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Migraine
Reviewed by the PMC Medical Team · Promise Medical Centre
Overview
Migraine is a common neurological condition characterised by recurrent, often severe headaches, typically on one side of the head, frequently accompanied by nausea, vomiting, and sensitivity to light and sound. It affects roughly 1 in 7 people worldwide and is more common in women than men. Migraine attacks can last from a few hours to several days and can significantly disrupt work, school, and daily life, though it is not life-threatening.
Symptoms
Migraine attacks often occur in phases, though not everyone experiences all of them:
• Throbbing or pulsating headache, usually on one side of the head
• Nausea and, sometimes, vomiting
• Sensitivity to light (photophobia), sound (phonophobia), and sometimes smell
• Visual disturbances ("aura") before the headache in some people — flashing lights, zigzag lines, or blind spots
• Tingling or numbness in the face or hands (with aura)
• Fatigue and difficulty concentrating
• Neck stiffness
• Worsening pain with physical activity
When to See a Doctor
See a doctor if you experience recurrent headaches that disrupt daily life, if over-the-counter pain relief is no longer effective, or if headaches are becoming more frequent or severe.
Seek emergency care immediately for a headache that is:
• The "worst headache of your life," coming on suddenly and severely
• Accompanied by fever, stiff neck, confusion, seizures, double vision, weakness, numbness, or difficulty speaking
• Following a head injury
• New in someone over 50, or in someone with cancer or a weakened immune system
• Progressively worsening despite treatment, or changing in pattern
Causes
The exact cause of migraine is not fully understood, but it involves changes in nerve pathways, brain chemicals (particularly serotonin), and blood vessels in the brain. Migraine tends to run in families, suggesting a genetic component. Attacks are often triggered by:
• Hormonal changes (menstruation, pregnancy, hormonal contraceptives)
• Certain foods and drinks (aged cheese, alcohol — especially red wine, caffeine, or caffeine withdrawal)
• Stress and anxiety
• Sensory stimuli (bright or flickering lights, strong smells, loud noises)
• Changes in sleep pattern (too much or too little)
• Weather or barometric pressure changes
• Skipping meals or dehydration
• Physical exertion
Risk Factors
• Family history of migraine
• Female sex (migraine is up to three times more common in women, linked to hormonal fluctuations)
• Age: often begins in adolescence, peaks in the 30s
• Hormonal changes, including menstruation, pregnancy, and menopause
• High stress levels
• Sleep disorders
• Obesity
Complications
• Chronic migraine (headaches on 15 or more days a month)
• Status migrainosus: a severe attack lasting longer than 72 hours
• Medication-overuse headache from frequent use of painkillers
• Reduced quality of life, missed work or school days
• Rarely, migrainous infarction (a stroke associated with migraine with aura)
Prevention
• Identify and avoid personal triggers (keeping a headache diary can help)
• Maintain a regular sleep schedule
• Eat regular meals and stay well hydrated
• Manage stress through relaxation techniques, exercise, or counselling
• Limit caffeine and alcohol intake
• Take preventive medication as prescribed by a doctor if migraines are frequent or severe
• Exercise regularly, in moderation