Migraine

A neurological condition, not a bad headache. Around one in seven people, and the second leading cause of years lived with disability worldwide.

What it is

Calling migraine a headache is like calling epilepsy a twitch. It is a neurological condition affecting around 10 million people in the UK, and the World Health Organization ranks it among the leading causes of disability globally.

An attack has phases. A prodrome hours or days before: yawning, mood change, food cravings. Sometimes an aura: visual disturbance, numbness, speech difficulty. Then the headache, often one-sided and throbbing, with nausea and extreme sensitivity to light and sound. Then a postdrome, the migraine hangover, which can last another day.

Some migraines involve no headache at all, which is why they get missed entirely.

Signs you might notice

Moderate to severe head pain, often one-sided, worse with movement.

Nausea and vomiting. Needing a dark, quiet room.

Aura: zigzag lines, blind spots, tingling spreading up an arm, difficulty finding words.

Attacks lasting 4 to 72 hours.

Triggers that are usually cumulative rather than single: missed meals, poor sleep, dehydration, hormonal changes, stress and, importantly, the let-down after stress.

How it can affect day-to-day life

Medication overuse headache is the trap almost nobody is warned about. Taking painkillers, including triptans, on more than 10 to 15 days a month causes a persistent daily headache that only improves by stopping them, which takes weeks and feels dreadful.

The workplace cost is enormous and largely hidden, because people work through attacks badly rather than reporting them.

Chronic migraine, 15 or more headache days a month, is a specific diagnosis that unlocks specific treatments including Botox and CGRP drugs, and many people who qualify have never been assessed for it.

Supporting someone well

Keep a diary. Attack days, medication days, and what preceded them. It is what makes a preventive treatment decision possible, and it catches medication overuse.

Treat early and adequately. A half dose taken late works far less well than a full dose taken at onset.

Count medication days per month and act if they exceed ten.

Ask about preventive treatment if there are four or more attacks a month. Several options exist and many people are never offered any.

Regularity beats avoidance. Consistent sleep, meals and hydration prevent more attacks than eliminating individual foods.

At work, a dark quiet space and the ability to leave early prevents more lost days than presenteeism does.

Where to get help

A GP manages most migraine. Ask about preventives, and about referral to a headache clinic for chronic migraine.

The Migraine Trust have a helpline and a good diary tool.

Sudden severe headache reaching maximum in seconds, or headache with fever, neck stiffness, weakness or confusion, is an emergency.