About migraines

What is a migraine?

A migraine is a severe headache that usually causes a throbbing or pulsing pain on one side of your head. Approximately 10 million people in the UK live with migraine, with 3 million workdays being lost each year to migraine-related illness.

Migraines are debilitating and can interfere with your usual daily routine, and cause other symptoms as well as a bad headache, such as feeling or being sick, and sensitivity to light.

Although there’s currently no cure for migraine, effective treatments are available that can reduce the frequency, severity, and length of migraine attacks.

Types of migraine

Migraines are broadly classified as with or without aura, but there are several subtypes.

Some of the common migraine types are:

1. Migraine without aura (common migraine) – The most common migraine type that causes a severe headache, usually on 1 side of the head. Sometimes causes other symptoms like feeling and being sick, and sensitivity to light and sound.

2. Migraine with aura (classic migraine) – Usually has warning signs just before the migraine starts, known as aura. This may include:

• seeing zigzag lines
• numbness or tingling
• dizziness
• difficulty speaking

3. Migraine aura without headache (silent migraine) – Some people experience aura (the warning signs of a migraine) but don’t get the headache.

Other migraine subtypes include:

• migraine with brainstem aura – some people experience neurological symptoms, including vertigo, double vision, slurred speech, ringing in their ears, or fainting before a migraine
• hemiplegic migraine – a rare but severe form of migraine that causes temporary paralysis or weakness on 1 side of the body that can last days
• menstrual migraine – these affect women and usually start a few days before your period and can last for a few days afterwards
• chronic migraine – defined as having a headache on at least 15 days of the month, and affects around 2 in 100 people
• abdominal migraine – more common in children and causes abdominal symptoms like stomach pain and feeling or being sick, with or without headache
• retinal migraine – a migraine that affects the eyes, causing temporary vision loss in 1 eye
• vestibular migraine – a migraine that causes vertigo, dizziness, or balance issues

What are the symptoms of a migraine?

Different types of migraine cause different symptoms. There are a range of features or symptoms that can make up a migraine, but there are also differences in how severe a migraine can be, depending on the type and the individual.

Some of the most common migraine symptoms include:

• throbbing or pounding headache, often on 1 side of the head
• feeling sick (nausea)
• being sick (vomiting)
• light, noise, or smell sensitivity
• low energy

Stages of a migraine

Typically, there are 4 stages of a migraine. At each stage, you may get a variety of symptoms. However, each person's experience will be unique to them.

The stages of a migraine are as follows:

	Definition	Symptoms
1 – Prodrome or premonitory	Occurs hours or days before a headache and can include a variety of physical and mental changes that can last from 1 to 24 hours.	Tiredness, food cravings, mood changes, feeling thirsty, neck stiffness, and yawning.
2 – Aura	Around a third of people experience this stage, which can cause several symptoms that may alert you that a migraine is coming. It’s caused by a wave of electrical activity spreading across the brain, affecting its function and triggering migraine symptoms.	Visual disturbances, numbness, tingling, and slurred speech.
3 – Headache or main attack	This is the stage that involves severe head pain, usually including throbbing and is made worse by movement, light, or sound. It can last from 4 hours up to 3 days.	Severe, throbbing headache, and feeling or being sick.
4 – Postdrome (recovery)	Follows the headache phase and can last for several hours to a few days, and is often described as feeling like a ‘hangover'.	Fatigue, mood changes, and hunger.

How long does a migraine last?

Migraines usually last between 4 and 72 hours, but can last beyond that in some cases. Some symptoms start 2 days before you experience head pain.

What causes migraine?

The exact cause of migraines is not known, but genetics may play a part, with 35 to 60% of people getting migraines because of their genes. So, if someone in your family has a history of migraines, you may be more likely to develop them yourself, although it’s not guaranteed.

Scientists and doctors agree that they result from abnormal brain activity that affects the brain's nerve signals, chemicals, and blood vessels. Certain genes may be linked to this abnormal brain activity.

Several factors can trigger migraine attacks or increase your risk of having one. These triggers can vary from person to person, but include:

• anxiety and depression
• stress
• tiredness
• starting a period or other hormonal changes
• skipping meals or not eating regularly
• consuming too much caffeine
• not getting enough exercise
• certain medications
• weather or environmental changes
• strong smells

How to get rid of a migraine

There is no cure for migraines, but there are treatments available to help you manage the symptoms. Many people find that certain triggers bring on a migraine attack. Identifying what causes or worsens your migraines can help you reduce their frequency.

Over-the-counter painkillers are the first-line treatment to help deal with migraine effects, but if they do not work for you, a doctor may prescribe other medications. These can be taken to prevent or manage migraine symptoms.

Preventive medications are usually taken every day to help stop migraines from occurring. These are prescribed if:

• you get migraines frequently (more than once a week)
• your migraines are so severe that they impact your daily life, even if you’re taking migraine medications

Prescription migraine treatments

Prescription migraine treatments include:

1. Triptans

Also known as serotonin receptor agonists, they target serotonin receptors in the brain. The brain’s blood vessels can widen during a migraine, causing migraine symptoms, but triptans narrow the blood vessels to help relieve the headache.

2. Anti-sickness medication

Examples include prochlorperazine, which works by blocking the dopamine receptors in the brain to reduce nausea and vomiting during a migraine.

3. Gepants

A newer type of migraine treatment that is suitable for people with heart-related conditions because they do not narrow blood vessels. They may also cause fewer side effects than triptans, have a longer-lasting effect, and may work even if you’ve tried triptans and they did not have an effect. Some gepants can also be used to prevent migraines.

Gepants are calcitonin gene-related peptide (CGRP) receptor antagonists, which means they block CGRP from attaching to its receptors. CGRP is a substance released during a migraine attack, and while it’s not the main cause of migraines, it’s been found to play a big role in the development and severity of migraine attacks.

At ZAVA, we can provide the following migraine treatments following a consultation with one of our doctors:

Sumatriptan

Sumatriptan is a tablet that contains the active ingredient sumatriptan.

How to take it

Take 1 tablet with water as soon as you notice migraine symptoms.

How it works

Acts on serotonin receptors to narrow the brain’s blood vessels and relieve migraine symptoms.

Effectiveness

Relieves headaches in 52 to 57% of people within 2 hours compared to 19% treated with a placebo.

How long it takes to work

30 to 60 minutes.

Imigran

Imigran is a nasal spray that also contains sumatriptan.

How to take it

Spray 1 puff of Imigran 20mg into 1 nostril as soon as you notice migraine symptoms.

How it works

Acts on serotonin receptors to narrow the brain’s blood vessels and relieve migraine symptoms.

Effectiveness

When taking 20mg of Imigran for migraine relief, studies show it can reduce moderate or severe pain to mild or none in up to 63% of people after 2 hours.

72 to 74% of people also reported that after 2 hours of taking Imigran, they were only mildly affected by their migraine, or not at all.

How long it takes to work

15 minutes.

Buccastem

Buccastem is an anti-sickness medication that can treat nausea and vomiting caused by migraine. It’s a buccal tablet, so instead of swallowing it, you place it high up along your top gum (under your lip) and allow it to dissolve.

Buccastem contains the active ingredient prochlorperazine maleate.

How to take it

Take 1 to 2 tablets twice a day, for a maximum of 2 days.

How it works

Blocks the action of dopamine in the brain to relieve migraine symptoms, such as feeling and being sick.

Effectiveness

Can effectively stop a migraine attack and is more effective than placebo, metoclopramide, and other medications for headache relief.

How long it takes to work

30 to 60 minutes.

What’s the best treatment for migraine?

The best migraine treatment for you will depend on several factors, including what’s causing your migraine, its severity, and your symptoms. It can take time for you to find which treatment works best for you. Many people find that over-the-counter painkillers, like paracetamol, ibuprofen, or aspirin, effectively treat their symptoms.

However, if over-the-counter options aren’t working for you, a doctor may recommend triptans, gepants, or anti-sickness medications. Finding the most effective treatment for you will depend on your preferences and any contraindications, but your doctor will discuss these with you before issuing a prescription.

What are the side effects of migraine tablets?

The potential side effects of migraine treatments will depend on the medication. Some side effects may be similar to migraine symptoms and may be a contributing factor in your decision to try specific migraine treatments.

Triptans

Common triptan side effects include:

• chest tightness
• feeling or being sick
• tiredness
• dizziness
• temporary blood pressure increase
• muscle aches
• shortness of breath

Rare triptan side effects include:

• liver function changes
• a serious allergic reaction (a medical emergency in which you should call 999 straight away)

This is not a full list of side effects. For a full list and further information, see the patient information leaflet that comes with your migraine treatment.

Anti-sickness

Common prochlorperazine/Buccastem side effects include:

• sleepiness
• blurred vision
• dry mouth
• headaches
• stuffy nose

Rare prochlorperazine/Buccastem side effects include:

• jaundice
• blood problems
• a serious allergic reaction (a medical emergency in which you should call 999 straight away)

This is not a full list of side effects. For a full list and further information, see the patient information leaflet that comes with your migraine treatment.

Gepants

Common gepants side effects include:

• feeling sick (nausea)
• fatigue
• constipation
• allergic reaction

Rare gepants side effects include:

• Raynaud’s phenomenon (a temporary reduction in blood flow to your fingers and toes, causing a change in skin colour, coldness, or numbness)
• hair loss
• liver function changes
• a serious allergic reaction (a medical emergency in which you should call 999 straight away)

This is not a full list of side effects. For a full list and further information, see the patient information leaflet that comes with your migraine treatment.

How long do side effects last?

Migraine treatment side effects are usually mild and temporary, usually lasting a few hours to a few days, but can vary depending on how your body reacts to the medication. If you find the side effects bothersome or they are not going away, talk to your doctor.

What to do if you get side effects?

If you experience migraine treatment side effects, you can help manage them by:

• drinking plenty of fluids to prevent dehydration and replace any lost fluids
• getting plenty of rest until the side effects pass
• eating, smaller, frequent, and bland meals if you are feeling or being sick

If you experience any of the following serious side effects, stop taking the medication and call 999 or get someone to take you to A&E:

• shortness of breath with difficulty breathing or swallowing
• swollen lips, tongue, mouth, or face
• itchy skin rash
• collapse
• severe chest pain that doesn’t go away quickly

Who can take migraine medications?

Prescription migraine treatments may not be suitable for everyone. It’s important to thoroughly discuss any previous medical history or current medications with your doctor before taking any new medication, so they can assess if migraine treatment is safe and suitable for you.

Tell your doctor if any of the following apply to you:

• you’re under 18
• you have severe liver or kidney problems
• you’re pregnant, planning to get pregnant, or breastfeeding

You should also tell the doctor about any prescription, over-the-counter or herbal medications you are currently taking or planning to take. These include:

• other migraine treatments
• antidepressants
• itraconazole and clarithromycin to treat fungal or bacterial infections
• ritonavir and efavirenz to treat HIV infections
• St. John’s wort to treat depression
• bosentan to treat high blood pressure
• phenobarbital to treat epilepsy
• rifampicin to treat tuberculosis
• modafinil to treat narcolepsy

How do I know if I need migraine tablets?

You may want to consider migraine treatment if your migraines are affecting your daily life, such as your ability to work, socialise, or carry out daily tasks. If over-the-counter pain relief hasn’t worked, prescription treatments may be the next option.

Here are some of the reasons you may want to try migraine tablets or treatments:

• frequency – if you get frequent migraine attacks, usually 4 or more days per month
• severity – if migraines severely impact your daily life or last a long time
• other treatments or preventative measures have not worked – if lifestyle changes, trigger avoidance measures, or over-the-counter medications are not providing relief
• poor response to your current medication – if the current medication you are taking is not working, you may want to discuss an alternative with your doctor

To get a migraine diagnosis, you will need to visit a doctor. They will ask you about your symptoms, how long they last, and how often you experience them. It can help to keep a diary, noting down any triggers, symptoms, duration, how you feel, and any medications or remedies you try to provide relief.

How to prevent migraines

One of the best ways to prevent a migraine is to understand your potential triggers. Keeping a diary that lists foods and drinks you consumed before a migraine or any activities you did or environmental factors you might have been exposed to can help identify any particular causes.

Doctors also recommend several lifestyle changes you can try to help manage and prevent migraines. They include:

• sleeping or lying down in a dark room during an attack
• avoiding obvious triggers, including foods and drinks
• staying hydrated
• limiting your caffeine and alcohol intake
• maintaining a healthy weight
• eating at regular mealtimes and avoiding skipping meals
• participating in regular exercise
• managing stress

Medications are available to prevent migraines. Speak to your doctor about this if you experience more than 1 migraine per week and have already tried avoiding triggers.