Migraine Headache

A migraine headache is a type of headache characterized by a pulsing or throbbing pain in one area of the head. The intensity of the pain may be moderate or intense, and a headache attack can last anywhere between 4 and 72 hours if left untreated. 1

The pain of a migraine headache may be accompanied by symptoms such as nausea, vomiting and an uncomfortable sensitivity to environmental factors, such as light (photophobia) and sound (phonophobia). Some people experience neurological ‒ primarily visual ‒ disturbances, called an aura, during the migraine attack or as a sign that it is about to begin.

People of all ages can be affected by migraine headaches. According to the American Migraine Foundation, they affect more than 36 million men, women and children in the United States. 1 The World Health Organization classifies the migraine headache as a primary headache disorder, meaning that migraine headaches are not currently known to be caused by any underlying condition. 2

In most cases, migraine headaches develop during puberty. Women are three times more likely to be affected by migraine headaches than men, because the development of headaches often relates to the hormonal changes that occur during the menstrual cycle. 3

People affected by migraines usually experience headache attacks recurrently, on a lifelong basis after becoming initially affected. The frequency of attacks varies between people, occurring as often as several times per week in some people, and as rarely as once every few years in others. 4

Migraines are primarily an episodic condition. This means that an affected person is at an increased likelihood of experiencing headache attacks during some time periods.

The likelihood of experiencing headaches relates to changeable factors and triggers, such as diet, stress levels, lifestyle, hormonal changes and a person’s overall health. If somebody is affected by migraine attacks on more than 15 days per month ‒ which is the case for eight percent of all people affected by migraines ‒ this is a rare subtype of the condition called chronic migraine. 5

Appropriate methods for providing relief for migraine headaches can vary, depending on the type of migraine headaches a person experiences. Broadly speaking, treatment focuses on reducing the frequency of migraine attacks and alleviating the symptoms of the headache episodes. Currently, there is no cure for migraine headache disorder because the pathophysiology ‒ disordered physiological processes ‒ that result in a person developing migraine headaches are not yet fully understood. 6 However, with effective treatment and management, the potential negative impact of the condition on a person’s quality of life can usually be minimized effectively.

The principal symptoms of a classic migraine headache ‒ also called a migraine without aura ‒ include: 6 7

• A sensation of throbbing, pulsing pain: this usually builds up over one to two hours and intensifies with movement or physical activity
• Pain which is localized to one side of the head, which may affect the eye area but can occur anywhere in the head or neck
• Sensitivity to light
• Sensitivity to sound
• Vision changes, such as blurred vision
• Nausea and food intolerance, which may in turn cause light-headedness
• Vomiting

The duration of a migraine headache can be between 4 and 72 hours, if left untreated.

Other symptoms which may accompany a migraine headache attack may include: 4 6 7

• Muscle tenderness, particularly in the cranial and cervical areas
• Sensitivity to smell
• Hypertension (high blood pressure) or hypotension (low blood pressure)
• Tachycardia (elevated heart rate) or bradycardia (low heart rate)
• Weakness
• Numbness or tingling
• Puffy eyelids, conjunctival injection (red eyes) or adie-type pupil (dilated pupil which reacts slowly to changes in lighting)
• Horner syndrome: decreased pupil size, drooping eyelids and sweating on one side of the face
• Fatigue
• Abdominal (tummy) pain
• Diarrhea or constipation
• Sweating
• Neck pain
• Fever, very rarely

Most, but not all people affected by migraine headaches, will experience some of these symptoms in addition to the headache pain. There are many different types of migraine, and one person’s secondary symptoms may therefore be different from those experienced by another.

Some symptoms which accompany a migraine can indicate a more serious condition requiring urgent medical attention, such as a stroke or meningitis. These include: 4

• Slurred speech or difficulty speaking
• A sudden, sharp pain which is unlike any pain that the person has previously experienced
• Paralysis or weakness in one or both arms and/or in one or both sides of the face
• A high temperature (fever), combined with a stiff neck and possible seizures, which may, but do not always, present as convulsions, as well as confusion, double vision and a rash.

Seek urgent medical attention if a person experiences any of these symptoms.

Most people have no warning signs before they experience a migraine headache attack. However, between 10 and 30 percent of people affected by migraine headaches experience additional accompanying neurological disturbances called an aura; this often results in a temporary loss of vision, or visual disturbances, such as flashing lights. 6 8 The aura often occurs just before the headache attack begins, but may occur during the attack, afterwards or on its own.

The typical migraine aura is characterized by visual symptoms including: 6 8

• Coloured or blind spots in the field of eyesight
• Sparkles, stars or flashing lights
• Scintillating scotoma: an arc or band of absent vision, often with a shimmering border or zig-zag lines
• Tunnel vision
• Temporary blindness

Physiological symptoms of typical migraine aura which may accompany the visual disturbances include: 6 8

• Numbness or tingling
• Weakness, usually on one side of the body
• Dizziness or a feeling of spinning
• Pins and needles in the limbs

A typical migraine aura usually has a rapid onset, between five and 20 minutes, and may have a duration of up to an hour.

Good to know: It is possible to experience a typical migraine aura without also being affected by a migraine headache. This is called a silent migraine, also known as a migraine sans migraine, or aura without migraine. 4

Around eight percent of people affected by migraine headaches experience chronic migraines, meaning that they are affected by migraine headache attacks on over 15 days per month.

Risk factors for becoming affected by chronic migraine include: 9

• Overusing medication designed to relieve the acute symptoms of migraines
• Using treatments for migraine symptoms that prove ineffective
• Depression
• Periods of stress
• Obesity
• Being elderly
• Being female

A person previously affected by episodic (less frequent) migraine headache attacks can develop chronic migraine headaches in one of two ways: 10

Transformed migraine. A person can begin experiencing headaches increasingly frequently, to the point where they no longer have significant gaps between headache attacks. They will be diagnosed with chronic migraine if their headache attacks occur on more than 15 days per month.

New daily persistent headache (NDPH). This diagnosis is given in cases where a person becomes affected by a migraine attack which does not alleviate within the normal timeframe of 4-72 hours, instead persisting over the coming days.

Chronic migraine is not always a permanent condition. It is possible for a person affected by chronic migraine headaches to begin experiencing migraine headache attacks increasingly infrequently ‒ usually achieved as a result of successful treatment rather than spontaneously ‒ to the point where their migraine headache disorder can be reclassified as episodic.

Good to know: Chronic migraine can be co-diagnosed with another recognised headache disorder called medication overuse headache, in cases where chronic migraine is believed to have developed as a result of the overuse of certain medications. 9

Migraine headaches are the most common, acute and recurrent type of headache affecting children. 11

According to the American Migraine Foundation, children whose parents are affected by migraine headaches are significantly more likely to experience them than children whose parents do not get migraines. If a child has one parent who is affected, they have a 50 percent risk of experiencing migraine headaches themselves. This risk increases to a 75 percent likelihood if both parents experience migraine headaches.

In adolescence, the symptoms of a migraine attack are likely to be similar to those experienced by adults. In children aged five to 10, the most common symptoms of migraine headache include: 11 12

• A painful headache. This only occurs in some cases; other children may experience nausea and/or abdominal pain as the primary characteristics of their migraine attacks. When headache occurs, it is characterized by throbbing and may affect the whole of the head or neck, rather than just one area, as in adults.
• Nausea. This may be more intense than the head pain. Frequent car-sickness* can be a sign that a child is prone to experiencing migraine headaches.
• Vomiting. This may mark the end of the migraine attack, reducing other symptoms.
• Needing to sleep. This may mark the end of the migraine attack, reducing other symptoms.

Other commonly experienced symptoms of migraine headache in children include:

• Abdominal cramps
• Sensitivity to light and/or sound and/or smells

The migraine attack may be accompanied by secondary symptoms, including: 11 13

• Teary, red eyes
• Dark circles under the eyes
• Paleness
• Swollen nasal passages
• Dizziness
• Anxiety
• Depression
• Problems concentrating
• Thirst
• Dehydration: excessive sweating and/or decreased urination
• Diarrhea

In children, migraine headaches usually come on more suddenly than in adults, with symptoms, including the headache pain (when present), reaching their full intensity after around 15 minutes. Migraine attacks in children can last for between 30 minutes and several days, if left untreated. 13 If you think that your child, or a child you that know, may be affected by migraine headaches, you can get a free symptom assessment by downloading the Ada app.

Always seek medical attention if a child experiences one or more headache attacks in order to establish what type of headaches they are experiencing and whether their headaches are primary headaches, as in headaches caused by a headache disorder itself or secondary headaches. Secondary headaches are headaches which are caused by another health problem which will then need to be identified and treated. Causes of secondary headaches in children may include:

• Infection, in the head or elsewhere
• Injuries to the head or neck
• Sinusitis
• Meningitis
• High blood pressure

If children younger than five display headache symptoms, it is especially important to keep a diary of their headache symptoms and to identify headache triggers, as they may be unable to verbalize accurately what they are experiencing. Young children who experience episodes of dizziness, or who were affected by colic as a baby, are at greater risk of developing migraine headaches in later life than other children. 12

A variant of migraine headache which specifically affects children, childhood periodic syndromes, usually involve attacks of pain or vomiting which are classified as possible precursors to migraine by the International Classification of Headache Disorders. Children who experience these symptoms are usually affected episodically, and are symptom-free in between bouts. Symptoms, when present, may occur with or without headaches and may include: 14

• Vertigo; sudden attacks accompanied by the inability to stand without support; usually affects children between ages 2-4 years
• Cyclic vomiting; usually affects children around age 5
• Abdominal pain; usually affects children around age 7

In order to be diagnosed with childhood periodic syndromes, all other possible causes for a child’s symptoms, such as the possibility of any other underlying conditions, must be ruled out.

There are many variants of the migraine headache. The type of migraine which a person experiences is related to the specific symptoms that they experience during headache attacks, in addition to the principal migraine symptoms.

Most people who are affected by variants of migraine headache have a previous history of migraine with aura. However, it is possible to develop a variant of migraine headache on its own. In all cases, other possible causes for a person’s symptoms, including underlying conditions, will be eliminated before a diagnosis of any variant of migraine headache is given.

Variants of migraine headaches may be characterised by particular features or triggers of the headache or aura, or by the affected person experiencing specific physical or neurological symptoms in addition to the headache. For instance, a person may experience temporary weakness or paralysis in one side of the body (hemiplegic migraine) or find that their headache attacks occur at a particular point in their menstrual cycle (menstrual migraine).

Variants of migraine headache include:

Many women affected by migraines find that headache attacks occur two days prior to or during menstruation, due to a drop in estrogen levels that occurs during this period. Commonly, menstrual migraines are more severe than migraines which occur at other times in a woman’s natural cycle. Other factors which may influence the development or cessation of hormonal headaches include: 15

• Pregnancy. Migraine attacks may get worse during the first few weeks of pregnancy, but do not pose any risks to the developing baby. Those affected should consult a doctor to ensure that any painkillers they may wish to take are safe for use in pregnancy.
• Menopause. The fluctuating hormone levels that occur during menopause can cause migraines to worsen or develop, particularly as periods occur more frequently.
• The combined contraceptive pill. The combined pill (containing estrogen and progesterone, or substitutes) can reduce migraines for some women and cause or worsen headaches in others. In those affected by migraines, the drop in estrogen levels during the pill-free week can worsen or bring on migraine attacks.

This condition is also called an ocular migraine. In contrast to a normal migraine headache, a retinal or ocular migraine is primarily an eye condition which causes a person to experience partial loss of vision in one eye, usually lasting 10-20 minutes, after which vision returns. This will be accompanied by a migraine headache, typically resulting in painful throbbing in the head on the same side as the affected eye. 16

It is important to seek medical attention the first time a retinal migraine is experienced or suspected because loss of vision may indicate a range of more serious conditions affecting the eye, or a stroke.

Treatment for retinal migraines usually involves: 16

• Taking medications, including non-steroidal anti-inflammatory medications (NSAIDs), or medications used to treat high blood pressure, as recommended by a doctor to lessen the symptoms and reduce the likelihood of the headache attacks.
• Identifying and avoiding triggers, which may include internal triggers such as dehydration, stress and high blood pressure and external triggers such as strong light, changes of temperature and excessive heat.

This is a rare subtype of migraine in which a person experiences hemiplegia: a sensation of paralysis or weakness on one side of the body as part of the migraine headache attack. The headache and sensation of paralysis or weakness may be accompanied by pins and needles, a migraine aura, fever nausea and/or vomiting.

There are two varieties of hemiplegic migraine condition: 17

• Familial hemiplegic migraine (FHM). If a person has hemiplegic migraine headaches in their family history, their condition is believed to be hereditary.
• Sporadic hemiplegic migraine (SHM). If an affected person has no family history of hemiplegic migraine headaches, meaning that the headaches are caused by a new ‒ or sporadic ‒ gene mutation.

A hemiplegic migraine attack may be as short as one hour in duration, but may last for several days. Normally, the paralysis or weakness that features in a hemiplegic migraine attack relieves within 24 hours. 17

Seek medical attention urgently if a hemiplegic migraine attack is suspected. Due to its rarity, it is especially important to accurately diagnose and begin treating hemiplegic migraine headaches as soon as possible, ruling out other conditions with similar symptoms, such as epilepsy. 18

Although hemiplegic migraine headache attacks can be a particularly distressing type of migraine headache to experience or witness, they are not life-threatening. Treatment usually focuses on discerning the right course of preventative medication for each person, according to their medical history, the frequency of their headaches and their overall health.

A migraine with brainstem aura, formerly known as a basilar-type migraine, is a rare subtype of migraine accompanied by an aura. A migraine with brainstem aura is different from a migraine with a regular aura in that the headache pain affects the back of the head, on both sides. 19 MBA headaches are believed to originate in the brainstem, at the base of the brain, above the spinal cord. 20

People affected by MBA will experience two or more of the following symptoms during a headache attack: 19 21

• Visual disturbances, which affect both eyes
• Difficulty hearing and/or ringing in the ears (tinnitus)
• Difficulty speaking
• Sensations of tingling, particularly in the hands and feet
• Dizziness
• Loss of balance
• Confusion
• Vertigo
• Fainting and/or loss of consciousness

A person affected by migraine with brainstem aura may find their symptoms distressing, particularly the first time. This may cause secondary symptoms to develop, including anxiety and hyperventilation. It is important to seek medical attention promptly the first time an MBA is suspected ‒ particularly if secondary symptoms are present ‒ in order to ensure a correct diagnosis. MBA may be confused with other conditions with similar symptoms including: 20

• Epilepsy
• Stroke
• Transient ischemic attack

Treatment for MBA focuses on reducing the symptoms during a headache episode, often with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiemetic medications, which are used to relieve nausea and vomiting. People affected by frequent attacks may also be prescribed preventive medication. 19

Good to know: People affected by migraine with brainstem aura may also experience other kinds of migraine headache attacks, most commonly migraine with typical aura (MTA). If this is the case, a person will receive two separate diagnoses, e.g. MBA and MTA. 20

A vestibular migraine is believed to be caused by widening of the blood vessels in the brain, including the vestibular artery, which affects the balance control system of the inner ear. For this reason, the symptoms of this kind of migraine are mainly related to balance and hearing. During an attack of vestibular migraine, people may experience: 22

• Vertigo; this is the primary symptom of vestibular migraines
• Dizziness and difficulty balancing
• A sensation of pressure in the head and/or ear
• Pain or nausea when moving the head, e.g. to look up or around
• Difficulty hearing low, soft sounds
• Tinnitus; ringing in the ears
• Neck pain

People who are affected by vestibular migraines do not always get a headache during an attack. However, a vestibular migraine attack may be accompanied by additional symptoms including: 22

• Headache
• Partial vision loss
• Hazy vision
• Visual disturbances such as blotches

Treatment involves leading a healthy lifestyle, minimising contact with triggers and, for some people, taking medications to reduce the frequency and duration of headache attacks.

The exact biological cause of migraine headaches is not yet fully understood, but they are believed to result from abnormal brain activity, which disrupts the normal function of nerve signals, blood vessels and chemicals in the brain. 4 23

Keeping a diary of the circumstances surrounding migraine attacks is recommended for all affected people in order to identify their potential triggers. These can then be avoided, with a view to reducing the frequency of headaches. Triggers vary considerably between people, and somebody may grow out of particular triggers or develop new ones. Some commonly recognised triggers of migraine headaches include: 4

• Environmental triggers. Loud noises, bright lights, flashing lights, strong smells like paint thinner, extreme hot or cold temperatures, poorly ventilated spaces.
• Physical triggers. Fatigue, poor posture, lack of sleep, sudden and strenuous exercise, head and neck tension, low blood sugar.
• Dietary triggers. Caffeine, alcohol, dehydration, irregular meal times, certain food additives such as aspartame and monosodium glutamate (MSG), chocolate, aged cheeses, salty foods and citrus fruits.
• Emotional triggers. Stress, shock, anxiety, low mood, tension.
• Hormonal triggers. Menstruation, pregnancy, menopause, the combined contraceptive pill, hormone replacement therapy.
• Medicinal triggers. In particular, vasodilators and sleeping tablets. Always check the packet or consult a doctor to ascertain whether medications are associated with headaches before use.

Although anybody can be affected by migraine headaches, certain factors render a person more likely to develop the condition. These include:

• A family history of migraine headaches
• Being adolescent; most people are first affected by migraine headaches during puberty
• Being female; women are three times more likely than men to be affected; pregnancy and menstruation are also risk factors for developing migraine headaches

Always seek a medical opinion the first time a migraine headache is suspected. This is vital in order to rule out the possibility that they are secondary headaches, due to other, potentially serious, underlying causes. There is no diagnostic test for migraine headaches, so a doctor will make a diagnosis by:

• Assessing headache symptoms in relation to a person’s medical history and overall health
• Assessing circumstantial details related to the headache attack (or attacks), to identify potential triggers and discern how severely a person’s daily routine is affected during attacks
• Noting whether the person has a family history of migraine headaches or other headache disorders
• Ruling out other possible causes for a person’s symptoms, such as a brain tumor. This may involve performing imaging tests to visualise the inside of the head using a CT or MRI scanner. See this resource for more information about undergoing a CT scan of the head](/procedures/ct-scan-head/).
• Performing a complete neurologic examination. This can be carried out by a GP during the initial appointment, using equipment like a Snellen chart (for eye tests) and a reflex hammer.

A complete neurologic examination includes:

• A motor exam
• A sensory exam
• A cranial nerve exam
• Tests of the deep tendon reflexes, coordination and gait
• Tests for signs of meningeal irritation

Good to know: The principal purpose of all of the tests involved in a complete neurologic examination is to check whether the nervous system is impaired. A migraine headache attack, in and of itself, does not lastingly impair the nervous system. Evidence of impaired nerve function would therefore suggest the presence of an alternative underlying condition.

A diagnosis of migraine headaches will be given when all possible other causes for the symptoms that a person is experiencing have been ruled out, including other primary headache disorders. After diagnosing a person with migraine headaches, doctors will then help the affected person to devise a treatment and management plan to reduce their impact on the person’s quality of life.

Treatment for migraine headaches focuses on: 3

• Preventing headache attacks and reducing their frequency
• Relieving the symptoms during attacks

Behavioral changes that are recommended for preventing migraine attacks include: 3 4

• Developing techniques to manage and reduce stress, such as deep breathing exercises and regular physical activity
• Keeping a diary to identify migraine triggers, such as exposure to strong smells, which can then be avoided if possible
• Sleeping well, and establishing a consistent sleep cycle
• Staying hydrated, by drinking water and other non-alcoholic, non-caffeinated beverages throughout the day
• Establishing regular meal times, and adopting a healthy, balanced diet
• Devising a new medication plan with one’s doctor, if any medications which a person takes regularly are thought to be causing the headaches
• Following a safe weight-loss programme is recommended, for obese people affected by migraine headaches

In some cases, particularly if a person has more than two headache episodes per month, medication may be prescribed to prevent migraine headaches. The medications that have been found most effective at migraine prevention include: 4 24

• Anticonvulsant medications, such as those used to treat epilepsy
• Non-selective beta-receptor blocking agents, such as those used to treat high blood pressure
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• OnabotulinumtoxinA (Botox®) injections are approved by the FDA as a treatment for chronic migraine

These medications can be suitable for both adults and children. When used to prevent migraine headaches, they are usually taken on a long-term, ongoing basis. As a result, some of these medications may be unsuitable for some people, in relation to their overall general health and any other medications they may be taking. Doctors will advise on the appropriate dose, and course of treatment, for each person.

A variety of treatments and medications, which are suitable for adults and children, are available to reduce the acute symptoms during a migraine attack. These include:

These include medications such as ibuprofen and aspirin. They can be purchased over the counter or prescribed, depending on the type and strength. NSAIDs are helpful in reducing headache pain; their anti-inflammatory properties can relieve the migraine’s characteristic throbbing/pulsing sensation.

However NSAIDs are not suitable for daily use, as they can cause complications, including gastrointestinal disorders. People who experience frequent migraine attacks and need regular pain relief should consult their doctor to ensure that their use of NSAIDs is appropriate. An alternative painkiller that is safe for ongoing use may be prescribed.

These medications work by making blood vessels constrict and blocking pain pathways in the brain, which is thought to be a causal factor of migraines. They are often prescribed if OTC or prescription NSAIDs have proved ineffective for treating headache pain and work by imitating the action of a brain chemical called 5-hydroxytryptamine (5-HT), also known as serotonin, which reduces inflammation and constricts the widened blood vessels associated with a migraine attack. 25

Good to know: NSAIDs can be taken before a migraine attack begins, as soon as a person is aware that they may be developing a migraine. In contrast, triptan medications should be taken at the first sign of actual headache pain and not beforehand, as they can be less effective if used before the headache has fully developed.

Ergotamine is derived from a fungus called ergot. Normally, this medication is available with a combination of ergot and caffeine, and it has a long history of use in providing quick relief from migraine symptoms during headache attacks. However, it is recommended that affected people use ergotamine preparations no more than twice per month, as it has been linked to the development of chronic, persistent headaches in between migraine attacks.

Good to know: Ergotamine medications should not be combined with triptans, as they are believed to have harmful cross-reactivity with one another.

Opioid medications are sometimes prescribed for people who cannot take, or do not gain relief by taking, triptans, ergot medications or non-steroidal anti-inflammatory drugs (NSAIDs).

Good to know: These medications are best used for occasional pain relief as they contain narcotics. Regular use, for example, treating chronic migraine headaches, can lead to dependency and also increases a person’s risk of developing medication overuse headaches.

Usually administered by a doctor as an injection, this type of corticosteroid medication may be prescribed in conjunction with other forms of medication to provide additional pain relief and reduce the frequency of headache attacks.

Good to know: These medications are only recommended for short-term use. As with other steroid medications, long term use of glucocorticoids can lead to the development of severe side effects, including increased risk of developing conditions such as gastritis, osteoporosis and diabetes.

In cases where no other preventive or acute treatments have provided significant relief from migraine headaches, an affected person may be recommended to explore neuromodulation therapies. As described by the International Neuromodulation Society, these are a recent development in the treatment of migraine headaches, which involve the use of technological devices which alter, or modulate, a person’s nerve activity by delivering targeted electrical or pharmaceutical agents to a specific area.

In treating migraine headaches, the device is used to supply the electrical or pharmaceutical agents to a specific area of the head or neck, for a particular amount of time. These factors will vary according to which particular treatment is used.

For more information about neuromodulation therapies in the treatment of medically refractory migraine headaches and other headache disorders, see this fact-sheet from the International Neuromodulation Society.

It is possible for a person to develop complications relating to the treatments used for their migraine headaches. If a person is newly diagnosed with migraine headaches, they should be aware of the possibility of developing treatment-related complications in future. These may manifest as headaches themselves, or other symptoms, and may include:

• Medication overuse headaches. These are headaches occurring regularly as a result of overusing medications designed to alleviate headache symptoms.
• Abdominal pain. Certain pain relief products, such as nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, can cause gastrointestinal side-effects if overused or used on a long-term basis.
• Serotonin syndrome. This is a life-threatening complication which occurs when there is too much serotonin in the body, a potential consequence of using more than one medication which alters levels of serotonin.

Good to know; People who are taking migraine medications called triptans and antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) are at increased risk of serotonin syndrome. Symptoms may include changes in behavior, mood and motor function.

People who are affected by migraine headaches are advised to inform their doctors of any changes to their symptoms, or new symptoms. These may indicate that the development of possible treatment-related complications, which can then be diagnosed and treated.

People who have been diagnosed with migraine headaches may wish to be referred to a migraine specialist; a doctor whose primary focus is treating migraine headaches. This is due to the fact that coming up with an effective treatment and management plan may be an ongoing or complex process, and research into the pathogenesis and treatment of migraines is a rapidly developing field.

Migraine specialists can be found:

• At dedicated migraine clinics
• Neurology departments of wider practices
• For children: in some Neurology or Pediatrics departments

However, a regular GP (general practitioner) will be usually able to help a person devise a treatment and management plan that works to minimise the impact of their migraine headaches.

• migraine
• megrim (archaic)

Q: What are the best natural products/home remedies for treating migraine headaches?
A: During, or at the onset of a migraine attack, a person may find it helpful to spend time in a quiet, dark environment, lie down, drink plenty of water and gently massage the affected areas of the head and neck to relieve tension. Some people find it helpful to take a hot bath and/or use a hot compress in order to help soothe the pain and inflammation. For others, a cooler temperature, such as can be achieved by applying an ice-pack, may have the same effect.

Products based on certain herbs and spices, such as cayenne pepper, ginger and/or peppermint, have anti-inflammatory properties and may help to alleviate headache symptoms. Always use herbal products according to the instructions on the packet and consult a doctor before using them in conjunction with prescription medications, in order to prevent harmful cross-reactivity.

Q: Are migraine headaches different from cluster headaches?
A: Yes. Cluster headaches (CHs), another primary headache disorder, are often confused with migraine headaches due to the fact that people can also be affected by migraines in bouts, or clusters, and the headache attacks can have a similarly adverse impact on a person’s quality of life.

Key differences include the fact that CHs are always unilateral (affecting one side of the head); migraines involve a more generalized pain and typically affect both sides of the head at once. The duration of a migraine is usually much longer than that of a CH, which lasts between 15 minutes and three hours, without treatment. People affected by a migraine tend to want to sit or lie down, whereas a person experiencing a CH is prone to agitated movement, in response to the acuity of the pain.

Read more about Cluster Headaches »

Q: What is an ophthalmoplegic migraine?
A: An ophthalmoplegic migraine is a term used to describe a painful paresis (muscular weakness) of one or more of the muscles that move the eye, accompanied by a headache. Young people are most commonly affected, and additional symptoms may include dilated pupils, difficulty moving the affected eye and a drooping eyelid. Despite its somewhat misleading name, the International Headache Society does not consider this condition to be a type of headache disorder, and instead classifies the condition as a recurrent cranial neuralgia. 26

Q: Are migraine headaches linked to the development of any other conditions?
A: People who are affected by migraine headaches are considered to be at greater risk than the general population of developing certain conditions, including: 4

• Psychological conditions, such as anxiety and depression
• Ischemic stroke, particularly in those whose migraines are accompanied by an aura
• High blood pressure
• Hearing problems

The links between having migraine headaches and developing these conditions are not fully understood. Always consult a doctor at the first sign of any new psychological or physical symptoms, even if they do not appear to be related to a particular headache episode, in order to ensure that any potential related conditions are diagnosed and treated promptly. Feeling unwell? Get a free symptom assessment at any time by downloading the Ada app.

Q: Is it true that piercing particular parts of the ear can relieve migraine headaches?
A: No. Anecdotal evidence that migraine headaches can be relieved by piercing the daith, the ear's innermost cartilage fold and the crus of the helix, has recently received significant media coverage. The theory behind its reputed efficacy is that, similarly to acupuncture, having a piercing in this area functions to disrupt the nerve signalling that leads to migraine headaches, reportedly reducing their frequency and intensity. However, there is currently no scientific evidence to support the use of daith piercings in the treatment of migraine headaches.

Good to know: If you are considering getting a piercing in any part of the body, U.K.’s National Health Service (NHS) recommends always visiting a licensed body piercer, and practicing appropriate aftercare throughout the healing process, to reduce the risk of infection. 27