Migraines

What do we mean by migraines?

Not all headaches are the same:

• The most common kind is called a tension-type headache. About half of adults have occasional achy tension-type headache – less than one a month, usually lasting only a few hours. They make both sides of the head and often the neck hurt. They are probably caused by muscle tension. (If you get tension-type headaches, see our Headache section)
• Migraines are common too but they are not due to muscle tension. Often very painful, throbbing and one-sided, they may cause sickness or vomiting and visual disturbance (such as flashing lights, stars, patchy loss of sight, blurring and zig-zags). Migraines are three times more common in women than in men. Women who get migraines get them more often than men as well.
• If you have recently started taking new medication, speak to your pharmacist about whether this might be the cause of your problems. Overuse of pain-relieving medications can trigger rebound headaches. Other medications that can trigger migraines include GTN for angina, and the oral contraceptive pill.
• Cluster headaches are much less common. They take the form of a severe, one-sided headache.

What causes migraine?

Scientists see migraine as a sort of electrical reaction in the nerves in the brain. When something sets this reaction off, the arteries on the brain surface go into spasm. This sensitivity is partly inherited, so you are more likely to get migraines if a close relative gets them.

As a migraine attack comes on, sensitivity to pain signals increases. This is why, for most migraine sufferers, anti-migraine drugs work only in the early stages of the attack. For this reason, you should always take pain-relieving medication within 20 minutes of an attack and while the migraine pain is still mild.

Migraine triggers are highly individual, and the things that affect one person probably won’t apply to someone else. For most people there could be a combination of trigger factors. On their own they might be tolerated but it’s when they come occur together that migraine is triggered.

Hormonal changes in women

A drop in the hormone oestrogen often triggers a migraine attack. This may happen at puberty, during a period, when you are ovulating, or when you get pregnant. (Migraine may start up or stop during pregnancy.) The menopause, taking oral contraceptives or using hormone replacement therapy (HRT) can all cause migraine. Sometimes menopause brings a lifetime of migraines to an end.

Psychological stress

It may seem strange but some people say that being able to relax after a stressful time will bring on a migraine, often at a weekend or at the start of a holiday. More often, it will be feeling unable to cope easily with worries, conflicts, major life changes or work pressures that brings on a migraine. The pressure might also come from unresolved problems from the past, emotions you can’t express, or feelings that lead to anxiety or depression. Seek advice from a health professional if you feel this sort of emotional stress is making your migraines worse.

Other triggers

Other triggers can include:

• bright lights, noise, strong smells
• sleep problems
• physical stress
• weather changes
• other health problems
• certain medicines.

Preventing migraine attacks?

You won’t have to avoid all these possible triggers! To find out which ones affect you personally, it’s a good idea to keep a migraine diary. For a month or so, make a note not just of what you eat and drink, but also of your physical activities, stress and moods, and anything unusual in your surroundings (such as lights, noise and unusually hot, cold, stormy, wet or dry weather). If something triggers a migraine, it will usually happen within 12 hours (or 24 at the most).

Prevention should start with non-drug approaches, including keeping a diary to identify your triggers, using relaxation techniques and making lifestyle changes. But if you are getting weekly attacks, your GP will probably recommend trying preventive medication. When used appropriately, medication can provide quick relief from sickness and pain during an attack.

What other information may be helpful?

If you think that you might be suffering from stress or anxiety (feeling nervous or having worrying thoughts that are making you feel very tense), you might find our section on STRESS AND ANXIETY helpful. – If you are feeling low or depressed, particularly when you wake and this seems to be making the pain worse, you might find our section on DEPRESSION helpful.

• If you have general feelings of aches and pains in several places in your body, you might find our section on MUSCLE ACHE useful.
• If you think your headaches might be caused by lack of sleep, try the information on SLEEP PROBLEMS.