No clear reason for attacks of Migraine

By Dr Michelle Cooper

Published 25/06/2016 | 00:00

Dr Michelle Cooper. Photo Eye Focus
Dr Michelle Cooper. Photo Eye Focus

About 1 in 4 women and about 1 in 12 men develop migraine at some point in their lives.

 It most commonly starts in childhood years or in early adult life. Some people suffer from frequent attacks - sometimes several attacks per week. Others suffer from infrequent attacks only occurring now and then and some may go for years between attacks. In some people, the migraine attacks stop in later adult life. However, in some cases the attacks continue (persist) throughout life.


There are two main types of migraine:

- Migraine without aura - sometimes called common migraine.

- Migraine with aura - sometimes called classic migraine.

Migraine without aura: This is the most common type of migraine. Symptoms include the following:

- Headache which are usually on one side of the head, at the front of the head or sometimes on both sides of the head. Occasionally headaches start on one side, and then spread all over the head. The pain may be moderate or severe and is often described as throbbing or pulsating. Movements of the head may make the headache worse. Headaches often begins in the morning, but may begin at any time of the day or night. Typically, pain gradually gets worse and peaks after 2-12 hours, then gradually eases off. However, headaches can last from 4 to 72 hours.

- Other migraine symptoms are as follows: feeling sick (nausea; being sick (vomiting); not liking bright lights or loud noises.

Migraine with aura: About 1 in 4 people with migraine have migraine with aura. The symptoms are the same as those described above (migraine without aura), but also include a warning sign (known as an aura) before the headache begins.

- Visual aura is the most common type of aura. Examples include a temporary loss of part of one's vision, flashes of light as well as objects which may seem to rotate, shake, or boil within ones visual field.

- Numbness and pins and needles are the second most common type of aura. Numbness usually starts in the hand, travels up the arm, then involves the face, lips, and tongue. The leg is sometimes involved.

- Problems with speech are the third most common type of aura.

- Other types of aura include an odd smell, food cravings and a feeling of well-being.

One of the above auras may develop, or several may occur one after another. Each aura usually lasts a few minutes before passing and usually passes before the headache begins. The headache usually develops within 60 minutes of the end of the aura, but it may develop a lot sooner than that - often straight afterwards. Sometimes the aura occurs and no headache follows. Most people who have migraine with aura also have episodes of migraine without aura.


Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Common triggers include the following:

- Dietary factors - dieting, irregular meals, cheese, chocolate, red wines, citrus fruits, and foods containing a food additive called tyramine.

- Environmental factors - smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.

- Psychological factors - depression, anxiety, anger, tiredness, stress, etc. Many people with migraine cope well with stress but have attacks when they relax, leading to so-called weekend migraine.

Medicines e.g. hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.

- Other factors - periods (menstruation), shift work, different sleep patterns, and menopause.


Painkillers - Paracetamol or aspirin works well for many migraine attacks.

Anti-sickness medication - Migraine attacks may cause a feeling of sickness (nausea) which can cause poor absorption of tablets into your body. If you take painkillers, they may remain in your stomach and do not work well if you feel sick. Like painkillers, they work best when taken as soon as possible after symptoms begin.

Triptan medications - A good alternative to painkillers if painkillers do not help. They work by interfering with a brain chemical called 5HT. An alteration in this chemical is thought to be involved in migraine. Triptans should not be taken too early in an attack of migraine. (This is unlike painkillers described above which should be taken as early as possible.)

Your GP can advise on the various preventative medications available. For further advice please visit

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