What is Migraine?

Migraine is a condition of the nervous system (a neurological condition) characterised by severe headache often affecting one side of the head only. The headache may be associated with other symptoms such as nausea and vomiting.

A migraine attack can last anywhere from two hours to even days and can affect people of any age, sex or ethnicity. Most people are symptom-free between attacks. It is estimated that migraine affects up to 15 per cent of the UK population. Around two thirds of sufferers are female, which may be attributable to the hormonal changes associated with the menstrual cycle. The frequency of migraine attacks can vary from a few attacks during a lifetime to one or two attacks a week. Migraine is primarily a condition of younger people (aged 20 to 50 years) and tends to improve with age.

What are the symptoms of migraine?

Migraine headache is usually described as an intense throbbing or pulsating pain. The headache is often one-sided (unilateral). Migraine sufferers may also experience nausea, vomiting or diarrhoea, often accompanied by increased sensitivity to light (photophobia), noise (phonophobia) or smells (osmophobia). A migraine attack may cause some or all of these symptoms. In children the headache may be less severe and stomach ache may be the more predominant symptom.

An estimated 10 and 30 per cent of migraine sufferers also experience symptoms known as 'aura' up to an hour before an attack. These symptoms usually take the form of visual disturbances such as blind spots or flashing lights, or other sensory alterations such as hearing disturbances, confusion, mood changes or co-ordination problems. Rarely, people may suffer partial paralysis or loss of consciousness.

Some migraine sufferers may experience warning symptoms a day or two before an attack. These symptoms are often referred to as the prodrome and may include mood changes (such as irritability or depression), tiredness, hyperactivity, feeling thirsty, a stiff neck or cravings for certain foods.

What causes migraine?

Experts still do not know for certain what causes migraine but it is thought that it may be the result of a chemical imbalance in the brain, which affects the blood vessels and the gastrointestinal tract (digestive system). It is thought that there may be a genetic predisposition to the condition as it often runs in families.

It is known that some things can trigger an attack, for example, overtiredness or changes in sleep patterns, high blood pressure (hypertension), alcohol (especially red wine), lack of food or infrequent meals, or eating certain foods (eg, cheese, chocolate, or foods containing monosodium glutamate [MSG]). In some people an attack may be triggered by extreme hot or cold or other environmental factors such as loud noise, strong perfume or a flickering computer screen. Stress is a common trigger and migraine often occurs when the stressful period is over and the body starts to unwind.

In women, hormonal changes such as those occurring during the monthly period, pregnancy, the menopause, or when taking the contraceptive pill, may trigger an attack. Women are also more susceptible to other trigger factors at these times.

Migraine attacks will often be triggered by a combination of factors that occur together rather than one single factor. Therefore, there is a need to be aware of a number of trigger factors - identifying a single factor may not be enough.

What treatment is available?

Currently, there is no cure for migraine but usually it can be treated effectively with drugs. Simple painkillers available over the counter, such as paracetamol, aspirin and ibuprofen, will be effective in many cases. If not, a combined product also containing codeine may work and may be particularly useful if diarrhoea is a symptom. Products containing a painkiller plus an anti-sickness agent (anti-emetic) such as buclizine may help if the headache is accompanied by nausea. Migraleve® Pink contains paracetamol plus codeine phosphate and buclizine and is available over the counter in pharmacies. Prochlorperazine is another anti-sickness agent that is available alone as buccal tablets (Buccastem M®) which are placed high under the upper lip to dissolve. These can be bought over the counter.

If stronger painkillers and/or anti-sickness drugs are required, your doctor can prescribe them for you. Anti-sickness drugs available on prescription include metoclopramide (eg, Maxolon®) and domperidone (eg, Motilium®). Combination preparations such as Paramax® (paracetamol plus metoclopramide) and Migramax (lysine acetylsalicylate [aspirin] plus metoclopramide) are also available.

The newest agents for the acute treatment of migraine are the triptans, which can help even when an attack has already started. They are all available as tablets but some are also available as a nasal spray, an injection or as a tablet that dissolves on the tongue. Members of this class of drugs include almotriptan (eg, Almogran®), eletriptan (Relpax®), frovatriptan (Migard®), naratriptan (Naramig®), rizatriptan (eg, Maxalt®), sumatriptan (eg, Imigran®) and zolmitriptan (eg, Zomig®). Most triptans are available only on prescription but sumatriptan tablets can be bought from pharmacies without a prescription.

There are a number of other preparations for migraine, which your doctor may prescribe if other therapies are ineffective. Examples include tolfenamic acid, cyproheptadine (Periactin®), products containing ergot derivatives (eg, Migril®) and Midrid® (paracetamol plus isometheptene).

If you suffer from more than two migraine attacks a month and are suffering significant disruption to your life as a result your doctor may prescribe a preventative drug to be taken regularly. This is usually a beta-blocker such as metoprolol, propranolol (eg, Bedranol®, Beta-Prograne®, Syprol®) or timolol but sometimes a serotonin blocker such as pizotifen is used. Clonidine (eg, Dixarit®) and topiramate (eg, Topamax®) may also be prescribed for the prevention of migraine.

There are a number of other preparations for migraine, which your doctor may prescribe if other therapies are ineffective. Examples include tolfenamic acid, cyproheptadine (Periactin®), products containing ergot derivatives (eg, Migril®) and Midrid® (paracetamol plus isometheptene).

Botulinum toxin (Botox®) is a different type of preventative for people who have frequent attacks. It is injected into muscles in the head and neck to block the release of pain-causing chemicals.

Self help measures

Keep a diary and try to identify any pattern in attacks - this may help to identify any trigger factors. You will need to record all your daily activities, what you eat and drink, the weather, your mood, any attacks and symptoms and any medications you take. You may then be able to prevent attacks by avoiding any trigger factors identified. However, while useful, this is not a failsafe method as the trigger factors may not always be under your control. Stress is a significant trigger for migraine and stress management can be very beneficial. Relaxation techniques and changing daily routines can improve your stress levels.

Further information available from:

The Migraine Trust
52-53 Russell Square
London WC1B 4HP
Tel: 020 7631 6970
Email: info@migrainetrust.org
Internet: www.migrainetrust.org 

Migraine Action
27 East Street
Leicester LE1 6NB
Helpline: 0116 275 8317 (Monday to Friday, 10am-4pm)
Email: info@migraine.org.uk
Internet: www.migraine.org.uk 

Fact sheet provided by MIMS

Date last reviewed: June 2014

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