Migraines are thought to affect one in 10 people worldwide.1 These intense headaches involve throbbing pain and many people experience nausea, vomiting, and sensitivity to light and sound.2 Read on to find out more about the symptoms and stages of migraines, and how they are treated.

What is migraine?

A migraine is an intense headache with throbbing pain that usually affects one side of the head. It often comes with nausea, vomiting, and extreme sensitivity to light and sound. Migraines commonly last for at least four hours and can go on for several days – in many cases they affect the ability to carry on with daily activities.2

What are the main types of migraine?

Migraines are generally split into two categories: migraine with aura and migraine without aura.

‘Aura’ is a word used to describe symptoms that can come on before a migraine attack. It can last up to an hour and around 1 in 3 people experience aura before a migraine. These symptoms act as warning signs to indicate a migraine is coming. Auras often involve visual symptoms, such as seeing flashing lights or wavy lines, or getting blind spots. Some people also experience tingling in the arms and legs and changes to speech.2

A migraine without aura is the most common type. This is where a migraine occurs without warning signs. People can also experience migraine aura without headache, also known as ‘silent migraine’. In this case, a person will experience the aura warning signs of a migraine, but it is not followed by a headache.3

How many people have migraines?

According to the World Health Organization (WHO), it’s estimated that half to three-quarters of adults aged 18 to 65 have experienced a headache in the last year. Of those, 30% or more have had a migraine.4

A 2016 review in the Journal of the Neurological Sciences found that migraine affects one in 10 people worldwide and reported that migraines are on the rise around the globe1. In Europe, studies show that migraine occurs in around 15% of adults.5

Symptoms

The main symptom of migraine is an intense headache. This usually involves throbbing pain on one side of the head, but some people get pain on both sides of the head or even in the face and neck.2

What are the symptoms of migraine?

The most common migraine symptoms are:
  • A headache that tends to start as a dull ache and develops into throbbing pain, often on one side of the head
  • Pain that gets worse with movement and often prevents daily activities
  • Nausea
  • Vomiting
  • Sensitivity to light and sound
Other symptoms may include:
  • Tummy (abdominal) pain
  • Feeling very hot or cold
  • Sweating or feeling clammy

What are the stages of migraine?

Everyone’s experience of migraine is different. For many people, migraines follow four stages – prodrome, aura, attack, and postdrome – but not everyone experiences every stage.

1. Prodrome

The prodrome stage can come on one to three days before the migraine appears. During this stage, it’s common to notice subtle signs that indicate a migraine may be coming. These include:
  • Increased sensitivity to light, sound, or smell
  • Tiredness and yawning
  • Food cravings
  • Mood changes
  • Stiffness in the neck

2. Aura

Migraines may also be accompanied by an aura. ‘Aura’ is a term used to describe symptoms that appear before a migraine, acting like a warning.2 Not everyone who gets migraines experiences auras. For those who do, they can last for up to an hour and include symptoms such as6:
  • Seeing flashing lights, blind spots or wavy lines
  • Partial loss of vision
  • A tingling or numb sensation in the face or limbs
  • Changes to speech, smell, taste, or touch

3. Headache Stage2

A migraine itself usually lasts for at least four hours but can go on for several days. It is usually a throbbing pain on one side of the head, it can also be accompanied by feeling and being sick, and extreme sensitivity to light and sound.

4. Postdrome6

This is when the pain of the headache has faded, it is also known as a ‘migraine hangover’. After having a migraine it’s common to feel tired, depressed, achey, and have a mental ‘fogginess’ for up to two days. This phase doesn’t necessarily occur after every headache, and symptoms differ from person to person.

Causes, risk factors and life expectancy

While migraines in themselves are not life-threatening, they can have a big impact on general health and greatly affect daily life.

Research from Harvard Medical School shows that people who experience frequent migraines are more likely to have other health issues, such as anxiety, depression, insomnia, irritable bowel syndrome, and restless leg syndrome.7 Other research suggests that migraines are associated with an increased risk of heart attack and stroke.8,9

What causes migraines?

Doctors are still unsure about the exact causes of migraine, but they think it could be related to temporary changes in the chemicals, nerves, and blood vessels in the brain. Some people find their migraines are related to certain factors such as their menstrual cycle, diet, tiredness, or stress.10

Are migraines hereditary?

Genetics have been found to play a role, around 70% of migraine sufferers also have a close relative with the condition.7

Scientists know that migraines often run-in families, but they aren’t sure exactly how. There is ongoing research into why some families are susceptible to migraines and how genetics may influence people’s experiences of migraine.11

Who gets migraines?

Migraines tend to affect more women than men. A global review of migraines published in 2016 found that they affect 13.8% of females, compared with 6.9% of males. The same review found that students are a high-risk group, with 12.4% affected. It also revealed that where people live can be significant, with over 11% of urban residents experiencing migraines compared with 8.4% of people living in rural areas.1

Migraines can come on at any age. However, they seem to be more problematic in middle age and ease off in the later stages of life. Children are also susceptible – 10% of 5-15 year-olds experience migraine, and common symptoms in this age group include episodic attacks of moderate to very severe headache accompanied by nausea and sensitivity to light and sound.12

How long can you live with migraines?

Migraines can have a severe impact on daily life, especially for people who suffer from regular, long-lasting attacks.

A 2019 report in the Journal of Head and Face Pain looked at the effects of migraine on relationships, careers, and finances and found that the condition can negatively affect many important aspects of life. These included marital, parenting, romantic and family relationships, career/financial achievement and stability, and overall health. In the report, over 32.1% of survey respondents said they worried about long‐term financial security due to migraine.13

Diagnosis

It can take time to diagnose migraines, because they are often unpredictable, and the process can include several tests. It can be helpful to keep a migraine diary to help doctors get a better picture of what’s happening.14

How are migraines diagnosed?

To help rule out other possible causes of the symptoms, the doctor will first examine vision, reflexes, and coordination and ask questions about the headaches. Keeping a migraine diary can help them to spot any patterns and is often a useful tool for making a firm diagnosis.14

How to keep a migraine diary

It’s easy to keep a migraine diary – simply draw up a table or print one off from an online source, such as The Migraine Trust. Note down any of the following information whenever a migraine occurs15:
  • When the migraine happened
  • How long it lasted
  • The severity of the pain
  • Whether there were any other symptoms, such as dizziness or nausea
  • Whether any medication was taken
  • Other factors that may be relevant, such as the weather, menstrual cycle phase, stress factors, and social or work activities.

Tests to diagnose migraine

There are no specific tests to identify migraines, but sometimes doctors will want to do tests to rule out other conditions with similar symptoms. These may include: magnetic resonance imaging (MRI) scans, which provide detailed images of the brain and blood vessels from magnetic fields and radiowaves; and a computerised tomography (CT) scan, which uses x-rays to take detailed, cross-sectional pictures of the brain.16

Treatment and medication

While there is no cure for migraines, there are different treatment options available that can help to reduce their impact or prevent them from happening.17

How is migraine treated?

The main way to treat migraine is with medication. However, there are a range of other therapies and interventions that can be helpful; lifestyle changes are often effective, too.

Medication

Medication for migraine falls into two categories:

  • Prophylactic medication: This is also known as preventive treatment and includes beta-blockers, anticonvulsants, tricyclic antidepressants and – more recently – calcitonin gene-related peptide (CGRP) target drugs18. Prophylactic treatments are mostly used for people who experience at least four migraine attacks every month or at least eight headache days per month, but it can take several months before it works properly.19
  • Acute medication: This is medication that is taken at the time of the attack to stop or greatly reduce the pain. It includes NSAIDs and triptans20 as well as over-the-counter painkillers and prescription medicines.

Another possible medication for migraine is anti-sickness medicine (anti-emetics). Some people find that these help their migraines, even when they don’t experience feeling or being sick (nausea or vomiting) as a side effect.17

Remember that all medication may have side effects. Always talk to a doctor before starting any new medication.

Therapy and intervention

Studies have found that acupuncture can help to lessen the effects of migraine in some people. In one study, patients who were given 12 acupuncture treatments over the course of three months experienced 34% fewer headache days than they recorded at the start of the study21.

Green light therapy has also been found to be beneficial for migraines. This involves spending time in a specific, narrow band of green light from a special lamp while filtering out all other light22. It’s important to use this therapy properly, as lights of other colours – including white, blue, amber, and red – can exacerbate migraines23.

Using mindfulness meditation to help with the pain of migraines may also be beneficial. A recent study found that, although mindfulness did not reduce the frequency of migraines, it had a positive effect on many other measures. Those who practiced mindfulness had fewer ‘disability days’ per month, reported improved quality of life, had lower depression scores, and an improved attitude towards pain.24

Diet

Altering diet may be useful as part of a wider approach to lifestyle changes to help alleviate migraines. Generally, try to stick to a healthy, balanced diet and eat at regular times3.

Again, keeping a headache diary will help you to identify any foods that may affect migraines. This should include details about25:

  • Everything eaten and drunk
  • The time of day
  • Activity and location at the time of eating or drinking (for example, watching TV, sitting at the dining table, working at a desk)

Keeping a diary may help identify what dietary factors are triggering migraines. For example, one of the most common food-related causes of migraine attacks is not having enough food; being sure to eat regular, nutritious meals could help prevent a migraine attack. High amounts of caffeine, alcohol and sugar may also be a trigger for some people25.

Certain supplements or vitamins can also help relieve migraines. For instance, it has been found that taking oral supplements of magnesium can reduce the frequency and intensity of migraines26. It in important to note that supplements and vitamins do not work for everyone, and for some more research is needed to prove their effectiveness at treating migraines. A doctor should be consulted before starting any new supplements, as they can interact with other medications and aggravate some existing health conditions.27

Exercices

Some people find that exercise can trigger migraines, while others say it is beneficial. The main benefit of regular exercise is that it helps to reduce stress, which is a common trigger for migraines. As obesity is thought to be linked with migraines, it’s also worthwhile exercising regularly to maintain a healthy body weight.28

Prevention

One of the most effective ways of preventing migraines is by identifying triggers using a headache diary, and then trying to avoid them. For instance, if you find it is a certain food or activity which brings on a migraine attack, you can take measures to prevent this.

If you are a woman and find that your migraines are triggered by your menstrual cycle, there are both non-hormonal treatments and hormonal treatments which can help prevent this. Hormonal treatments, such as the contraceptive pill, are not recommended if you experience migraines with aura so make sure you speak to your doctor about which would be best for you.

If avoiding possible triggers does not work, there are a number of medicines which can have been shown to help prevent migraines in some people, but they may not be suitable if there are any other health problems and have to be prescribed by a doctor.

Scientific studies

Research into migraine medication has made notable strides in the past five years, including clinical trials of new medication classes to treat acute migraine, and non-drug therapies such as transcranial magnetic stimulation (TMS), external trigeminal nerve stimulation and non-invasive vagus nerve stimulation (nVNS).30 Researchers are also interested in prophylaxis drugs that target calcitonin gene-related peptide (CGRP), a chemical which nerve cells in the brain use to communicate.31

Research has also shown the importance of understanding the prodromal phase of migraine, which can happen several hours before a headache occurs. It includes symptoms such as yawning, light sensitivity, tiredness, and food cravings; it is yet unclear why these symptoms then lead to migraines in some people. By developing a deeper understanding of the interaction between different areas of the brain in this phase, we may be able to develop treatments which stop the headache occurring before it has begun.32

Referenced sources

  1. Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2017;372:307-315.
  2. NHS. Migraine. Symtpoms. Updated May, 2019. Accessed October 28, 2021.
  3. NHS. Migraine. Overview. Updated May, 2019. Accessed October 28, 2021.
  4. World Health Organization. Headache disorders. Published April 2016. Accessed January 2021.
  5. Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010;11(4):289-299.
  6. Healthline. Migraine. What Are The Stages of a Migraine Episode? Updated April, 2021. Acessed October 28, 2021.
  7. Harvard Health Publishing. Feel your pain: the health risk of migraines in men. Published September 2016. Accessed December 2020.
  8. Kurth T, Winter AC, Eliassen AH et al. Migraine and risk of cardiovascular disease in women: prospective cohort study [published correction appears in BMJ. 2016 Jun 17;353:i3411]. BMJ. 2016;353:i2610.
  9. Øie LR, Kurth T, Gulati S, Dodick DW. Migraine and risk of stroke. J Neurol Neurosurg Psychiatry. 2020;91(6):593-604. doi:10.1136/jnnp-2018-318254
  10. NHS. Migraine. Causes. Updated May, 2019. Accessed October 28, 2021.
  11. Gormley P, Kurki M, Kiekkala ME et al. Common variant burden contributes to the familial aggregation of migraine in 1,589 families. Neuron. 2018;98(4):743-753.
  12. Teleanu RI, Vladacenco O, Teleanu DM, Epure DA. Treatment of Pediatric Migraine: a Review. Maedica (Bucur). 2016;11(2):136-143
  13. Buse DC, Fanning KM, Reed ML et al. Life with migraine: effects on relationships, career, and finances from the Chronic Migraine Epidemiology and Outcomes
  14. NHS. Migraine. Diagnosis. Updated May, 2019. Accessed October 28, 2021.
  15. The Migraine Trust. Keeping a headache diary. Accessed October 28, 2021.
  16. Mayo Clinic. Migraine. Diagnosis. Updated July, 2021. Accessed October 28, 2021.
  17. NHS. Migraine. Treatment. Updated May, 2019. Accessed October 28, 2021.
  18. Edvinsson L, Haanes KA, Warfvinge K, Krause DN. CGRP as the target of new migraine therapies – successful translation from bench to clinic. Nat Rev Neurol. 2018;14(6):338-350.
  19. Silberstein, S. D. Preventive migraine treatment. Continuum: Lifelong Learning in Neurology, 2015; 21(4 Headache), 973. doi: 10.1212/CON.0000000000000199
  20. Öztürk V. Acute Treatment of Migraine. Noro Psikiyatr Ars. 2013;50(Suppl 1):S26-S29.
  21. Vickers AJ, Rees RW, Zollman CE et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004;328(7442):744.
  22. Healthline. Migraine. Can Green Light Therapy Help Your Migraine? Updated May, 2020. Accessed October 28, 2021.
  23. Noseda R, Bernstein CA, Nir R-R et al. Migraine photophobia originating in cone-driven retinal pathways. Brain. 2016;139(Pt 7):1971-1986.
  24. Wells, R.E., O’Connell, N., Pierce, C.R., Estave, P., Penzien, D.B., Loder, E., Zeidan, F. and Houle, T.T. Effectiveness of mindfulness meditation vs headache education for adults with migraine: a randomized clinical trial. JAMA Internal Medicine, 2021; 181(3), pp.317-328.
  25. The Migraine Trust. Migraine attack triggers. Accessed October, 2021.
  26. Chiu HY, Yeh TH, Huang YC, Chen PY. Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials. Pain Physician. 2016;19(1):E97-E112.
  27. Healthline. Migraine. 5 Vitamins and Supplements for Migraines. Updated June, 2020. Accessed October 28, 2021.
  28. Amin FM, Aristeidou S, Baraldi C et al. The association between migraine and physical exercise. J Headache Pain. 2018;19(1):83.
  29. NHS. Migraine. Prevention. Updated May, 2019. Accessed October 28, 2021.
  30. Goadsby J. Primary headache disorders: five new things. Neurol Clin Pract. 2019;9(3):233-240. doi:10.1212/CPJ.0000000000000654
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