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Migraine

migraine; headache; head; ache; pain; aura; classical; cluster; headaches;

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Migraine is a type of really bad headache that is often felt on one side of the head (behind the eye). It can last for a couple of hours, a day or even up to a few days.

Sometimes the person will get some warning that a migraine is on its way and may be able to lessen its effects.

People with a migraine headache often feel sick, and may vomit during the headache. The pain of a migraine is often so severe that the person is not able to carry on with normal activities such as working, reading or school activities. Even after the headache stops they may still feel unwell for a few more hours. After that they are completely well again.

Migraine headaches can occur a couple of times a week, a couple of times a month, or quite rarely. Most people with migraine will find that there are other people in the family who also get bad headaches.

Alert!
If you get a severe headache for the first time, or a severe headache that is different to your usual headaches, you need to be seen by a doctor urgently, because some major health problems such as meningitis, concussion or bleeding inside the head can cause a severe headache.

What causes migraine?

  • It is not clear why some people get migraine, but it is probably in their genes. Most people who get migraines have other family members who get migraines.
  • Much of the pain seems to be caused by changes in blood flow to the brain and to the tissues covering the brain (the meninges), but there is also something going on inside the brain itself. Chemicals called neurotransmitters (chemicals which transmit a message from one nerve cell to the next), such as tryptamine and dopamine, are involved.

Who gets migraine?

  • Migraine is common - about one in ten people get migraine headaches. Migraines often start in the teenage years, but some younger children get them.
  • After puberty, about three times as many girls and women get migraines compared with boys and men.
    • For many girls and women, migraines tend to happen around the start of their period, probably due to hormone changes.
    • Many girls will have their first migraine after they have started having periods.
    • Migraines tend to happen less often during pregnancy.
  • It seems that more people may be getting migraine now than 20 years ago. It has been suggested that this is because of increasing exposure to things that can trigger migraine.

Types of migraine

There are several different patterns of migraine. Three of the more common types are common migraine, migraine with aura, and cluster headaches.

Common migraine

Common migraine affects about 80% of people who get migraines.

  • There is no 'aura' (see 'Migraine with aura' below) but there may be some signs that the person will get a migraine, such as mood changes, irritability, increased sensitivity to light, sound or smells and difficulty concentrating. These can start several hours or up to a day before the migraine pain begins.
  • The headache usually starts on one side of the head, but sometimes spreads to both sides. Sometimes the pain is on both sides of the head from the beginning.
  • The pain is usually throbbing, and it is usually made worse when the person moves.
  • The person often feels sick and vomits, and is very sensitive to light and sound.
  • The person usually needs to lie down in a dark room.
  • The headache can last for a few hours, or sometimes up to 3 or more days, and may go away if the person can get to sleep.

Migraine with aura

Migraine with aura is also known as 'Classical' migraine.

  • Before the pain starts, some people will get some signs that a migraine is coming (an 'aura'). It may be that they suddenly notice they cannot see clearly and they may have flashing spots (sometimes in a semicircle which slowly gets larger). Sometimes the aura may be a feeling of weakness or tingling on one side of the face or body, or difficulty talking.
  • The aura usually lasts less than 40 minutes, then it clears and the headache starts.
  • The pain and other effects (including feeling sick and vomiting) are the same as a common migraine, but may not last as long (usually less than 24 hours).

Cluster headaches

Someone with 'cluster headaches' will have a lot of severe, one sided headaches, which may last an hour or so, but come back several times a day or several times in the next few days. These types of migraine headaches happen more often for males (sorry guys!). They may start at the same time of the day, often at a particular time at night.

Migraine triggers

It may be possible to find out what triggers a migraine attack for some people.

  • Some triggers include:
    • hormone changes (eg. before a period)
    • missing a meal
    • missing sleep
    • alcohol
    • stress or excitement
    • exercise
    • heat
    • some smells
    • some foods or food additives
    • some medicines
    • bright lights or flashing lights
    • vision problems, such as being long-sighted
    • changes in the weather (eg before a storm).
  • Some people regularly get a migraine on the day after stressful times, such as the day after an exam (this may be called a 'let down' migraine).
  • Although food triggers are often spoken about, they affect only a small number of people who get migraine. The most likely food causes are usually said to be chocolate, hard cheeses, citrus juices (orange or lemon) and red wine. Missed meals or not having enough to eat probably trigger more attacks than all the food triggers combined.
  • In the earliest stage of a migraine, a person can be sensitive to bright lights, foods or smells and may link them to the migraine, even though they did not trigger the migraine.

Preventing migraine attacks

  • It might help if you can avoid migraine triggers, such as being very careful not to miss meals (especially not skipping lunch at school).
  • Glare and bright light can be reduced by wearing polarised glasses - wraprounds are best - and wide-brimmed hats.
  • Get your eyes checked to find out if you have vision problems.
  • If stress seems to be a trigger, learning relaxation techniques may help cut down the number of attacks and might make them less severe. Have a look at the topics about Stress.
  • If you are getting a lot of attacks, your doctor may be able to give you some medicine to take each day to prevent an attack starting.
  • If the migraines are happening most of the time at the same stage of a menstrual cycle, taking hormones such as the ones in some types of the Pill may help. (Note: sometimes some types of the Pill can make the headaches more common).

If migraines are happening often, keep a diary of the headaches to see if there is a pattern to the headaches.

  • This might help you to find the triggers (for example, girls could see at what stage of a menstrual cycle they are happening, or you might find out that they only happen when you have to do a lot of reading).
  • It can also help to find out if there are early signs of the headache which might allow you to start treatment before the pain starts.

Treating an attack

  • It is important to get advice from a doctor about managing bad headaches.
  • If you get a warning (aura), the headache might be avoided or the pain might be much less severe if you take medication immediately, before the pain starts. Simple pain relievers such as paracetamol or ibuprofen may work if taken early.
    • There are many other medications that are also often effective if taken early in an attack. These usually need to be prescribed by a doctor.
    • Once the pain becomes severe, medicines taken orally (swallowed) often do not work because the migraine stops them being absorbed into the body. If the attack is severe, medication may need to be given by injection.
  • If possible, stop other activities, and lie down in a cool, darkened, quiet place.
  • Cold packs placed on the forehead, and hot packs on the back of the head and neck may help.

References and further information

MedlinePlus (National Library of Medicine USA) 'Migraine':
http://medlineplus.gov/

HealthInsite (Australia) 'Migraine':
http://www.healthinsite.gov.au/topics/Migraine

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).
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