Understanding migraine

A migraine is far more than a bad headache. It is a neurological condition with attacks that can last from a few hours to three days, usually with throbbing pain on one side of the head, worsened by movement, and often with nausea and sensitivity to light and sound.

Why does it happen?

During an attack, nerve cells in the brainstem become over-excitable and release chemical messengers — especially a protein called CGRP. This inflames and widens blood vessels around the brain's covering and sensitises the trigeminal nerve, which carries pain from the face and head. Genetics play a large role, so migraine often runs in families, and hormones, sleep, stress and diet influence how easily an attack is set off.

The four phases

Prodrome — hours to days before: yawning, mood change, food cravings, neck stiffness.
Aura — in about a third of people: zigzag lights, blind spots, tingling or speech trouble, usually under an hour.
Headache — 4 to 72 hours of throbbing pain, nausea, light and sound sensitivity.
Postdrome — the "migraine hangover": tiredness and difficulty concentrating for a day after.

Common triggers

Stress or sudden relief after stressMissed meals and dehydrationToo little or too much sleepBright or flickering light, loud noise, strong smellsHormonal changes around menstruationAlcohol, caffeine changes, aged cheese, processed meatsWeather and air-pressure changesScreen glare and eye strain

Medicines that stop an attack

Over-the-counter pain relievers

Ibuprofen, naproxen, aspirin or paracetamol/acetaminophen, sometimes combined with caffeine. Best taken early in an attack. Using them more than about 10-15 days a month can cause medication-overuse headache.

Triptans

Sumatriptan, rizatriptan and similar prescription tablets that narrow widened blood vessels and calm pain pathways. Not suitable for everyone with heart or blood-pressure conditions.

Nurtec ODT 75 mg (rimegepant)

A CGRP blocker that dissolves on the tongue. Used to stop an attack, and in some patients every other day to prevent attacks. Common side effects include nausea and stomach upset.

Ubrelvy (ubrogepant)

A CGRP blocker tablet taken when an attack starts, 50 mg or 100 mg, with a second dose allowed after two hours if needed. Common side effects include nausea and sleepiness.

Anti-nausea medicines

Metoclopramide or ondansetron are often added when nausea and vomiting are part of the attack.

Medicines that prevent attacks

Qulipta (atogepant)

A daily CGRP-blocking tablet taken to reduce how many migraine days you have each month, for episodic or chronic migraine.

CGRP injections

Monthly or quarterly injections such as erenumab, fremanezumab or galcanezumab for frequent attacks.

Older preventives

Beta blockers (propranolol), topiramate, amitriptyline or candesartan are still widely prescribed and effective.

When to seek urgent help

Get medical help straight away for a sudden "worst ever" headache, a headache with fever, stiff neck, confusion, weakness, fainting or a headache after a head injury.

This page is general information only and is not medical advice. Dosages and choices of medicine must come from your own doctor.