A migraine is a throbbing, intense headache in one half of the head.  The pain begins suddenly and may be preceded or accompanied by visual, neurological or gastro-intestinal symptoms. There are two main types of migraine - migraine with aura and migraine without aura. Migraine without aura is the most common type of migraine, affecting three quarters of all sufferers.

Migraine affects at least one in 10 of the adult population.  Overall, in any Western adult population, 6% of men and 15% of women will be active migraineurs.  Migraine usually starts during childhood or adolescence, with most people having their first migraine before the age of 19 years.  Onset of migraine after the age of 50 years is rare.

People aged 30–39 years suffer most frequently, with just over a quarter of women of this age experiencing migraine.

Migraine attacks occur when arteries to the brain become narrow (constrict) and then widen (dilate) which activates nearby pain receptors.  What causes the blood vessels to do this is not known but abnormally low blood levels of a chemical substance called serotonin, which is involved in nerve cell communication (neurotransmitter), may trigger the contractions.

Migraine trigger factors include:

• stress
• hormonal changes (particularly in relation to the menstrual cycle or the use of oral contraceptives)
• physical exertion
• too little sleep
• skipping meals
• foods such as alcohol, fatty foods and tea or coffee

Migraine headache, which is typically throbbing, unilateral and aggravated by activity, is the most prominent feature of a migraine attack.  Other symptoms include photophobia (sensitivity to light), phonophobia (sensitivity to sound), visual disturbances, nausea and or vomiting.

Where sufferers experience aura, it nearly always precedes the headache, lasts between 5 and 60 minutes and usually includes visual symptoms such as flashing lights or a growing black spot surrounded by shimmering lights.

Migraine attacks vary in frequency. The average is about one attack per month, but 10% of sufferers experience more than one attack every week and women generally experience more attacks than men.

Diagnosis is based entirely upon symptoms as the causes of migraine are unclear and there are no diagnostic tests.  Doctors must take a careful history from their patients.  Diary cards – used to record information about specific symptoms – can be useful to distinguish between different types of headache.  Migraine is consistently under-diagnosed, partly because many sufferers do not consult a doctor.

There are two approaches to the treatment of migraine:

Management of acute attacks to lessen their debilitating impact. A variety of medicines are available both on prescription and over the counter, ranging from simple analgesics to drugs specifically designed to treat migraine.

Prophylactic treatments are taken daily to reduce the frequency of attacks. They are available on prescription only and are usually reserved for patients with more than two partially or totally disabling attacks a month, lasting at least four days.

Treatment should be tailored to the individual, if side effects occur, it is important to discuss these with your doctor who can look at changing the dose or switching to an alternative therapy.

For most migraine sufferers, prevention is a matter of identifying and then avoiding the trigger factors that set off an attack. This may not be easy. For some, a combination of two or more triggers may apply. A single trigger may be difficult to identify it if occurs as part of other activities, e.g. getting up early, lack of suitable food, tiredness and stress as part of travel. Some trigger factors may prove difficult to avoid, e.g. menstruation or climate changes.

Using a diary card to record details of your attacks may help in identifying your trigger factors.

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