Migraine: Triggers, Treatment and Prevention

Migraine affects around one in seven people worldwide and is one of the leading causes of disability in adults under 50. The good news: most people can cut the number and severity of attacks once they understand their pattern.

Imagine you’re halfway through a busy Monday when the zigzag lights appear in the corner of your eye. Within an hour the throbbing starts, light feels painful and you want to lie in a dark room. Last month it happened three times, always after short nights and skipped lunches. Spotting that link is the first step to fewer lost days.

How migraine differs from an ordinary headache

• Moderate to severe pain, often on one side and throbbing
• Worse with movement, so people want to stay still
• Nausea or vomiting, and sensitivity to light, sound or smells
• Lasts 4 to 72 hours if untreated
• About a quarter of people get an “aura” first, such as flashing lights, zigzags or tingling

Common triggers

Triggers vary, and often it’s a combination rather than one thing. Frequent culprits include too little or irregular sleep, skipped meals, dehydration, stress (and the “let-down” after stress), hormonal changes around periods, alcohol (especially red wine), and bright or flickering light. A simple diary of attacks, sleep, food, periods and stress for two to three months usually reveals a pattern.

Treating an attack

• Treat early. Painkillers work best taken at the first sign of pain.
• Simple options include ibuprofen, aspirin (adults only) or paracetamol, sometimes with an anti-sickness medicine.
• Triptans are prescription medicines designed specifically for migraine and help many people who don’t respond to simple painkillers.
• Rest in a dark, quiet room and sip water.

Using painkillers or triptans on more than about 10 to 15 days a month can cause “medication overuse headache”, which makes headaches more frequent. If you’re reaching for tablets most days, talk to a doctor.

But what if attacks keep coming?

If you have several migraine days a month, preventive treatment is worth discussing. Options include daily tablets originally used for blood pressure, epilepsy or depression, and newer treatments such as CGRP-targeting injections in some countries. Regular sleep, meals, exercise and managing triggers support any medicine you take.

When to get urgent help

Seek emergency care for a sudden, severe “thunderclap” headache, headache with fever and stiff neck, new weakness, confusion, difficulty speaking, a headache after a head injury, or a first-ever severe headache over age 50.

Sources: World Health Organization (Headache disorders), NHS (Migraine), Mayo Clinic (Migraine), The Migraine Trust.