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Advice for Migraine
Migraine is a common condition which affects over eight million people in the UK. It is a severe headache which can persist for several days. In most cases, the headache consists of a throbbing pain on one or both sides of your head. It is believed that migraines may be caused by the widening of blood vessels in the head.
There are many different types of migraine, and people experience them differently. But migraines are usually characterised by severe headaches and can be accompanied by nausea and/or sensitivity to light, sounds and smells. Migraines can affect on average one in five women and one in 15 men, usually starting in early adulthood.
Migraines are very individual with different people experiencing different symptoms with varying impacts on their lifestyle. At the most extreme end migraines can occur several times a week, involve severe pain, sickness and sensitivity to light and/or sound, lasting days at a time. At the other end of the spectrum, migraines may only occur occasionally with months, or even years, between attacks that can be fairly mild and short-lived.
When you’re having a migraine you’ll probably find that you can’t carry on with normal activities, and you might have to lie down in a darkened room. The symptoms will normally continue for several hours, but might last for as long as 3 days, after which you may feel extremely tired.
Another key feature of a migraine is that it’s usually triggered by something like stress, tiredness, hormonal changes, or something in your environment like bright lights or loud noises. Figuring out your migraine triggers can really help you manage your condition.
The two main types of migraine are:
Migraine without aura
The most common type of migraine is migraine without aura – it’s thought that 70-90% of people with the condition have this type. This type of migraine causes the symptoms include: a throbbing pain, usually on one side of the head, which affects your ability to do normal activities. You may be sensitive to light and sound, and you might feel sick and throw up, or have diarrhoea. The symptoms will usually last between four and 72 hours.
Migraine with aura
Some people who get migraines have the kinds of symptoms described above, as well as some additional neurological ones. These neurological symptoms are known collectively as “migraine aura” – they’re often described as warning signals, as they tend to occur before the headache starts.
Normally, migraine aura causes visual disturbances like blind spots, coloured spots, sparkles, flashing lights, tunnel vision, and zigzag lines. Aura can also cause temporary blindness. Other aura symptoms include numbness, tingling, pins and needles, and weakness on one side of the body, as well as dizziness and vertigo.Aura symptoms develop within about five minutes and usually last up to one hour. Normally a headache will follow aura symptoms, but for some people the pain may only be mild.
Other types of migraine include:
Migraine aura without headache - Some people experience the migraine aura symptoms, but don’t have a headache afterwards.
Chronic migraine-A condition where you’re regularly experiencing migraine headaches. Usually this is more than fifteen headache days per month over a three month period of which more than eight are migrainous.
Menstrual migraine - This is related to falling levels of oestrogen in the run-up to your period. If you get menstrual migraines, you’ll probably experience symptoms in the two days before you start menstruating, or in the first three days of your period.
Hemiplegic migraine - This is a type of migraine that causes weakness down one side of the body, and sometimes numbness and pins and needles too. The weakness might affect the face, arm and leg. Normally this type of migraine also involves head pain, which may come before or after the weakness.
Ocular migraine - is a distinctive type of migraine that causes visual problems in just one eye, rather than both. You might experience partial or total vision loss in the affected eye for about 10 or 20 minutes. You might also have a headache.
A diagnosis of migraine is normally made by your GP; it is based on the pattern and severity of headaches along with occurrence of other associated symptoms as well as your response to migraine treatments. This can take time depending on the frequency, severity and associated symptoms of your migraines.To aid your diagnosis it is helpful to keep a migraine diary to keep an accurate record of your condition.
At Pharmacinta, we have a range of prescription medications to help manage your migraine condition.
Migraine symptoms can vary from person to person and depending on the type of migraine experienced. The main symptom is most usually a strong headache, typically to one side of the head with a pulsing or throbbing pain. In addition, you may also experience:
- Nausea and vomiting
- Blurred vision
- Sensitivity to light, sound or smell
- Seeing spots, wavy lines, flashing lights
If you experience a sudden, very intense headache, you should seek urgent medical care. This could be a sign of a more serious health condition.
Stages of a migraine
To understand the symptoms of a migraine, it is also important to understand the phases of a migraine. They will normally have four distinct phases, although some people may not experience all of them. The four distinct phases of a migraine are:
Prodromal phase: generally involves changes in mood, behaviour, energy levels or appetite that occur from a few hours to days before a migraine attack.
Aura phase: the visual stage that occurs closer to the migraine attack, normally 5 minutes to 1 hour before. It usually involves flashes of light or blind spots in the vision.
Headache phase: the phase that involves the typical migraine symptoms including throbbing headache, sensitivity to light and sound, as well as nausea and vomiting. This can last for anything from a couple of hours to 3 days depending on the severity of symptoms and the treatment used.
Resolution stage: as the symptoms of the headache phase leave you may be left feeling drained or tired for a number of days afterwards.
You should seek urgent medical attention at the hospital if you have any of the following migraine symptoms:
- Paralysis/weakness of one or both arms or the face
- Slurred speech
- A sudden onset headache with agonising pain
- Fever, stiff neck, confusion, seizures, double vision, or a rash.
The exact cause of migraines is still unknown. However, research suggests a number of factors can make you more likely to experience them, including genetics and environment. In addition, there is reason to believe that temporary changes to the brain stem, such as chemical imbalances, widening of the blood vessels and nerve changes, could also contribute.
There are common triggers that can bring one on. These will vary from person to person, but can include physical and emotional stress, tiredness, missing a meal, drinking caffeine or alcohol, and foods containing tyramine (cured meats, some cheeses and yeast extracts). Also, bright lights, loud noises and changes in climate.
While the root cause of migraine has yet to be determined, people who do suffer migraines often get them in response to certain stimuli. These factors, commonly referred to as “triggers”, vary from person to person but can include:
- Hormones – changes to hormonal balance, for instance from periods, ovulation, pregnancy or menopause
- Diet – missing meals, having irregular meal times, eating certain foods or becoming dehydrated
- Medicines – hormonal replacement therapy (HRT), the contraceptive pill and some sleeping tablets
- Sleep – irregular sleeping patterns or not getting enough sleep
- Stress – chemicals that are released into the brain when you’re experiencing stress
- Tiredness
- Skipping meals and fasting
- Sensory stimuli, including loud sounds, strong smells, sun glare and bright lights
Recent research into migraines has focused on whether serotonin - a chemical produced in the brain that affects mood and contributes to happiness - could play a role in the condition. In addition, it is suspected that certain neurotransmitters may contribute to the attack phase of migraines, including calcitonin gene-related peptide (CGRP).
There is currently no cure for migraines, but they can be managed effectively with the right treatments. It’s important to remember that you may not find the right treatment for you immediately - it’s possible you’ll have to try a few different combinations before finding the most effective one.
An effective way to prevent migraines is to identify your triggers and avoid those. Most people find the most effective way to manage a migraine is not using painkillers, but simply sleeping or lying down in a dark, silent room. Migraines are often exacerbated by bright lights and loud noises, so removing these stimuli can help significantly when trying to manage pain and aura symptoms.
There is a range of prescription migraine treatments available to treat and even prevent migraines, such as migraine tablets. In addition, there are combinations of anti-sickness and over-the-counter pain relief that can be very effective when taken with prescribed treatment. Finding the right mix for you may take time.
Triptans which are taken alongside painkillers, cause the blood vessels in the brain to contract. As some of the changes that occur in the brain to trigger a migraine attack are believed to involve the blood vessels widening, Triptans help to reverse this process and relieve the symptoms of migraine. They may also have some effect by stabilising some of the chemical changes that occur in the brain during a migraine attack.
Triptans are common medication for migraine and have a very similar mode of action, however each can work differently depending on the person. Although there are slight variations in effectiveness and side effects, it is much more important to find the right drug for you. This may mean trying a few different Triptans before you find the most effective one for you.
When choosing the correct triptan it is worth considering the method of administration as this can help to improve the effectiveness. Tablets are the standard form of triptan that are effective in most people, however if you experience nausea or vomiting they may be difficult to take. These tablets need to be taken early on in a migraine attack for a maximal effect as there is some evidence that the absorption of drugs may decrease during a migraine attack.
At Pharmacinta, we have the following medication to help manage your condition: Sumatriptan and Rizatriptan. The exact type of treatment you’ll need will depend upon a few factors, including the type of migraine you have and the severity of your symptoms.
Natural Remedies
There are a plethora of hoax 'home remedies' for migraines online that have little to no scientific backing, however there are a handful of simple natural remedies that are proven to help reduce the symptoms. Ginger is able to ease nausea, including that experienced with a migraine. Magnesium deficiency is closely linked to headaches and migraines, and supplementing your diet with magnesium oxide has been shown to help prevent migraines with auras.
Sleep
Too little, too much and irregular sleep can all trigger migraines. Think about how much sleep is right for you, and when would be the best times to sleep and wake. Try to keep to a regular sleeping pattern and make your sleeping environment as restful as possible.
Exercise
Regular exercise can be an effective way of decreasing the number of migraine attacks. Walking, jogging, swimming, dancing, and cycling are ideal. Make sure that you have had enough to eat and drink, and are not tired before you begin, as this may bring a migraine on.
Healthy Diet
Eat well and eat regularly. Foods, drink and eating habits have long been linked to migraines. Sometimes it's not necessarily the food itself that triggers the attack, it may be a food additive. The brain needs a continuous energy supply to work. Not eating enough, skipping meals, dieting or exercising without eating can all cause a dip in energy levels and bring on a migraine.
Hydration
Water is essential for so many chemical processes within our bodies. If you are not getting enough of it, your body cannot function well and can cause migraines. To avoid this it is recommended that you drink at least eight glasses of water per day.
Caffeine
Too much caffeine or sudden drops in caffeine can set off a migraine. Try to cut down slowly as stopping suddenly can also be a trigger factor. No more than 2-3 cups of tea, coffee or caffeinated drinks (like cola) a day is ideal.
Transcranial magnetic stimulation (TMS)
TMS involves a small device which delivers magnetic pulses to your skin. It has been found to reduce the severity of migraine symptoms in some patients but it doesn't work for everyone. In order to benefit from TMS, you need to undergo treatment during the beginning stages of a migraine. There is currently only limited evidence that the magnetic pulses are an effective treatment for migraine and little is known about potential side effects of the treatment.
Acupuncture
This form of traditional Chinese treatment has a long history in medicine, and involves the insertion of very fine needles into the skin at various key points on the body. These points are said to line up with the flow of Qi through the body, and acupuncture is believed to allow for the free flow of qi, reducing illness. Research demonstrates a definitive improvement in people across many different conditions following acupuncture, however placebo is thought to heavily contribute to its effectiveness.
Stress Management
Stress is the most commonly reported trigger of migraines amongst sufferers, even more frequent than dehydration! Anxiety, pressure or unhappiness in your life can play on one's mind, causing stress that has a very real physiological response, one of which being headaches and migraines. To eliminate, or at least reduce, this contributing factor, participate in the regular practice of stress-reducing activities such as meditation, deep breathing and yoga.
Massage Therapy
Massaging has a well-documented application for pain relief. Massage has been shown to be effective at relieving chronic back pain, acutely damaged skeletal muscles, and even chronic tension headaches [4,5,6]. In addition, massage therapy can be used as a complementary treatment for depression, stress, anxiety and poor quality sleep. This holistic treatment is great for improving circulation, posture and flexibility, and reducing inflammation and stiffness.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) can be used as a psychological treatment for chronic pain, aiming to reduce the negative impact chronic pain has on a person’s mental health. Whilst there is no evidence to suggest that this method is effective at reducing pain in the long term, one study found CBT to be effective at reducing pain immediately after treatment.
Yoga
This practice is a method of relaxing, strengthening and keeping the body flexible through performing specific poses that stretch different areas of the body. There have been mixed conclusions from studies investigating the effectiveness of yoga as a physical pain relief method, but it does help individuals to cope with their pain, and many report feeling more in control of how their pain affects their daily life.
Painkillers
Simple painkillers such as paracetamol, ibuprofen or aspirin, can help to relieve the throbbing headache associated with a migraine attack if they are taken early enough. You should take them at the first onset of symptoms, do not wait until you are already experiencing a painful headache as it will be too late and they may be less effective. Soluble painkillers are absorbed into your system quicker and may be more effective at relieving migraine pain.
If simple painkillers do not relieve pain, stronger painkillers containing codeine, such as Solpadeine or Nurofen Plus, may be more effective. Take care when using painkillers as overuse can be dangerous. Regular use of any painkillers can cause headaches and make migraines worse.
Anti-sickness Treatments
Anti-sickness treatments, such as Buccastem, can be taken to relieve the symptoms of nausea and vomiting that are experienced as part of a migraine attack. Like painkillers, anti-sickness treatments for migraine are best taken as early as possible in an attack if you know you usually experience nausea. The earlier they are taken in the migraine attack, the more effective they tend to be at treating the nausea and sickness.
Preventive Treatment
Preventive migraine medication can be taken daily to reduce the frequency and severity of attacks. This type of treatment is prescribed for people who are severely affected by migraines. Examples of preventive medicines include beta-blockers (like propranolol), amitriptyline, and topiramate.
Frequently Asked Questions
Ocular migraines, also known as retinal migraines, are an eye condition characterised by brief attacks of blindness or visual disturbances like flashing lights in one eye. Though unsettling, these episodes are usually harmless and only last a short time.
A migraine trigger is any event, change or physical act which results in a migraine. In summer, the hot and humid weather, as well as lifestyle factors, may result in more migraines.
Each person has unique triggers which may cause a migraine, including stress, sleep deprivation, anxiety, shock, exhaustion and even poor posture. In order to prevent migraines, it is recommended to eat healthy, exercise regularly, get enough sleep and avoid known triggers.
Medication overuse headaches (MOH), also known as rebound headaches is a type of headache which develops and gets worse with frequent use of headache medication. MOH can occur as a withdrawal action when pain relievers are stopped. They tend to occur every day, or nearly every day.
If someone has a migraine with aura, the aura stage generally lasts between 5 minutes and 1 hour. The headache stage of a migraine can last between 4 and 72 hours.
The main symptom is an intense headache that causes moderate or severe pain. Generally, it occurs on one side of the head and can cause a pulsating or throbbing sensation. Other common symptoms that appear alongside these headaches are sensitivity to light, sweating, nausea, diarrhoea and vomiting. Some people get temporary ‘aura’ symptoms before the main symptoms appear. These symptoms include pins and needles, difficulty speaking and visual disturbances.
Generally, a migraine headache is a moderate or severe headache and may be more severe than another type of headache. Migraine headaches are usually on one side of the head and cause a throbbing sensation. Other migraine symptoms are possible such as nausea, vomiting, sensitivity to light, and aura. Some people also may see spots or flashing lights or have a temporary loss of vision. Migraine can occur almost any time any time of the day, though it often starts in the morning. A tension headache is usually a mild to moderate pain, it's distracting but not debilitating. It affects both sides of the head and rarely causes sensitivity to light.
Migraines are most common in females; 75% of migraine sufferers are women. There is no known cause for the difference in migraine occurrence between the sexes.
Over 50% of migraines in women occur right before, during, or after a woman has her period. This is called “menstrual migraine.” It is still unclear how the menstrual cycle and migraine are linked. It is known that just before the cycle begins, levels of the female hormones, oestrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine.
Changing blood sugar levels can be a trigger for migraines.
It is a well-known myth that if you avoid chocolate, cheese and red wine, you won't get migraine. Although these can all be triggers for migraines, there are many different triggers and what may affect one person does not necessarily affect another.
There may be a hereditary predisposition to migraines, as it does tend to run in families although not everyone in the family will suffer with them. There will usually be a number of factors influencing whether you develop migraines, not just your family history.
Alcohol can be a migraine trigger for certain people. For this reason, migraine sufferers tend to consume alcohol less often than most. A bad hangover also has the potential to cause a migraine in those who are prone to the affliction.
Obesity does not directly cause migraines, however, it is a risk factor and may mean that it’s more likely – depending on how overweight the person is.
Precision tinted lenses are thought to help reduce the discomfort experienced when a migraine attack occurs. They do this by normalising excessive brain activity, which can sometimes act as a trigger.
Some research shows that taking magnesium tablets (usually magnesium oxide) once a day can help to prevent menstrual-related migraines.
It depends on the severity and regularity of your migraines. You may find some medicines are more effective than others and some can be taken with or without migraine auras.
Anti-emetics are a type of medicine used to treat nausea and vomiting. For migraine patients, however, anti-emetics can sometimes effectively stop migraine headaches when triptans haven’t been effective.
Triptans are the newest and most popular type of migraine treatment. They include almotriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan.Triptans work by constricting the widened (dilated) blood vessels in the brain that are thought to occur during a migraine. They may also stabilise the changes in activity of some brain chemicals that occur during a migraine attack.
There is no best migraine treatment that suits everyone. All Triptans would probably work well in most people with migraine. However, there is some evidence to suggest that some are slightly more effective than others; but also, that side effects may vary between each different Triptan and each can have different levels of effectiveness in separate individuals.
Yes, you can take a painkiller like paracetamol if your sumatriptan dose is not effective.
Yes, you can buy two 50mg sumatriptan tablets from pharmacies without a prescription for those previously diagnosed with migraines. It can be prescribed in higher quantities and strengths online by our UK registered doctors.
The drug is sold in two other forms: as orodispersible tablets that disperse on the tongue and wafers that dissolve in the mouth. The wafers are recommended for those who feel nauseous or are unable to swallow tablets with water.
The active ingredient in Rizatriptan is rizatriptan benzoate while the active substance in Sumatriptan is sumatriptan succinate. Being of the same class of medication, they both narrow the blood vessels surrounding the brain. However, Rizatriptan has been clinically proven to work faster than Sumatriptan, while food affects the action of Sumatriptan less than Rizatriptan.
Imigran is a brand of medication which contains the active ingredient sumatriptan. Sumatriptan belongs to the family of anti-migraine medications called ‘triptans’. Imigran and our generic version of sumatriptan are medically equivalent and interchangeable. The difference is that Imigran is the branded version of the medication, and therefore costs more than the generic version of sumatriptan.
If the first dose of Sumatriptan did not work, you can take a painkiller such as paracetamol, aspirin or a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen.
It is advised to not drink alcohol because Sumatriptan may cause drowsiness or dizziness which would make the effect worse if mixed with alcohol.
Sumatriptan can be used in pregnancy if over the counter medication has been ineffective but it is best to consult with your GP before using Sumatriptan. Similarly, it is best to consult with your doctor if you are breastfeeding, as sumatriptan can pass into breast milk.
