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Our blog series investigating migraine will delve into everything about the condition. From the symptoms to how you can soothe and treat it, in this first blog, we’ll cover what migraine is and what the causes are.

What is migraine?

Migraine is a neurological disease that causes various symptoms, most notably severe headaches. They are classified as a primary headache, meaning no underlying health condition or other illness causes it. Around 1 in every 5 women and 1 in every 15 men experience migraine.

In the UK alone, around 190,000 migraine attacks occur every day, with around 10 million 15-69-year-olds suffering from migraine in the UK. Some people regularly experience migraine, while others do not as often. There are various treatment options available, such as the Cefaly Dual.

Many people believe migraine to be just a headache. However, migraine is so much more than a bad headache. It is a complex neurological disease with an array of debilitating symptoms.

The significant difference between headaches and migraine is the severity of pain. Headaches can occur anywhere in the head, neck, or shoulders, have varying pain intensities, and only last a few hours. A migraine, on the other hand, can last for days and result in throbbing and debilitating unilateral pain in the forehead area.

Not every migraine attack can cause head pain, however. Sometimes, an attack can include other symptoms such as an aura (visual disturbances), nausea, dizziness, or a numb tingling feeling (like pins and needles). People may also experience sensitivity to light or certain sounds and smells, photophobia (light sensitivity that hurts the eyes), and phonophobia (fear of loud noises).

An attack can last anywhere from a few hours to a few days. Symptoms can occur up to 24 hours before the head pain and can last up to 24 hours once the head pain has passed. Most people don’t tend to experience symptoms between attacks, but many with chronic migraine do. This phase is known as the interictal phase of an attack. Any form of physical activity or movement can worsen the head pain.

As migraine causes instability in how the brain deals with incoming sensory information, most people cannot function normally during an attack. Migraine can be an inherited condition with more than half of those with migraine having at least one family member suffering.

There are many different types of migraine, including with aura, without aura, silent migraine, vestibular, hemiplegic, and menstrual migraine. A migraine without an aura displays no prior symptoms, while a migraine with an aura develops sensory disturbances just before the head pain. A silent migraine experiences the aura but with no head pain.

What causes migraine?

Migraine occurs when certain nerves in your blood vessels send pain signals to the brain. Inflammatory substances are then released into the blood vessels and nerves in the brain. Why this happens, though, is still not clear.

While the exact cause of migraine is still unknown, we now have a far better understanding of the mechanisms involved. Research shows that CGRP (Calcitonin Gene Related Peptide) is released into the brain at the start of an attack. CGRP is known to be involved in the process which causes pain during a migraine attack.

Women are more likely to experience migraine compared to males, which is believed to be because of the role of hormones. Before puberty, both males and females experience migraine at the same rate. Hemiplegic migraine causes one side of the body to weaken, while retinal migraine affects vision.

A migraine can occur in four stages or phases, each occurring in order. Not everyone may experience the first phase of a migraine. The four stages or phases are:

  1. Prodrome
  2. Aura
  3. Headache
  4. Postdrome

Prodrome is the first stage and typically lasts a few hours to a few days. This stage does not happen for every migraine, and not everyone may experience it. The Prodrome stage is subtle changes that can often warn people of an upcoming attack.

Different symptoms can be experienced during this stage, including mood changes, depression, euphoria, food cravings, frequent yawning, stiff neck, increased thirst, urination, or constipation.

The Aura phase occurs just before the headache and usually occurs between a few minutes to an hour beforehand. An aura may not occur before every migraine attack. During the aura phase, people experience sensory disturbances, such as flashing lights or blurred vision.

The Headache phase can last between a few hours to a few days in a localised forehead position. While most people may experience throbbing and debilitating headaches, such as an ice pick sensation, some may only experience mild head pain.

The last phase, Postdrome, is often called a ‘migraine hangover’ and can last for a few hours to a few days. Around 80% of migraine sufferers experience Postdrome after an attack, leaving people tired, drained, or lacking concentration.

What can trigger migraine attacks?

There are a wide range of triggers experienced by migraine sufferers. Not all triggers affect everyone, and it may also depend on the intensity or combination of triggers building up. In most cases, a migraine occurs more in the morning (especially after waking up) than at other times.

Certain types of migraine, such as menstrual migraine, occurs before menstruation. There is also some evidence to suggest that migraine gets better the older someone gets.

Here is a list of some of the most common migraine triggers:

Health triggers:

  • Changes in hormone or oestrogen levels in females
  • Menstruation
  • Sex
  • Bipolar disorder
  • Sleep disorders
  • Epilepsy
  • Infections, such as flu

Emotional triggers:

  • Emotional stress
  • Stress or anxiety
  • Shock or depression
  • Excitement
  • Tension

Physical triggers:

Diet triggers:

  • Skipping a meal
  • Drinking caffeine or a lack of caffeine
  • Dehydration
  • Alcohol, especially red wine
  • Tyramine found in certain foods
  • Certain foods, such as citrus fruit, chocolate, or cheese

Medication triggers:

  • Daily consumption of pain-relieving medication
  • Combined contraceptive pill
  • Certain sleeping tablets
  • Hormone replacement therapy

Other triggers:

  • Flashing or fluorescent light
  • Weather changes (such as a stuffy atmosphere)
  • Exposure to certain smells or odours
  • Smoking/tobacco or the smell of smoke
  • Loud sounds
  • Damp or mould
  • Schedule changes
  • Motion sickness

Migraine triggers vary from person to person, with some triggers being rarer than others. It can be challenging to pinpoint the exact triggers, but keeping a migraine diary can be helpful in identifying the factors involved and the symptoms to watch out for.

Stay tuned for our next Investigating Migraine blog post on the different types of migraine.