Migraines: Everything You Need to Know

If you’re a migraine sufferer or know someone who experiences migraines, you might be familiar with the nausea, sensory sensitivity and debilitating pain that can be caused by the condition and take seemingly forever to subside. Thankfully, there are numerous migraine treatments that can help treat symptoms even in instances when other pain relief medication does not work.

In this guide, we go over everything you need to know about migraines - from the scientific mechanism behind what causes migraines to symptoms, triggers, treatments and more.

What is a migraine?

A migraine is a type of headache that typically results in a throbbing pain affecting one side of the head. For some individuals, migraines present with additional symptoms that are collectively known as ‘aura’ which can appear before, during or after the pain phase. Migraines are usually either acute (one-off) or chronic (recurring) in nature.

According to the NHS,^[1] there are three main types of migraines - migraine with aura, migraine without aura and migraine aura without headache (also known as a silent migraine). Individuals may also be diagnosed with a migraine subtype depending on the root cause and/or primary symptom experienced. These subtypes include ocular (retinal) migraines, menstrual migraines, vestibular migraines (which cause vertigo and dizziness) and abdominal migraines.

What causes migraines?

Migraines are believed to be caused by a series of complex neurological events that result in abnormal brain activity, affecting nerve signals/pathways, blood vessels and chemicals in the brain.^[2,3,4] These events can be triggered by various factors such as smoking, dehydration, low blood sugar levels or stress. Additional triggers include high blood pressure, hot weather, bending over (causing a sudden rush of blood to the head) and/or being at a high altitude.

Recommended reading: Migraines - Curious triggers

How long do migraines last?

Migraines can last anywhere from a few hours to a few days. The exact length of time during which symptoms may be experienced depends on numerous factors such as the individual’s unique brain chemistry and overall health, the trigger, the type of migraine experienced and when treatment is commenced.

Migraine symptoms

Acute migraines (also known as ‘typical migraines’)

The most common symptom of an acute migraine is a throbbing headache affecting one side of the head, causing moderate to severe pain. Additional symptoms can manifest as the migraine moves through its four stages - prodrome, aura, attack and postdrome.^[5] Each phase has its own set of symptoms, and the earlier phases can give you warning signs that a migraine is around the corner.

Prodrome symptoms

Prodrome is the earliest phase of a migraine and can occur 1-2 days before a full migraine attack. Prodrome symptoms can include:

• Mood changes, from depression to euphoria
• Neck stiffness
• Frequent yawning
• Food cravings
• Increased thirst and subsequent urination
• Constipation

Aura symptoms

The aura phase of a migraine typically occurs immediately before an attack. Auras are characterised by temporary symptoms affecting the nervous system that can build up over several minutes and last for up to an hour:

• Visual disturbances, such as flashes of light, bright spots or shapes
• Pins and needles in an arm or leg
• Partial or complete loss of vision in one eye (a temporary blind spot)
• Weakness or numbness on one side of the body or face, manifesting as a loss of strength and/or sensation in these areas
• Trouble speaking due to slurred speech and/or difficulty choosing words
• Auditory disturbances, such as hearing noises or music

In some rare cases, the aura phase may also cause the individual to experience involuntary spasms or other movements. It’s worth noting that the aura phase doesn’t affect all individuals.

Attack (pain phase) symptoms

The most severe symptoms of a migraine occur during the attack phase, also known as the pain phase. Symptoms during this phase may be experienced for anywhere from 4 to 72 hours:

• A throbbing headache, usually on one side of the head, but sometimes on both
• Sensitivity to light and sound (common)
• Nausea and vomiting
• Sensitivity to certain smells and touch (occasional)

Postdrome

Postdrome refers to the phase immediately after a migraine attack. The symptoms that occur during this phase typically last between 24-36 hours although the exact range can vary from person to person, with some individuals feeling symptoms for a shorter period and others for a few more days. Some individuals may also experience lingering symptoms and pain brought about by sudden head movements.

Some of the most common symptoms during this stage include:

• Confusion
• Fatigue
• Continued mood changes (including feeling elated)
• Sensory sensitivity
• Vertigo and dizziness

Recommended reading: Managing winter migraines

Chronic (recurring) migraines

According to the NHS,^[6] chronic migraines are defined as migraines that occur at least 15 days per month with the frequency of episodes gradually increasing over time. Chronic migraines typically result in the same symptoms as an acute migraine during the prodrome, aura, attack and postdrome stages - but the frequency of episodes can make the symptoms feel debilitating.

The symptoms of a chronic migraine include:

• Hypersensitivity to light, sounds and smells which can result in more frequent nausea and vomiting than those who have acute migraines
• Chronic fatigue and body pains (particularly affecting the neck and back)
• Lapses in concentration and memory
• Irritability

Ocular (retinal) migraines

Ocular migraines (also known as retinal migraines) are characterised by brief losses in vision followed by a headache within an hour of the onset of the visual symptoms.^[7] Some of the visual disturbances that may be felt during an ocular migraine include flashing lights in one eye.

Retinal migraines are a separate and unrelated condition to headache-type migraines or migraines with aura. The symptoms can include:

• Partial or total loss of vision in one eye - this typically lasts 10 to 20 minutes before vision gradually comes back
• Headache - this might happen before, during or after the vision attack
• Other visual disturbances, such as flashes of light, patterns of blank spots, blurring or dimming

Menstrual migraines

Menstrual migraines typically commence shortly before a menstrual cycle and last for a few days. They produce similar symptoms to typical migraines (such as a throbbing pain on one side of the head, sensory sensitivity and nausea) that can last longer than the symptoms of other types of migraines.^[8]

It is important to note that menstrual migraines don’t typically have an aura phase, which means they do not produce visual symptoms such as temporary loss of vision.

Migraine treatment

Triptans

Triptans are one of the most commonly prescribed treatments for migraines. They refer to a group of chemicals that bind to serotonin receptors in the brain’s blood vessels and nerve endings, blocking the release of inflammatory neuropeptides (protein-like molecules that neurons use to communicate with each other) to prevent migraines.

Triptans are sometimes considered to be an abortive therapy for migraines because they are most effective when taken early at the onset of symptoms (typically during the prodrome phase). With that said, triptans can still provide relief even after the prodrome phase has begun.

It is important to note that triptans are only effective at treating migraine pain and should not be used to relieve other types of pain. Moreover, triptans are designed for temporary use and are not suitable for people with cardiovascular conditions due to their constriction effect on blood vessels. Taking triptans for an extended period of time can create tolerance for them in the body, causing overuse headaches - a condition where headaches become more frequent and severe due to overuse of headache medications.

Some of the most commonly prescribed triptans include Sumatriptan, Rizatriptan and Zolmitriptan.

Sumatriptan

Sumatriptan (also available under the brand names Migraitan and Imigran) affects receptors in the brain known as 5-HT1B and 5-HT1D, constricting arteries in the head to prevent the onset of migraine symptoms. Sumatriptan also prevents the release of inflammatory proteins called CGRPs into the bloodstream, reducing the risk of feeling pain, nausea, and light sensitivity.

Sumatriptan is available in tablet form and is also the primary active ingredient in Imigran Nasal Spray. It is important to note that Sumatriptan can relieve migraine symptoms but it does not prevent future attacks.

Rizatriptan

The scientific mechanism of Rizatriptan (also available under the brand name Maxalt) is the same as Sumatriptan. However, Rizatriptan’s molecular structure makes it more soluble and a greater proportion of the drug remains intact after passing through the liver, decreasing its absorption time in the body and leading to a faster onset of effects than Sumatriptan. These properties make Rizatriptan ideal for individuals looking to quickly treat migraine symptoms before they become more severe as the migraine moves beyond the prodrome stage.

Zolmitriptan

Like Sumatriptan and Rizatriptan, Zolmitriptan (also available under the brand name Zomig and as Zomig Nasal Spray) affects receptors in the brain known as 5-HT1B and 5-HT1D to prevent migraines. However, it produces an additional substance in the body called N-desmethyl metabolite that has an added effect on the 5-HT1B and 5-HT1D receptors. This effect makes Zolmitriptan potentially more effective than Sumatriptan and Rizatriptan at treating migraines, although research on this is still ongoing.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen Lysine (the active ingredient in Nurofen Maximum Strength Migraine Caplets) can be used to treat some of the symptoms of mild to moderate migraines. NSAIDs reduce inflammation by inhibiting the activity of enzymes that produce prostaglandins (a neurochemical that causes inflammation and blood vessel dilation in the brain, resulting in migraines).

It’s worth noting that NSAIDs are specifically formulated to alleviate pain. They are not suitable to treat additional migraine symptoms such as nausea or sensory sensitivity.

Answering common questions about migraines

What’s the difference between migraines and headaches?

Migraines are a type of headache, producing symptoms that are generally more intense and affecting specific areas of the head.

Recommended reading: The difference between migraines and headaches

How do you know if you have migraines?

If you experience sensory sensitivity, nausea and severe throbbing pain on one side of the head, you may have a migraine. It is recommended to see a GP or doctor for an accurate diagnosis.

How long do retinal migraines last?

Retinal migraines last for up to an hour depending on individual factors such as the severity of the attack and the unique physiology of the person who experiences them.

Is a headache that does not respond to painkillers the same as a migraine?

No - a headache that does not respond to painkillers is not always a migraine. Headaches that are seemingly untreatable using painkillers can arise due to several factors like the overuse of medication (causing the body to develop a stronger tolerance against them) and lifestyle issues like stress.

Is it normal to experience euphoria before a migraine?

It is not common to experience euphoria before a migraine, but it can occur occasionally during the aura stage.

What are long migraines?

Migraines that last more than 72 hours are called long migraines.

What is abortive therapy for migraines?

Abortive therapy for migraines refers to treatment at the onset of a migraine to stop or reduce the severity of symptoms. The use of triptans and NSAIDs can both be classified under abortive therapy for migraines.

What are calcium channel blockers for migraines?

Calcium channel blockers are sometimes used for migraines because they reduce blood vessel constriction, aiding blood flow and alleviating the pain associated with migraines. It is vital to speak with a pharmacist or GP prior to taking calcium channel blockers for migraines.

Which migraine treatment is the best?

The best migraine treatment varies from person to person. Factors such as the nature and severity of symptoms, the frequency of attacks and the migraine subtype experienced can impact which treatment is prescribed.

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