Frequently asked questions

Migraine is a chronic health condition. Most people who suffer from migraines get headaches that can be severe. A migraine headache is usually an intense, throbbing pain on one, or sometimes both, sides of the head. Most people with migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved. Besides pain, migraine also can cause nausea and vomiting and sensitivity to light and sound. Some people also may see spots or flashing lights or have a temporary loss of vision.

Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to 72 hours. Some people get migraines once or twice a week. Others, only once or twice a year. Most of the time, migraines are not a threat to your overall health. But migraine attacks can interfere considerably with your day-to-day quality of life.

We don’t know what causes migraine, but some things are more common in people who have them:

• Often, migraine affects people most severely between the ages of 15 and 55.
• Most people have a family history of migraine or of disabling headache.
• They are more common in women.
• Migraine often becomes less severe and less frequent with age.

Migraine pain and symptoms affect 18% of women and 8% of men. According to the Department of Health (2005) eight million people get migraine making it the most prevalent long term neurological condition. Migraine is the most common form of disabling headache that sends patients to see their doctors.

The exact cause of migraine is not fully understood. Most researchers think that migraine is due to abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they can cause inflammation. This inflammation then causes blood vessels in the brain to swell and press on nearby nerves, causing pain.

Genes also have been linked to migraine. People who get migraines may have abnormal genes that control the functions of certain brain cells.

Experts do know that people with migraines react to a variety of factors and events, called triggers. These triggers can vary from person to person and don’t always lead to migraine. A combination of triggers—not a single thing or event—is more likely to set off an attack. A person’s response to triggers also can vary from migraine to migraine.

Frequently mentioned migraine trigger factors include:

• Lack of or too much sleep
• Skipped meals, getting hungry or not eating enough
• Bright lights, loud noises, or strong odours
• Hormone changes during the menstrual cycle
• Stress and anxiety or relaxation after stress
• Some weather changes
• Alcohol
• Caffeine (too much or withdrawal)
• Changes of routine and travel

Keeping a migraine diary may help in identifying triggers. You can use our online diary to do this

Yes, there are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.

Migraine with aura (previously called classical migraine).

With a migraine with aura, a person might have these sensory symptoms (the so-called “aura”) 10 to 30 minutes before an attack:

• seeing flashing lights, zigzag lines, or blind spots
• numbness; or tingling in the face or hands
• disturbed sense of smell, taste, or touch
• feeling mentally “fuzzy”

Only one in five people who get migraine experience an aura.

Migraine without aura (previously called common migraine).

With this form of migraine, a person does not have an aura but has all the other features of an attack.

Compared with migraine, tension-type headache is generally less severe and rarely disabling. Compare your symptoms with those in this chart to see what type of headache you might be having.

Adapted from a table produced by the American Council for Headache Education

Note that a type of headache called Chronic Daily Headache may have features of tension and/or migraine headache

Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by changes in the body’s hormone levels, change of routine and even changes in the weather. It is often said that the migrainous brain does not like change. Keeping to a regular routine for bedtime, meal times etc can be a lifestyle adjustment that may help those prone to migraine attacks.

There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, some drugs are migraine-specific and do not work for tension-type headaches for most people.

You can't tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.

Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:

In addition to my sinus symptoms, do I have:

1. moderate-to-severe headache
2. nausea
3. sensitivity to light

If you answer “yes” to two or three of these questions, then most likely you have migraine with sinus symptoms. A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.

The Migraine Trust recommends that migraine sufferers should obtain a diagnosis from their GP. A migraine diary can help a GP identify whether you have migraine and if so what type of migraine. The diary will also assist the GP in prescribing medication for your migraine.

Thinks that should be covered in the diary are:

1. how often you have headaches
2. where the pain is
3. how long the headaches last
4. when the headaches happen, such as during your period
5. other symptoms, such as nausea or blind spots
6. any family history of migraine
7. all the medicines that you are taking for all your medical problems, even the over-the-counter medicines (better still, bring the medicines in their containers to the doctor)
8. all the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had

The Migraine Trust has an online diary which will help you record this information. Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose migraine just from the information you provide. You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches.

Sometimes, headache can be a symptom of another health condition than migraine.

You should talk to your doctor about your headaches if:

• You have several headaches per month and each lasts for several hours or days
• Your headaches disrupt your home, work, or school life
• You have a severe headache with a stiff neck
• You have a headache with confusion or loss of alertness
• You have a headache with convulsions
• You have a headache after a blow to the head
• You used to be headache – free but now have a lot of headaches
• You develop severe headaches for the first time over the age of fifty
• You have symptoms that persist between attacks

Although migraine can change over the course of a person’s lifetime, it is always wise to see your GP if your migraine symptoms change, just to make sure the symptoms are still those of migraine.

There are no objective tests for migraine. It is diagnosed on the basis of the history, or the pattern of symptoms over time. This is why keeping a migraine diary can be helpful. Your doctor may refer you for tests such as CT or MRI scans to rule out other conditions that may cause similar symptoms.

Yes. About three out of four people who have migraines are women.

More than half of migraines in women occur right before, during, or after a woman has her period. This often is called “menstrual migraine.” But, just a small fraction of women who have migraine around their period only have migraine at this time. Most have migraine at other times of the month as well.

How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, oestrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because oestrogen controls chemicals in the brain that affect a woman’s pain sensation.