 or more days a month, or simple painkillers on 15 or more days a month, for 3 months or more.

The NHS says to call 999 if you or your child has a headache that came on suddenly and is extremely painful; problems speaking or remembering; loss of vision, blurred or double vision; drowsiness or confusion; a seizure; weakness on one side of the body or face; a very high temperature with symptoms of meningitis; or a recent head injury. Do not drive yourself to A&E.

See a GP if attacks are severe or getting worse, happen more than once a week, are hard to control, or happen regularly before or during your period.

On the NHS, migraine is usually diagnosed and managed by a GP, who can prescribe triptans and preventive medicine and arrange a referral to a neurology or headache service if treatments fail, as the NHS and NICE CKS describe.

Some people choose private neurology or headache clinics for faster review. Take your headache diary and a list of the medicines you have tried, and ask what the plan is if the first option does not work.