Migraines: what you need to know

Why migraines are more than ‘just’ a headache

• Migraines are around three times more common in women than men
• Symptoms often include fatigue, nausea, sound and light sensitivity – and not everyone will experience headaches
• Strategies on how to manage migraines

Migraine is a common inherited neurological condition that affects around one in seven people – and is around three times more common in women than men, some of this difference is related to hormonal factors, including perimenopause and menopause [1].

And I’m among that number, having suffered with migraines since I was a teenager. I know all too well how migraines can negatively affect work and precious time with family and friends.

Migraines can be incredibly isolating, and it’s important to acknowledge they cannot be simply ‘willed’ away. Like many people with migraines, I know the importance of planning ahead and having a toolbox of measures to draw on when an attack occurs. For me, that includes eating regularly, avoiding processed foods and alcohol, and prioritising sleep.

You may be reading this because like me, you also experience migraines, or perhaps you have a loved one, friend or colleague who does and you want to find out more about how you can support them.

That’s why I’ve written this guide: to explore the different symptoms, triggers and management strategies for migraines when an attack occurs.

RELATED: Migraines and menopause: what’s the connection?

Migraines explained

Migraine is an inherited neurological condition that causes many different symptoms. Each migraine can follow a different pattern, and this can change over the course of a lifetime.

There are several phases of a migraine.

Before an attack starts people may feel tired or yawn more, some may have more energy or experience craving, or find they need to pass urine more. These symptoms can start several hours or even days before the migraine attack.

The next phase is the aura which is experienced in around a quarter of people. Aura is the name given to part of the migraine made up of a range of temporary neurological symptoms including visual changes (flashes of lights, loss of vision, zigzag patterns), tingling sensations, speech problems, dizziness, weakness on one side of the body and, very rarely, loss of consciousness.

The headache phase follows aura (although some people can experience aura without headaches). The pain of migraine headaches can be severe, throbbing and is often accompanied by excessive sensitivity to light (photophobia), loud sounds (phonophobia), or smells/odours, as well as nausea and/or vomiting. Migraines commonly last between 4-72 hours and can be made worse by movement. Many migraine sufferers experience significant vestibular symptoms (vertigo, balance disturbance).

The final phase is the postdrome/recovery phase. At this stage the headache has gone but person is usually left feeling tired and washed out which can last for 2-3 days.

Migraine attacks can be frequent, or there can be gaps of weeks or months without them. For some people, it is possible to identify triggers whereas for others the triggers are less obvious. It is often a combination of factors that act together to trigger an attack.

Migraines can be lifelong and disabling for some people. The onset often peaks between the ages of 35-45 years [2]. They can affect physical and mental health in different ways. The migraine process itself can cause low mood and anxiety before, during and after an attack. Living with migraine can lead to worry and fear about experiencing attacks and how they may impact on plans and commitments. Migraine can have a significant impact on a person’s ability to function in daily life, and on their wellbeing.

Chronic migraines – having headaches on at least 15 days per month, with eight of these having migraine symptoms, for at least three months [3] – are one of the most common causes of disability worldwide, yet many people are unable to access adequate support and treatment. 

RELATED: Migraines and hormones

Migraine attack triggers

Common conditions that make you more susceptible to an attack include: 

• Bright or LED lights 
• Loud and unpredictable sounds 
• Certain scents, such as perfumes, air fresheners, cleaning products 
• Going too long without food and/or drink, or certain types of food and drink, including processed or high sugar foods, and alcohol 
• Sleep disturbance (too little or too much)
• The build-up of, or extreme stress 
• Lack of routine  
• Too strenuous exercise 
• Being too cold or too hot 
• Change in weather pressure 
• Travel.

While some of these triggers can be managed, others are beyond your control – and sometimes, migraines can just happen without an obvious reason.

What are the signs a migraine may be coming?

Early warning signs, also known as ‘prodromal’ symptoms, that a migraine attack is coming include,

• Pallor 
• Slurring words / not making sense 
• Nausea
• Yawning
• Not feeling hungry or feeling far more hungry than usual and craving certain food types
• Feeling very cold or hot 
• Having heightened hearing – small noises can be a real trigger 
• Headache.

Recognising early warning signs can, but not always, help people with migraines take action to reduce the severity of an attack.

Treatment for migraine

Although there is no cure for migraine, there are many different treatments available which can often reduce the severity of a migraine attack. Often a combination of medication and lifestyle changes can improve both frequency and severity of migraines.

Treatments for migraine are either ‘acute’ treatments, ‘preventative’ treatments or sometimes both. A headache diary can be very helpful to both help with guiding treatment as well as monitoring response to different treatments. It can be common to try several treatments before finding one that suits you and your treatment or treatments may change with time.

Acute treatments

Acute treatments are used to try and stop a headache once it has already started. Aspirin (dispersible, 900mg for adults) can be very effective. Some people find non-steroidal anti-inflammatory medication such as ibuprofen beneficial as an alternative to aspirin [4].

Anti-sickness medications can also be taken to improve the nausea and vomiting. These medications can also help you absorb your painkillers and any other medication faster. There are a group of medications which can be prescribed specifically for migraines called triptans. There are different types, formulations and doses of these medications – for example they are available as tablets, nasal sprays, orodispersible tablets and injections. Many people find that they have delayed emptying of their stomachs when they have a migraine attack which means that regular tablets are less likely to be absorbed effectively, which is why the nasal sprays, orodispersible tablets or injections work as alternative ways of getting the medication into your body. The different triptans can have different effects too, so if you have a side effect with one, or it doesn’t work like you hoped, then it is worth asking to be prescribed another to try.

Many people (including me) find that a combination of treatments, including a triptan, anti-sickness plus either aspirin or an anti-inflammatory taken all together at the start of an attack can be effective to either abort an attack or reduce the severity of one.

Preventative treatment

Preventative treatments are used to try and prevent migraines occurring [4]. If you are having frequent migraine attacks – more than three to four times per month, then you may benefit from taking a preventative medication.

These are not the same as the acute treatments.

Many of medications prescribed are actually licensed for different indications – for example for epilepsy, high blood pressure or depression – but clinical studies have shown that they can be effective for some people with migraines.

If these medications are not effective or lead to unwanted side effects, then injections of Botulinum toxin A (Botox) may be given. There are also a class of drugs called CGRP monoclonal antibodies which have been shown in many studies to be effective for frequent migraine where other treatments have not been successful [4].

There is a device called Cefaly which uses a mild electric current (eTNS) to stimulate and desensitise the trigeminal nerve, the primary pathway for migraine pain. It can be beneficial for some women to relieve acute symptoms and also to prevention migraines occurring [5].

For some people. Single Pulse Transcranial Magnetic Stimulation (STMS) is prescribed and can be beneficial to treat acute migraines and prevent future migraines. This patented dual migraine therapy directly targets and signals the brain to quiet the hyperactive nerves thought to be the source of migraines [6].

Migraines and hormones

Changing hormone levels can trigger migraines in some women – all three hormones oestradiol, progesterone and testosterone are made in your ovaries, adrenal glands but also your brain. They have important effects in your brain, so when levels of these hormones reduce and/or fluctuate then this can trigger a migraine [7].

It can be common for migraines to start during puberty and then worsen during perimenopause – these are both times when hormone levels greatly fluctuate.

Taking oral contraceptives is often not advisable for women with migraines as these are associated with a small risk of stroke and can lead to worsening of migraines. However, having natural (body identical) hormones at the right dose and type can really improve migraines – both their frequency and severity [8]. Using hormones can reduce the fluctuations as well as replace the missing hormones. In addition, there is some evidence that women who take testosterone have lower frequency and severity of migraines [9].

Lifestyle changes

Migraines can often be triggered by changes to routines so many people find it useful to try and eat their meals at the same times each day as well as go to bed and get up the same time each day. This includes the weekends – I set my alarm clock the same time each day so I can’t remember the last time I had a lie in!

Reducing or cutting out alcohol can be useful for some people. If you find certain foods – such as cheese or chocolate – trigger migraines, then it is worth reducing or even cutting out these food groups. Processed foods and sugary foods can lead to sugar spikes to often changing to fresh fruit and vegetables with plenty of fibre can improve migraines. Some people have benefit with various supplements – for example magnesium and fish oil.

Things that can help if done promptly: 

Food and drink: This can include drinking water to help with hydration, or eating a snack such as nuts or dates to avoid the peaks and troughs in blood sugar which can trigger migraines or make them worse in some people

Quiet and rest: moving away from an over-stimulating environment and getting some rest where possible may also help

Rescue medication: taking rescue medication – which could include an over-the-counter painkiller such as dispersible aspirin, and an anti-sickness medication such as prochlorperazine, can help with symptoms

Triptans are a group of medications which are prescribed to ease symptoms of a migraine. They work by changing the way your brain processes pain signals. Sumatriptan can be bought over the counter in some countries, but it is the triptan associated with most side effects

Neuromodulation: devices that use technology to alter nerve activity.

Supporting a loved one or friend? Here’s how you can help them through a migraine

Migraines usually affect thought processes, so it can be common for people with migraines to forget the tried and tested strategies they need when they need them the most, so you may have to prompt them – they may not appreciate it at the time, but they will when they feel better.

My husband has used these tips for decades for me, and my eldest daughter’s friends also use them with her.

Things you can do to support someone experiencing migraines: 

• Be reassuring: remind the person that the attack will not last for ever
• Ask them if stroking their head is helpful

• Helping the person into bed (if possible), make the room as dark as possible by closing the blinds and turning out the lights, and keep the environment as quiet as possible
• Making sure they have used the toilet before going to bed, and check if they have recently had a drink of water as well as putting a drink close to them
• Be present: offer to check on them regularly, for example every 15 mins 
• Avoid asking the obvious: you may find asking ‘how are you feeling?’ will only remind the person how bad they feel. Instead, be proactive: ‘is there anything you need?’ ‘can I get you some water?’
• Keep perspective: conversations with someone during a migraine are likely to not make sense: they may be emotional and negative – after all, they are in pain and also their thought processes are likely to be impaired. Listen, be empathetic and non-judgemental, and try not to dwell on their comments at this time
• You will often feel powerless to help but know for that person it will be a comfort just to know someone cares.

References

1. National Institute for Health and Care Excellence (NICE) (2024) Migraine: how common is it?

2. Bigal M.E., Liberman J.N., Lipton R.B. (2026), Age-dependent prevalence and clinical features of migraine, Neurology, 67(2):246-251. doi:10.1212/01.wnl.0000225186.76323.69

3. International Headache Society ‘Chronic migraine’

4. NICE (2024) ‘Scenario: migraine in adults’

5. Trimboli M., Marsico O., Troisi L., Fasano F. (2023), External trigeminal neurostimulation in patients with chronic migraine, Pain Manag, 13(3):185-192. doi: 10.2217/pmt-2022-0082

6. Bhola R., Kinsella E., Giffin N., Lipscombe S., Ahmed F., Weatherall M., Goadsby P.J. (2015), Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program, J Headache Pain, 16:535. doi: 10.1186/s10194-015-0535-3

7. Godley F. 3rd, Meitzen J., Nahman-Averbuch H., O’Neal M.A., Yeomans D., Santoro N., Riggins N., Edvinsson L. (2024), How Sex Hormones Affect Migraine: An Interdisciplinary Preclinical Research Panel Review, J Pers Med, 7;14(2):184. doi: 10.3390/jpm14020184

8. Sacco S., Ricci S., Degan D., Carolei A. (2012), Migraine in women: the role of hormones and their impact on vascular diseases, J Headache Pain, 13(3):177-89. doi: 10.1007/s10194-012-0424-y

9. Dourson A.J., Darken R.S., Baranski T.J., Gereau R.W., Ross W.T., Nahman-Averbuch H. (2024), The role of androgens in migraine pathophysiology, Neurobiol Pain, 6;16:100171. doi: 10.1016/j.ynpai.2024.100171