Ask the Doctor: ‘How can I stop my migraines, or be better prepared for them before they start?’

”I have always suffered with bad headaches and migraines. Recently I have had to call in sick to work and cancel plans with friends. Is there anything I can do to try and stop my migraines or prepare better for them? I have also heard some migraine sufferers know they are about to have a migraine beforehand. What should I look out for?”

Answer from Anhar Hassan, Consultant Neurologist, Beacon Hospital

Migraines are very common. They can be debilitating, leading to loss of productive days at work or school. A migraine headache typically lasts at least 4 hours (if left untreated), sometimes up to 2-3 days. It is usually throbbing or pounding pain on one side of the head. Common locations are behind the eye and over the forehead. The headache is usually accompanied by nausea or vomiting, or sensitivity to light, sounds or smells. It can be moderate to severe pain, although milder headaches can occur.

About 1 in 5 people with migraine have an ‘aura’ just before the headache. Most common is a visual aura: flashing lights, zigzag patterns, or distortions (‘heatwave’ or ‘looking through water’). These typically slowly enlarge then disappear after 15-60 minutes. Less common aura include tingling or numbness on one side of the body, vertigo (spinning sensation), confusion, or garbled speech. Weakness on one side of the body with migraine headache is very rare. This is termed “hemiplegic migraine” and can look like a stroke, so it is important to seek medical attention right away to investigate this. Rarely, aura may occur without a headache. Many patients notice a warning period before the headache, with tiredness, irritability, and altered appetite. After the headache, there may be a “hangover” effect with tiredness.

We don’t really know what causes migraine. It seems to be linked to oestrogen, which may explain why it is much more common in women than men. Sometimes it runs in families suggesting a genetic link. Some people notice a ‘trigger’ such as red wine, lack of sleep, or stress.

There are many effective treatments for migraine. Always consult your doctor or pharmacist about any treatments before starting them. To treat a mild-moderate migraine headache: Aspirin, paracetamol, or ibuprofen (or other NSAID) taken immediately at the start of the migraine can “nip it in the bud”, to prevent a full-blown headache. Combination drugs (paracetamol or NSAID, with codeine) should be taken rarely, as these can worsen headache.

To treat a moderate-severe headache: A triptan (e.g. sumatriptan, zolmitriptan) is a specialised migraine medication prescribed by a doctor. This is taken immediately at onset of the migraine to stop it. If not fully effective, switching triptans might provide a better result. Triptans should not be used more than 2 days per week or can worsen headaches. Triptans are not recommended for some people, so talk to your doctor. Anti-nausea medication can help nausea or vomiting.

If migraines are frequent (i.e. 2 or more headache days per week) or bothersome, your doctor may recommend a daily preventive medication. There are lots of different preventive medications (e.g. beta-blockers, other blood pressure medicines, amitriptyline, anti-seizure medicines). It can take up to 2-3 months to assess if it works. Magnesium or riboflavin supplements may also prevent migraine. Specialist treatment with Botulinum toxin injections and greater occipital nerve blocks can help certain patients. Keeping a diary is recommended to track headaches.

Getting enough sleep, regular meals, regular exercise, stress management and relaxation are also important for managing migraines. Consult your GP to start the conversation and embark on a treatment / prevention plan.

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