What is migraine? Information for patients Neurology

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1 What is migraine? Information for patients Neurology

2 page 2 of 12

3 What is migraine? A migraine is a headache which is usually felt at the front or side of the head. It can be felt as a throbbing or pulsating pain and may vary from moderate to severe. The pain may often be worse when moving around, so many individuals prefer to be still. Pain may last from a few hours to several days and may be associated with other symptoms, such as: Nausea Vomiting Sensitivity to light or sound The frequency of attacks may also vary from several times a week, to years in between attacks. Those individuals who are prone to migraine may find that they experience recurrent headaches that interfere with their lifestyles. What is migraine aura? In some individuals who have migraine, an attack may be preceded or accompanied by a sensation, or feeling known as an 'aura'. The most common type of aura involves visual symptoms such as bright zig-zag lines or spots affecting your vision. Such symptoms typically last less than an hour. Other less common types of aura include: Tingling of the arm or face Speech difficulties Difficulty in moving limbs Some individuals may have aura symptoms without experiencing any headache at all. page 3 of 12

4 How common is migraine? Migraine is estimated to occur in 20% of women (20 in every 100) and 6% of men (6 in every 100). It may occur at any age, although generally begins in the teens or 20 s. What causes migraine? The underlying causes of migraine are not known but it is considered to be a disorder of the brain. Patients with migraine often have a genetic background that makes them vulnerable to this condition. It is therefore common to have family member(s) who also experience migraine. It is thought that those experiencing migraine symptoms become more sensitive to their environment, such as light, sound, smell and sometimes touch. The exact reason for this is not known. One explanation is that individuals who are prone to migraines, process information differently to those who don't have the condition. Some theories include malfunction of nerve signals or the way in which salts move in and out of nerve fibres as being responsible for migraine. The abnormality is probably below microscopic level, so routine brain scans look normal. Another theory considers emotions as being a mechanism by which the brain becomes sensitised and could therefore play a part in the development of chronic migraine. What causes migraine 'aura'? During migraine aura there is thought to be extra electrical activity on the brain surface. Electricity can spread across the brain surface to those areas controlling our senses and cause symptoms related to visual changes or tingling/numbness in the face, arms or legs. page 4 of 12

5 Are there any triggers for migraine? Triggers may make migraine attacks more likely to occur. A common factor is the hormone oestrogen and some women will experience severe headache related to their menstrual cycle. Environmental factors can also trigger migraine, including: Bright light Strong smells Weather changes Stress Lack of sleep Sleeping late Missing meals Alcohol Some doctors advise avoiding all triggers but this is not always practical. A balanced lifestyle is perhaps the best approach. How is migraine diagnosed? Migraine diagnosis is based on the symptoms you have and an examination by your doctor. It is therefore helpful to keep a simple diary detailing the following: Date of the attack Severity Duration Treatment used Details of any other symptoms page 5 of 12

6 Are any investigations/tests required for migraine? As migraine symptoms can be severe, many patients become anxious that their headache is related to something more serious. In the vast majority of cases there is no physical abnormality, with studies showing that where abnormalities are found on scans, they are rarely linked to the migraine itself. The vast majority of migraine patients need no tests. If you have any concerns about this, please speak to your doctor. What treatment can I take for an attack of migraine? Drugs taken for a migraine headache at the time of the attack are known as 'abortive' drugs. Although some people can continue with their daily activities whilst having a migraine, many find it helpful to lie down in a dark, quiet room and sleep. This may shorten or prevent the migraine from becoming severe. The medications usually considered for migraine include: Acute or abortive treatments: Analgesics e.g. paracetamol, aspirin, ibuprofen. If you have stomach ulcers, a history of bleeding from your stomach or acid reflux you may not be able to take aspirin or ibuprofen and an alternative drug will have to be tried. Triptans e.g. sumatriptan. There are a number of triptan drugs that can be taken at the onset of a headache. However, they are not specifically designed to treat aura. A combination of a triptan and another drug such as aspirin or paracetamol For an acute migraine attack we now recommend a combination of medication. Your doctor will advise which is the best combination for you. page 6 of 12

7 Codeine is not recommended for the acute treatment of migraine. It is important when treating migraine that medication works every time. If the attack resolves within a short period of time after taking medication, but reoccurs within the next 24 hours then the medication can be taken again. If it does not work the first time then it is unlikely to work the second time. If, after three attempts at using a particular medication, two out of three attacks do not resolve, the medication should be abandoned and another tried. Anti-emetic (anti-nausea/sickness) treatments If your migraine is associated with nausea then anti-sickness drugs, known as anti-emetics, may be used. There are various options including: Metoclopramide Domperidone Prochloroperazine However, frequent use of these should be discussed with your GP or neurologist. Is there anything I can take to prevent migraines? There are some medications which can be taken to help prevent migraines, these are known as prophylactics. Prophylactics are commonly used to treat other disorders though studies show that they are also effective in preventing migraine. The most common preventive drugs are: Propranolol (used for treating high blood pressure) Topiramate (used for treating epilepsy) Amitriptyline (used for treating depression) page 7 of 12

8 A preventive drug should be taken every day, usually for a number of months. They should be started at low doses and built up gradually over time to find the most effective dose. The amount taken will vary for each individual. If you are not tolerant of one drug, it can be stopped and another tried, and so on until the one that suits you best is found. Occasionally, drugs that may be effective in the long term, cause temporary worsening of your headache symptoms in the initial stages. It is therefore worth persevering whilst trying such treatments with the possibility of increasing the drug slightly more slowly. No medication is guaranteed to be free of side effects. If you experience worrying problems when taking a new drug, you should contact your doctor or local pharmacist for advice. It is important to note that preventative treatment may only be helpful if you avoid caffeine and other acute drugs (such as painkillers). Can migraine drugs be taken during pregnancy? No drug is known to be 100% safe in pregnancy. The greatest risk is in the first few weeks of pregnancy (i.e. before your know you are pregnant). If taking preventative drugs for migraine, it is strongly advised to take contraceptive precautions to avoid pregnancy. Some drugs are known to be associated with a small increased risk to the unborn child. If you are thinking of, or planning, a pregnancy then you should discuss treatment of migraine with your GP or neurologist. page 8 of 12

9 What is medication overuse headache and why is it important? Some people have frequent migraines and rely on painkillers to manage their condition. Although such drugs can appear to work in the short-term, frequent medication use over a prolonged period of time can worsen headache for some people. If the headache worsens under these circumstances or does not resolve, the medication itself may be causing the headache. Your GP or neurologist will be able to provide further details about this type of headache and treatment if appropriate. Are there any other treatments? Yes, there are other treatments for migraine that can be tried. Research into the cause and treatment of migraine is taking place around the world, including the use of devices that do not use drugs. A number of these options are still being trialled and will take time to be formally approved. Further potential treatments can be discussed with your neurologist. Is migraine linked to depression or anxiety? Studies have shown that individuals with migraine are more prone to experience depression and anxiety. However, these disorders are independent of each other. This means that depression and migraine may occur in the same patient but will often occur at different times and not be related. Treatment of one will, therefore, not result in improvement of the other. page 9 of 12

10 What is the outlook long-term? The successful management of migraine involves a number of key factors which include: The correct diagnosis Managing your lifestyle Considering the use of acute and preventative treatment Management may take time but can result in good control of migraine with minimal disruption to your quality of life. Most individuals who experience migraine find that their symptoms improve as they age. page 10 of 12

11 Where can I find more information on migraine? Diagnosis and treatment of migraine: General information on migraine: information and support/advocacy for migraine. Information, advice and support for migraine. Some information/leaflets require membership or need to be purchased: This leaflet is intended to be a general guide to migraine. If you have any other queries or concerns about your headache or medications then please don't hesitate to discuss them with your GP or your neurologist. page 11 of 12

12 Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No Alternative formats may be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8562-PIL3616 v2 Issue Date: April Review Date: April 2018

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