Migraine

A migraine attack is a severe headache, usually present with other symptoms, that stops a person from going about their daily life.

Migraine overview

Migraine is a common condition associated with strong, disabling headaches.1 Some people also have symptoms know as ‘aura’ – temporary disturbances of vision or other senses.1

People with migraine often describe ‘trigger factors’ that increase the likelihood of them having a migraine attack. Examples of triggers include hormonal changes in women (such as changes that occur during the menstrual cycle), exposure to bright light, lack of sleep, hunger or dehydration, and stress.2 Alternatively, migraine attacks may occur for no apparent reason.3

Each person will experience migraine differently, and may be able to manage their symptoms themselves, or may require treatment.1,3

 

Symptoms

There are two major subtypes of migraine: without aura, and with aura.1

Migraine without aura – a moderate-to-severe, throbbing headache, typically on one side of the head (and normally towards the front), that lasts for at least a few hours, and possibly up to three days.1 The headache is made worse by normal activity such as walking or climbing stairs.1 A person with a migraine attack may feel nauseous, and may be extremely sensitive to light and sound.1

Migraine with aura – a headache together with a series of vision disturbances such as flashes of light, zig-zag patterns, or blind spots.1,3 Alternatively, the headache may be accompanied by feeling pins and needles, tingling, or numbness in a hand, an arm or the face.1,3 Less commonly, aura is associated with difficulty in speaking.1 Aura symptoms can last from 5 minutes to an hour, and usually start before the headache.1

In the hours (or even days) before and after a migraine attack, a person may experience symptoms such as tiredness, difficultly concentrating, or neck stiffness.1

People with very frequent migraine attacks, with headaches on 15 or more days per month and migraine characteristics on at least 8 of those days, are said to have ‘chronic’ migraine.1

Epidemiology and burden

Worldwide, 1.3 billion people suffer from migraine, making it one of the most common diseases in the world.4 The most likely age group to have migraine is 35–39 years, and women are about twice as likely to have the condition as men.5 Around 20% of migraine sufferers experience aura symptoms.3

A global survey by the World Health Organization (WHO) found that people with migraine or other severe headaches miss an average of 7 days of work or activities per year because of their condition.6 Furthermore, people with chronic migraine have more than three times as many days when they are unable to carry out their normal activities as those with less frequent migraine attacks.7

People with migraine may have problems outside of their migraine attacks, such as low energy, and emotional or mental health problems.8

 

Diagnosis and care

People who are concerned that they – or their loved ones – are experiencing symptoms of migraine should see their doctor for help and advice. Migraine is diagnosed based on a history of the person’s headaches (including how often they occur and if the pain is moderate to severe, ‘pulsating’, and on just one side of the head), whether they have noticed any triggers, and whether they have experienced other physical symptoms.3 It is often helpful for the person to keep a diary of their headaches to help their doctor to diagnose them correctly.3

Lifestyle adjustments, such as having regular meals and sleep, can be helpful to avoid triggers and to reduce the frequency of migraine attacks.3 Medications can be used during an attack to reduce its severity (acute treatment), and continuously to reduce the likelihood of a future attack (preventive treatment).3,9 However, in a 30-year study of people with migraine, only around 40% ever consulted a doctor, and only around 60% used treatment of any kind.10

It is important that migraines are well managed because overusing medication can result in a new headache or worsen an existing headache – this is called a ‘medication overuse headache’.1

 

References

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

2. Pavlovic JM, Buse DC, Sollars CM, Haut S, Lipton RB. Trigger factors and premonitory features of migraine attacks: summary of studies. Headache. 2014;54(10):1670–1679.

3. Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015;6(3):115–123.

4. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858.

5. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954–976.

6. Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Üstün TB, et al. Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2011;16(12):1234–1246.

7. Adams AM, Serrano D, Buse DC, Reed ML, Marske V, Fanning KM, et al. The impact of chronic migraine: the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study methods and baseline results. Cephalalgia. 2015;35(7):563–578.

8. Raggi A, Giovannetti AM, Quintas R, D’Amico D, Cieza A, Sabariego C, et al. A systematic review of the psychosocial difficulties relevant to patients with migraine. J Headache Pain. 2012;13(8):595–606.

9. National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. Clinical guideline. 2012. Available from: http://nice.org.uk/guidance/cg150 [accessed 15 October 2019].

10. Merikangas KR, Cui L, Richardson AK, Isler H, Khoromi S, Nakamura E, et al. Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ. 2011;343:d5076.

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