We have all suffered the discomfort of a headache at some point in our lives, but anyone who has ever suffered from migraines knows all too well the misery and suffering that this condition can cause.

Migraines are a disorder which are characterised by recurrent disabling headaches that are much more severe than your average headache, and it often begins in childhood or adolescence. The disorder is less common than other types of headache disorders, but it still affects many people, and is usually a long-lasting condition.

But how do we distinguish between migraine and other types of headaches? Well, there are certain features that are individual to migraine attacks specifically, which helps to set it apart from other types of headaches. Often, the migraine attack is divided into four distinct phases:

Prodrome Phase (60% of sufferers):

This phase occurs hours or even days before the attacks hits in full force. Symptoms can be physical or psychological. Watch out for:

  • Muscle stiffness
  • Food cravings
  • Constipation or diarrhoea
  • Altered perception (e.g of heat or cold) or sensitivity to light or noise
  • Feelings of depression, abnormal excitement or unusual fatigue

Migraine Aura phase (20% of people):

Aura symptoms can develop quickly and last up to one hour. They typically involve visual symptoms (but sometimes other strange physical signs) such as:

  • Bright rims around an area of visual loss
  • Flashing lights
  • Blurred vision
  • Areas of numb skin
  • Muscular weakness

Headache Phase:

This phase is experienced by all migraine sufferers, and can be extremely unpleasant. Typical characteristic include:

  • Moderate or severe pain, typically affecting one side of the head
  • Pain is throbbing in nature and lasts for 4-72 hours
  • Nausea and vomiting
  • Sensitivity to light, sounds, or smells
  • Stiff or tender neck or shoulder

Postdrome phase:

This phase follows the headache, and may last for up to 48 hours. Typical of this phase are:

  • Fatigue
  • Food intolerance
  • Nausea
  • Scalp tenderness
  • Sore muscles in the region of the head, neck or upper back

Causes of migraine

It is not totally clear what causes migraines but there are certain “triggers”.

Triggers do not directly cause migraines, but are implicated in some way in about 40% of attacks, so identifying these triggers (so that they may be avoided) is often a powerful first step in reducing the number of migraine attacks that you experience:

There are lots of triggers for migraines, but here are some of the most common ones:

  • Travel
  • Lack of sleep
  • Increased stress or anxiety
  • Changing hormone levels (in women) throughout the month
  • Excessive alcohol or caffeine
  • Dehydration
  • Certain foods (common culprits include chocolate and cheese)
  • Change to regular routine e.g shift work

Increasingly, it is thought that there is a genetic link to migraines; if someone in your family suffers from migraine, it is more likely that you will too.

Diagnosis of Migraine

Many people who suffer from regular severe headaches worry that their symptoms may be a sign of something very serious, such as a brain tumour. In reality, it’s very rare that headaches are a sign of a life-threatening underlying condition.  However, it’s best to consult a Doctor if:

  • Your headaches change – if they begin to occur more regularly than normal, or the symptoms change
  • If your headaches are impacting on your quality of life or your ability to function
  • If pharmacy remedies or lifestyle changes don’t improve your migraines
  • If you feel unwell between migraine attacks, or have other distressing symptoms, such as visual or personality changes

Your GP will want to know all about your symptoms. Keeping a “migraine diary” might be helpful, and will allow you and your GP to better understand your triggers, and the impact of the migraines on your life. Your GP can act as a source of support, advice and education.  There are many treatment options, and you may need to “experiment” with different ones until you find the one that works for you, but you can discuss this further with your GP.

Treatment of migraines

Migraines can be notoriously difficult to treat, but for many people, simple lifestyle changes can make a huge difference. Try some of the following tips:

  • Avoid your triggers: once you have identified what sets off a migraine for you, your trigger can be avoided!
  • Start a relaxation or mindfulness practice: mindfulness classes are becoming increasingly available in most areas, or you could simply fashion your own relaxation routine, such as deep breathing or guided meditation, all of which are techniques designed to help you take a moment for yourself, no matter how busy or stressful your routine
  • Eat and sleep well, and don’t forget to hydrate!
  • For some women, migraines are linked with the menstrual cycle, or taking oral contraception, such as the Combined Oral Contraceptive Pill (COCP). If you think this may be a problem for you, speak to your Doctor about alternatives for contraception
  • Minimise stress, anxiety and changing routines as much as possible


In some cases, lifestyle changes alone are not enough to tackle migraines, and further treatment is needed. A full discussion of the medications used to treat migraines is beyond the scope of this article, but common options for the acute (short-term) treatment of migraine include:

  • Pain relief such as paracetamol, aspirin or ibuprofen
  • Anti-inflammatory drugs such as diclofenac
  • Anti – nausea medication
  • Triptans – these are drugs that act at certain receptor sites in the brain, causing constriction of blood vessels, inhibition of the release of pain causing substances, and block transmission of pain to areas of the brain where pain is perceived. They are generally well tolerated.

Prophylaxis of migraines

Prophylaxis means prevention, and some people are so troubled by regular migraines that they opt to take medication daily to prevent new attacks. The medications used for prophylaxis are:

  • Beta- Blockers
  • Tricyclic Antidepressants
  • Serotonin Antagonists
  • Anti-convulsants
  • Calcium Antagonists

These medications are available on prescription only, and all may cause side effects, so it’s best to seek guidance from your GP if you are thinking about trying out a preventative treatment.


                                             Dr Seth Rankin is founder of London Doctors Clinic


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