Migraine in adults - What is it?

Key points for people with migraine

• Migraine attacks are severe headaches that last from four to 72 hours.
• You may also have other symptoms, such as feeling sick or being extra-sensitive to sound or light.
• About 1 in 6 people with migraine get what's called an aura. This can cause temporary problems with your vision or pins and needles or numbness in parts of your body.
• You may be more likely to get an attack if you are tired, hungry or stressed, or eat or drink certain foods.
• Aspirin can help if your pain is not too bad. Or you can try taking a tablet that has aspirin, paracetamol and caffeine for extra relief (two brand names for this are Anadin Extra or Alka XS Go).
• Ibuprofen also works for migraine, but you may need the higher dose, which you can get only on a doctor's prescription.
• Triptans are drugs that work quickly to make you feel better. They can help if you have bad attacks, but they do have side effects. And they don't suit everyone.
• If you get migraine attacks often, talk to your GP about medicine to prevent them.

Is my headache a migraine?

A group of headache specialists called the International Headache Society say that you have a migraine if your headache lasts between four and 72 hours and you have two of the symptoms listed below:[1]

• The pain is on one side of your head (this is called unilateral pain)
• The pain is a throbbing pain
• The pain gets worse when you move
• The pain is moderate or severe. If your pain is moderate, you may be able to keep working, but only half as well as you would normally. If your pain is severe, you usually need to go to bed.

If you have a migraine attack you will also have one or more of the symptoms in this list:[1]

• You may feel sick or have an upset stomach or you may actually be sick
• You may be extra-sensitive to light (photophobia)
• You may be extra-sensitive to sounds (phonophobia).

What causes migraine?

Researchers think that migraine is caused by a problem that makes some cells in your brain more excitable than normal.[2] It doesn't mean something is wrong with your brain. To understand what causes your attacks, you may find it helpful to learn a bit about what your brain does and why it does it. To find out more, see What does your brain do?

Researchers are using new types of scanners to see what happens in the brain when someone has a migraine attack.[1] One of these new types of scanners is a position emission tomography scan, or PET scan for short. This scan picks up the electrical and chemical changes that happen in the brain.

• Researchers believe that there is a pain centre at the base of the brain.
• If you get migraine attacks, you probably have a more sensitive pain centre than other people do. This means that your pain centre is overexcited by things that wouldn't bother someone else, such as bright lights or tiredness.
• The nerve cells in this centre react by telling the blood vessels in certain areas of the brain to open up (dilate). The walls of your blood vessels are slightly elastic, so they can get bigger to let more blood through or get narrower to let less blood through.
• When the blood vessels open up, nerves in the walls of the blood vessels release chemicals (called neurotransmitters) that make the vessels open up even more. These chemicals make the blood vessels inflamed. This is what causes the throbbing pain of a migraine attack.
• Migraine headaches can be so bad that they affect your sympathetic nervous system. This is the part of your nervous system which you have no control over. It gets your body ready to run away or fight any threat that comes along -- in this case, a bad headache. In a migraine attack the effect on this part of your nervous system can make you feel sick, vomit or have diarrhoea.
• When your sympathetic nervous system is affected, the action in your gut may slow down, so it takes longer for the food that you have eaten to leave your stomach. And it also takes longer for any tablets that you have taken to be digested and get into your blood. This is one reason why some treatments for migraine sometimes don't seem to work.
• Your sympathetic nervous system also makes the blood vessels in your skin get narrower, so you look pale. It can also make you more sensitive to what is going on around you, so that lights, noises or smells are hard to bear.

Why me?

If you have migraine, you may have inherited the tendency to get these attacks from one of your parents. This means that the tendency to get migraine attacks is in your genes. Genes are passed from parent to child. They programme how you develop and how your body works. Research shows that certain genes may be linked to migraine. However, genes don't completely explain why some people get migraine.

For some people, there may be something in their environment or something that happens when they are growing up (such as having a certain illness) that causes migraine.[5] Researchers believe that having migraine with aura is more likely to be caused by genes than migraine without aura.[5]

Should I see my GP?

You may want to see your GP if:

• Your symptoms don't get better using over-the-counter medicine
• Your migraine attacks have got worse and you get them more often
• You are worried that something other than migraine may be causing your attacks (for example, you may have other symptoms)
• You are not completely free of symptoms between attacks. Tell your doctor if, for example, part of your body feels numb or you have problems with vision even when you are not having an attack.[4] [6]

Researchers have found that more than half of people who get migraine attacks use only over-the-counter medicines. The researchers suggested that many people with migraine do not see their GP about their headaches because they think that there aren't any treatments that work.[7] But there are treatments that can help. One of the drugs known as triptans may work for you.