A migraine is usually a severe headache felt as a throbbing pain at the front or side of the head.

Some people also have other symptoms, such as nausea, vomiting and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around one in every five women and around one in every 15 men. They usually begin in early adulthood.

There are several types of migraine, including:

migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights

migraine without aura – where the migraine occurs without warning signs

migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop

Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It is possible for years to pass between migraine attacks.

When to seek medical advice

You should see your GP if you have frequent or severe migraine symptoms that cannot be controlled with over the counter painkillers.

You should also make an appointment to see your GP if you have frequent migraines (on more than five days a month), even if they can be controlled with medication, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you are with experiences:

paralysis or weakness in one or both arms and/or one side of the face

slurred or garbled speech

a sudden agonising headache resulting in a blinding pain unlike anything experienced before

headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as astroke or meningitis, and should be assessed by a doctor as soon as possible.

What causes migraines?

The exact cause of migraines is unknown, although they are thought to be the result of temporary changes in the chemicals and blood vessels in the brain.

Around half of all people who experience migraines also have a close relative with the condition, suggesting that genes may play a role.

Some people find migraine attacks are associated with certain triggers, which can include starting their period, stress, tiredness and certain foods or drinks.

How migraines are treated

There is no cure for migraines, but there are a number of treatments available to help reduce the symptoms.

These include:

painkillers – including over the counter medicationssuch asparacetamol and ibuprofen

triptans – medications that can help reverse the changes in the brain that may cause migraines

anti-emetics – medications often used to reduce nausea and vomiting

During an attack, many people find that sleeping or lying in a darkened room can also help.

Preventing migraines

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you have tried avoiding possible triggers and you are still experiencing symptoms, your GP may prescribe medication to help prevent further attacks.

Medications used to prevent migraines include the anti-seizure medication topiramate and a medication called propranolol that is usually used to treat high blood pressure.


Migraines can severely affect your quality of life and stop you carrying out your normal daily activities. Some people find they need to stay in bed for days at a time.

However, a number of effective treatments are available to reduce the symptoms and prevent further attacks.

Migraine attacks can sometimes get worse over time, but they tend to gradually improve over many years for most people.


A migraine is usually felt as a throbbing pain at the front or side of the head 

Symptoms of a migraine 

The main symptom of a migraine is usually an intense headache that occurs at the front or on one side of the head.

The pain is usually a severe throbbing sensation that gets worse when you move and prevents you from carrying out normal activities.

In some cases, the pain can occur on both sides of your head and may affect your face or neck.

Additional symptoms

Other symptoms commonly associated with a migraine include:



increased sensitivity to light and sound, which is why many people with a migraine want to rest in a quiet, dark room

Some people also occasionally experience other symptoms including sweating, poor concentration, feeling very hot or very cold, abdominal (tummy) pain and diarrhoea.

Not everyone experiences these additional symptoms when they have a migraine and some people may experience them without having aheadache.

The symptoms of a migraine usually last between four hours and three days, although you may feel very tired for up to a week afterwards.

Symptoms of aura

About one in three people with migraines have temporary warning symptoms, known as aura, before a migraine. These include:

visual problems, such as seeing flashing lights, zig-zag patterns or blind spots

numbness or a tingling sensation like pins and needles,which usually starts in one hand and moves up your arm before affecting your face, lips and tongue

feeling dizzy or off balance

difficulty speaking

loss of consciousness, although this is rare

Aura symptoms typically develop over the course of about five minutes and last for up to an hour. Some people may experience aura followed by only a mild headache or no headache at all.

When to seek medical advice

You should see your GP if you have frequent or severe migraine symptoms that cannot be managed with over the counter painkillers, such as paracetamol.

You should also make an appointment to see your GP if you have frequent migraines (on more than five days a month), even if they can be controlled with medication, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you are with experiences:

paralysis or weakness in one or both arms and/or one side of the face

slurred or garbled speech

a sudden agonising headache resulting in a blinding pain unlike anything experienced before

headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision, and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

Causes of migraines 

The exact cause of migraines is unknown, although they are thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

It's not clear what causes this change in brain activity, but it is possible that your genes make you more likely to experience migraines as a result of a specific trigger.

Migraine triggers

Many possible migraine triggers have been suggested, including hormonal, emotional, physical, dietary, environmental and medicinal factors.

Hormonal changes

Some women experience migraines around the time of their period, possibly because of changes in the levels of hormones such as oestrogen around this time.

These are known as menstrual-related migraines and they usually occur between two days before the start of your period to three days after. Some women only experience migraines around this time, but most experience them at other times too.

Many women find their migraines improve after the menopause, although the menopause can trigger migraines or make them worse in some women.

Emotional triggers:







Physical triggers:


poor quality sleep

shift work

poor posture

neck or shoulder tension

jet lag

low blood sugar (hypoglycaemia)

strenuous exercise, if you are not used to it

Dietary triggers:

missed, delayed or irregular meals



the food additive tyramine

caffeine products, such as tea and coffee

specific foods such as chocolate, citrus fruit and cheese

Environmental triggers:

bright lights

flickering screens, such as a television or computer screen

smoking (or smoky rooms)

loud noises

changes in climate, such as changes in humidity or very cold temperatures

strong smells

a stuffy atmosphere


some types of sleeping tablets

the combined contraceptive pill

hormone replacement therapy (HRT), which is sometimes used to relieve symptoms associated with the menopause 

Diagnosing migraine 

There is no specific test to diagnose migraines. For an accurate diagnosis to be made, your GP must identify a pattern of recurring headaches along with the associated symptoms.

Migraines can be unpredictable, sometimes occurring without the other symptoms. So obtaining an accurate diagnosis can sometimes take a long time.

On your first visit, your GP may carry out a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms.

Your GP may ask if your headaches are:

on one side of the head

a pulsating pain

severe enough to prevent you carrying out daily activities

made worse by physical activity or moving about

accompanied by nausea and vomiting

accompanied by sensitivity to light and noise

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks. Note down details including the date, time, what you were doing when the migraine began, how long the attack lasted, what symptoms you experienced and what medication you took (if any).

It may also be helpful to make a note of the food you ate that day and, for women, when you started your period, as this can help your GP identify potential triggers.

Referral to a specialist

Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system) for further assessment and treatment if a diagnosis is unclear, you experience migraines on 15 days or more per month (chronic migraine), or treatment is not helping to control your symptoms.


Keeping a migrane diary might be helpful

Treating migraines 

There is currently no cure for migraines, although a number of treatments are available to help ease the symptoms.

It may take time to work out which is the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.

If you find that you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.


Many people who have migraines find that over the counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms.

They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.

It is not advisable to wait until the headache worsens before taking painkillers because by this point it is often too late for the medication to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good alternative because they are absorbed quickly by your body.

If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus (back passage).


When taking over the counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.

Children under 16 should not take aspirin unless it is under the guidance of a healthcare professional. Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver problems or kidney problems.

Taking any form of painkiller frequently can make migraines worse. This is sometimes called "medication overuse headache" or "painkiller headache".

Speak to your GP if you find yourself needing to use painkillers repeatedly or if over the counter painkillers are not effective. Your GP may prescribe stronger painkillers or recommend using painkillers along with triptans (see below). If they suspect the frequent use of painkillers may be contributing your headaches, they may recommended that you stop using them.


If ordinary painkillers are not helping to relieve your migraine symptoms, you should make an appointment to see your GP. They may recommend taking painkillers in addition to a type of medication called a triptan and possibly anti-sickness medication (see below).

Triptan medicines are not the same as painkillers. They are thought to work by reversing the changes in the brain that may cause migraines. 

They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process.

Triptans are available as tablets, injections and nasal sprays.

Common side effects of triptans include warm-sensations, tightness, tingling, flushing, and feelings of heaviness in the face, limbs or chest. Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own.

Your GP will usually recommend having a follow-up appointment when you have finished your first course of treatment with triptans, so you can discuss whether they were effective and whether you had any side effects.

If the medication was helpful, treatment will usually be continued. If they were not effective or caused unpleasant side effects, your GP may try prescribing a different type.

 Anti-sickness medicines 

Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you don't experience nausea or vomiting. These are prescribed by your GP and can be taken alongside painkillers and triptans.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet, but are also available as a suppository.

Side effects of anti-emetics include drowsiness and diarrhoea.

 Combination  medicines 

You can buy a number of combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which one is best for you, ask your pharmacist.

Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each.

Seeing a specialist

If the treatments above are not effectively controlling your migraines, your GP may refer you to a specialist migraine clinic for further investigation and treatment.

In addition to the medications mentioned above, a specialist may recommend other treatments such as transcranial magnetic stimulation.

 Transcranial magnetic stimulation 

In January 2014, the National Institute for Health and Care Excellence (NICE) approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.

TMS involves holding a small electrical device to your head that then delivers magnetic pulses through your skin. It is not clear exactly how TMS works in treating migraines, but studies have shown that using it at the start of a migraine can reduce its severity. It can also be used in combination with the medications mentioned above without interfering with them.

However, TMS is not a cure for migraines and it doesn’t work for everyone. The evidence for its effectiveness is not strong and is limited to people who have migraine with aura.

There is also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects, including:

slight dizziness

drowsiness and tiredness

a muscle tremor that can make it difficult to stand


NICE recommends that TMS should only be provided by headache specialists in specialist centres, because of the uncertainty about the potential long-term side effects. The specialist will keep a record of your experiences using the treatment.

 Treatment for pregnant and breastfeeding women 

In general, migraine treatment with medicines should be limited as much as possible when you are pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is often recommended.

If medication is essential, then your GP may prescribe you a low-dose painkiller, such as paracetamol. In some cases, anti-inflammatory drugs or triptans may be prescribed. Speak to your GP or midwife before taking medication when you are pregnant or breastfeeding.

Migraine: Debbie's stor

Debbie has experienced migraines since she was a child. See how alternative therapies and relaxation techniques brought her some relief.

Media last reviewed: 20/08/2013

Next review due: 20/08/2015

 During an attack 

Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack.

Others find that eating something helps, or they start to feel better once they have been sick.

Complications of migraine 

Migraines are associated with a small increased risk of ischaemic strokes, and a very small increased risk of mental health problems.


An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries.

Studies have shown that people who experience migraines (particularly migraine with aura) have about twice the risk of having an ischaemic stroke at some point compared to people without migraines, although this risk is still small.

The reason why ischaemic strokes are linked to migraine is not entirely clear.

The risk of having an ischaemic stroke is also increased by the use of the combined contraceptive pill, so medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill.

Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors such as having high blood pressure or a family history of cardiovascular disease.

If you take the combined contraceptive pill and you experience aura symptoms, talk to your GP about alternative forms of contraception.

Mental health problems

Migraine is associated with a very small increased risk of mental health problems, including:


bipolar disorder

anxiety disorder

panic disorder

Preventing migraine

There are a number of ways you can reduce your chances of experiencing migraines.

Identifying and avoiding triggers

One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. 

You may find you tend to have a migraine after eating certain foods or when you are stressed and by avoiding this trigger, you can prevent a migraine.

Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you are taking is working.

In your migraine diary, try to record:

the date of the attack

the time of day the attack began

any warning signs

your symptoms (including the presence or absence of aura)

what medication you took

when the attack ended

Medication and supplements

Medication is also available to help prevent migraines. These medicines are usually used if you have tried avoiding possible triggers and you are still experiencing migraines.

You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Some of the main medications used to prevent migraines are outlined below.


Topiramate is a type of medication usually used to prevent seizures in people with epilepsy, but it has also been shown to help prevent migraines. It is usually taken every day in tablet form.

Topiramate should be used with caution in people with kidney or liver problems. It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives, so your GP should discuss alternative methods of contraception with women who are prescribed topiramate.

Side effects of topiramate can include decreased appetite, nausea, vomiting, constipation or diarrhoea, dizziness, drowsiness and problems sleeping.


Propranolol is a medication traditionally used to treat angina and high blood pressure, but it has also been shown to help prevent migraines. It is usually taken every day in tablet form.

Propranolol is unsuitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes.

Side effects of propranolol can include cold hands and feet, pins and needles, problems sleeping and tiredness.


If topiramate or propranolol are unsuitable or ineffective, you may be prescribed a medication called gabapentin. Like topiramate, this is a medication that is normally used to treat people with epilepsy that may also help prevent migraines. It is usually taken every day in tablet form.

Most people can take gabapentin, but it should be used with caution in people with kidney problems and those over 65 years of age.

Side effects of gabapentin can include dizziness, drowsiness, increased appetite, weight gain and suicidal thoughts.

Gabapentin has been recommended as a possible treatment for migraines by the National Institute for Health and Care Excellence (NICE), but recent research has suggested it may not be effective in preventing attacks and concerns have been raised about the quality of earlier research into the medication.


For some people, taking a 400mg supplement of riboflavin (vitamin B2) every day may help reduce the frequency and severity of migraines.

Riboflavin supplements are available without prescription, but it's a good idea to discuss using them with your GP first as it is not clear what the effects of taking high doses of riboflavin supplements each day might be.

Botulinum toxin type A

In June 2012, NICE recommended the use of a medication called botulinum toxin type A by headache specialists to prevent headaches in some adults with chronic (long-term) migraine.

Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. It is not exactly clear why this treatment can be effective for migraine.

NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three previous preventative medical treatments.

Under the NICE guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be administered every 12 weeks.

Preventing menstrual-related migraines

Menstrual-related migraines usually occur between two days before the start of your period to three days after. As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.

Non-hormonal treatments

The non-hormonal treatments that are recommended are:

non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller

triptans – medicines that reverse the widening (dilation) of blood vessels, which is thought to be a contributory factor in migraines

These medications are taken as tablets two to four times a day from either the start of your period or two days before, until the last day of bleeding.

Hormonal treatments

Hormonal treatments that may be recommended include:

combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring

progesterone-only contraceptives, such as progesterone-onlypills, implants or injections

oestrogen patches or gels, which can be used from three days before the start of your period and continued for seven days

Hormonal contraceptives are not usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke. Read about thecomplications of migraines for more information about this.

Transcranial magnetic stimulation

In January 2014, the NICE approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.


If medication is unsuitable, or it doesn't help to prevent migraines, you may want to consider acupuncture.

NICE states that a course of up to 10 sessions over a five to eight week period may be beneficial.

Advice and support

There are a number of organisations that can offer advice and support for people with migraines, including Migraine Action and The Migraine Trust.

Migraine Action can be contacted on 0116 275 8317 or by emailinginfo@migraine.org.uk. You can also join the Migraine Action forumwhere you can ask migraine experts any questions you have and talk to other people with the condition.

The Migraine Trust can be contacted on 020 7631 6970 or by emailinginfo@migrainetrust.org. You can also join The Migraine Trust's online community through Facebook.