Migraine
Recurrent, often disabling headaches with sensory sensitivity and nausea.
Overview
Migraine is a primary headache disorder. Attacks last hours to days and respond to specific acute and preventive treatments.
Symptoms
- • Throbbing, unilateral headache
- • Nausea or vomiting
- • Light and sound sensitivity
- • Aura (visual or sensory) in 25%
Risk factors
- • Female sex
- • Family history
- • Hormonal cycling
- • Sleep disruption
- • Stress
Causes
- • Neurovascular dysregulation with trigeminal activation
🚨 Red flags — seek urgent care
- • Sudden 'thunderclap' headache (peak within 1 minute)
- • New headache after 50
- • Fever, stiff neck
- • Focal weakness or speech change persisting beyond aura
When to seek care
- • More than 4 attacks per month
- • Aura without headache that is new
- • Medication overuse risk
Diagnosis
- • Clinical diagnosis using ICHD-3 criteria — recurrent moderate–severe unilateral throbbing headache, 4–72 h, with nausea or photophobia/phonophobia
- • With aura: visual, sensory or speech disturbance lasting 5–60 min
- • Imaging only if red flags (SNOOP4: Systemic features, Neurological signs, Onset sudden, Older, Pattern change, etc.)
Treatment
- • Acute: simple analgesia (paracetamol/NSAID) ± triptan ± antiemetic
- • Avoid opioids and overuse of acute medication (>10 days/month = medication-overuse risk)
- • Preventive (≥4 attacks/month or significant disability): propranolol, topiramate, amitriptyline, candesartan
- • Specialist: CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab), botulinum toxin for chronic migraine
- • Lifestyle: sleep regularity, hydration, trigger diary, manage stress
Prevention
- • Identify and manage personal triggers (sleep loss, dehydration, dietary)
- • Regular meal pattern and adequate sleep
- • Limit caffeine and alcohol; manage stress
- • Treat coexisting depression, anxiety and sleep disorders
Complications
- • Chronic migraine (≥15 headache days/month)
- • Medication-overuse headache
- • Migrainous infarction (rare)
- • Status migrainosus (attack >72 h)
- • Significant disability, mood disorder
Education & self-care
A headache diary helps identify triggers (sleep, dehydration, alcohol, specific foods) and confirms diagnosis.
Frequently asked questions
Is migraine dangerous?
The attacks themselves are not — but red-flag headaches need urgent assessment to exclude other causes.
Can it be prevented?
Yes — preventive medication, CGRP antagonists, and behavioral strategies all reduce attack frequency.
What is the difference between acute and preventive treatment?
Acute treatment (triptans, NSAIDs, paracetamol) is taken during an attack. Preventive medication (propranolol, topiramate, amitriptyline, CGRP antibodies) is taken daily to reduce frequency when attacks are frequent or disabling.
Are triptans safe?
Yes for most adults. They should be avoided in people with established coronary, peripheral or cerebrovascular disease, uncontrolled hypertension, or hemiplegic migraine.
Can painkillers cause migraine?
Yes. Regular use of acute medication on 10+ days per month (15+ for paracetamol or NSAIDs) can drive medication-overuse headache. Reducing intake — sometimes with bridging therapy — is the cure.