Migraine: symptoms, triggers, diagnosis and everyday management

Migraine is much more than an ordinary headache. It can disrupt work, study and family life, yet there are many ways to manage it. This review explains the symptoms, triggers, diagnosis and treatment of migraine, using information from the NHS, MedlinePlus and the US National Institute of Neurological Disorders and Stroke (NINDS).

1. Introduction

Migraine is a condition that causes recurring attacks of severe headache, nausea and sensitivity to light and sound. The NHS says it cannot be fully removed, but treatment can ease symptoms and reduce how often attacks happen ^[1]. NINDS describes it as linked to problems with nerve signalling, brain chemicals and blood vessels in the brain ^[3]. The exact cause is not known ^[1].

2. Signs and symptoms

NINDS and MedlinePlus describe attacks that can pass through four phases, though not every attack includes all of them ^{[2, 3]}:

• Prodrome: early warning signs hours to a day or more before the headache, such as food cravings, mood changes, yawning and needing to pass urine more often.
• Aura: felt by only some people. It can include zigzag lines or flashing lights, tingling or numbness, trouble speaking and dizziness. It usually lasts no more than an hour ^{[1, 3]}.
• Headache: usually a throbbing pain on one side of the head that builds gradually and may get worse with movement. Nausea, vomiting and sensitivity to light, sound and smell are common ^{[1, 3]}. Some attacks have no headache at all ^[2].
• Postdrome: tiredness, confusion and trouble concentrating that can last up to a day or two ^{[2, 3]}.

The NHS says attacks typically last from 4 hours to 3 days ^[1]. Chronic migraine means headaches on at least 15 days a month for more than three months ^[3].

3. Causes and triggers

Researchers believe migraine has a genetic basis, and a close family member with migraine raises the risk. Women are affected more often than men ^{[1, 2]}.

Triggers differ from person to person. Sources list stress and tiredness, skipped meals, too much caffeine, hormonal changes such as periods, bright or flashing lights, strong smells, loud noises, changes in weather, irregular sleep, tobacco and heavy alcohol ^{[1, 2, 3]}. Some foods may contribute alongside other triggers, and a migraine diary, which records when attacks happen and what came before them, helps you find your own pattern ^{[1, 3]}.

4. Diagnosis and tests

NINDS explains that diagnosis relies on a health history, physical and neurological examinations, and detailed questions about when the headaches start, how long they last and what they feel like. Scans such as MRI or CT are not usually needed unless another condition is suspected ^[3]. MedlinePlus says tests may be used to rule out other causes of similar symptoms ^[2].

5. Treatment and management

Your doctor decides the right plan. The sources describe these approaches:

• Relief during an attack: the NHS lists painkillers taken as soon as the headache starts, along with specific migraine medicines and medicines for sickness ^[1]. Taking medicines early tends to work better ^[2]. Resting in a quiet, dark room, a cool cloth on the forehead and drinking fluids may help ^{[2, 3]}.
• Preventing attacks: for people with frequent or severe attacks, doctors may offer regular preventive medicines. Finding one that works may take several tries ^[3].
• Non-medicine approaches: relaxation techniques, talking therapy, biofeedback and acupuncture are described by the NHS and NINDS ^{[1, 3]}.
• Supplements: NINDS notes that supplements are not well tested and can interact with medicines, so ask a doctor first ^[3].

The NHS warns that using painkillers on more than about 2 days a week can make headaches more frequent and migraine harder to treat ^[1].

Living with migraine often means planning ahead. People who know their triggers can adjust their routine, for example by keeping meal times steady and getting enough sleep. NINDS notes that migraine is more common in females, likely because of hormonal influences linked to the menstrual cycle and pregnancy, and that birth control can change how often attacks happen and how severe they are ^[3]. People with migraine also have higher rates of depression, anxiety, sleep disorders and epilepsy, so mention any changes in mood or sleep to your doctor ^{[2, 3]}.

6. Prevention and self-care

The NHS advises eating at regular times, limiting caffeine and alcohol, staying hydrated, exercising regularly, sleeping well, keeping a healthy weight and managing stress ^[1]. Migraine often improves with age, after menopause and sometimes during pregnancy ^[1].

7. When to see a doctor

See a doctor if attacks are severe, getting worse, happen more than once a week, are hard to control or regularly come around your period. Seek urgent advice if an attack lasts longer than 72 hours, an aura lasts longer than an hour, or you are pregnant or recently gave birth ^[1].

Get emergency help for a sudden, extremely painful headache, weakness on one side of the face or body, vision loss or double vision, speech or memory problems, confusion or drowsiness, a seizure, a high temperature with symptoms of meningitis, or a headache after a recent head injury ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Migraine is a common, long-term condition with recurring attacks that vary between people. Understanding the phases, learning your triggers and working with a doctor on both attack relief and prevention can reduce its effect on daily life.