Migraine Treatment

A migraine is a type of severe headache characterised by throbbing pain affecting one side of the head, nausea and increased sensitivity to light or sound. In some cases, migraines can also result in visual disturbances known as 'aura'.

Migraines are believed to be caused by certain biological factors that predispose an individual to experiencing symptoms. For instance, individuals with a family history of migraines are more susceptible to experiencing migraines themselves, as genetics can affect how an individual’s brain processes pain and responds to migraine triggers.

It is important to note that there is a subtle but important distinction between migraine causes and migraine triggers. Migraine causes, such as an individual’s genetics, predispose that individual to experiencing migraines. In contrast, migraine triggers refer to environmental, dietary and/or lifestyle factors that can initiate a migraine episode in individuals who are susceptible to experiencing migraines in the first place.

For more information, please refer to our comprehensive guide detailing everything you need to know about migraines.

Certain environmental, dietary and/or lifestyle factors can trigger a migraine due to their effects on the brain.

Environmental factors that can trigger a migraine include:

• Changes in barometric pressure - barometric pressure refers to the force exerted by atmospheric pressure on the skull, such as during a storm or when taking a flight. Changes in barometric pressure can cause dilation (widening) of blood vessels in the brain, triggering a migraine. Changes in barometric pressure can also affect the body's ability to retain fluids, causing dehydration which subsequently results in blood vessel constriction (narrowing). This mechanism can reduce blood flow to the brain, triggering a migraine.
• Air pollutants - inhaling certain air pollutants, such as sulphur dioxide, can cause airway constriction and inflammation, decreasing oxygen levels in the blood. This can subsequently trigger the body's stress response and potentially cause a migraine. Inflammation can also activate the trigeminal nerve, a major pain pathway that transmits sensory information from the face to the brain, resulting in the dilation (widening) of blood vessels in the brain. This increases pressure on the nearby nerves and tissues, potentially leading to a migraine.
• Loud noises - in some instances, the brain can accidentally perceive loud noises as a signal for a potential threat. This can initiate a ‘fight or flight’ response, prompting the release of stress hormones such as adrenaline and activating the trigeminal nerve which subsequently results in a migraine.

Dietary factors that can trigger a migraine include:

• Food additives - certain food additives, such as tyramine (in aged foods) and phenylalanine (in sweeteners), can alter the body’s levels of serotonin and noradrenaline which help regulate blood vessel constriction and dilation. This can affect blood flow to the head, increasing pressure on the nerves and subsequently triggering a migraine..
• Alcohol - alcohol inhibits ADH (antidiuretic hormone), causing the kidneys to excrete more water and leading to increased urination and subsequent dehydration. The loss of fluids causes the blood to thicken, changing blood flow and pressure. This results in the constriction and subsequent dilation of blood vessels, which can activate the trigeminal nerve responsible for the transmission of pain signals, causing a migraine.
• Caffeine withdrawal - consuming caffeine can increase the brain’s levels of a neurotransmitter known as adenosine, which causes blood vessels in the brain to dilate. Therefore, reducing or stopping the consumption of caffeine can cause a sudden drop in adenosine, causing blood vessel constriction which can reduce blood flow to the brain, resulting in a migraine.

Lifestyle-related factors that can trigger a migraine include:

• Irregular sleep - sleep deprivation can affect the brain’s levels of a neurotransmitter known as serotonin. Serotonin imbalances can lead to increased sensitivity in the brain's pain pathways, triggering the dilation of blood vessels in the brain. This can cause a sudden increase in blood flow to the brain, causing a migraine.
• Stress - stress increases the production of hormones such as cortisol and adrenaline which heighten the sensitivity of the trigeminal nerve, the brain's primary pain pathway. In response, the trigeminal nerve releases molecules known as neuropeptides which contribute to inflammation, leading to the dilation of blood vessels in the brain. This increases pressure on nerves surrounding the brain, triggering a migraine.

For more information, please read our Expert Guide to Avoiding Migraine Triggers.

Migraine symptoms occur due to the effects of certain triggers on the brain. Some of the most common migraine symptoms include:

• A throbbing pain affecting one side of the head caused by the dilation and inflammation of blood vessels in the brain
• Nausea and vomiting caused by an increase in neural activity in certain parts of the brainstem
• Visual disturbances (Aura), such as flashing lights and/or the appearance of zig-zag patterns, caused by a phenomenon known as "cortical spreading depression" which refers to a wave of brain activity that moves across the visual cortex, temporarily affecting how the brain processes visual information
• Sensitivity to light and sound caused by the over-activation of a part of the brain known as the thalamus, which serves as its main relay (communication) centre for sensory signals

Migraine triggers can cause the affected individual to experience symptoms as a result of three key mechanisms:

• Disruptions in nerve signalling - migraine triggers can increase the sensitivity of the ‘trigeminal nerve’, which relays sensory information from the face to the brain. This results in the transmission of excessive pain signals from the brain to the head, contributing to the throbbing pain experienced during a migraine. In addition, migraine triggers can cause ‘cortical spreading depression’ (CSD), which refers to changes in the electrical activity in regions of the brain associated with sensory perception. CSD can result in visual disturbances such as flashing lights (photopsia) and blind spots (scotomas).
• The narrowing and widening of blood vessels - migraine triggers can increase the sensitivity of the trigeminal nerve, causing blood vessels in the brain to constrict which subsequently results in aura symptoms, such as visual disturbances. This is typically followed by the dilation of the blood vessels, which increases intracranial pressure and exacerbates the throbbing pain caused by disruptions in nerve signalling.
• The release of serotonin within the brain - hypersensitivity in the trigeminal nerve due to migraine triggers can also affect the brain’s levels of serotonin, a neurotransmitter that helps regulate pain perception. During a migraine, serotonin levels initially increase to help modulate pain, before decreasing gradually due to prolonged neuronal activation and the depletion of serotonin stores. These fluctuations can lead to the release of inflammatory substances that exacerbate blood vessel dilation and contribute to symptoms such as nausea and heightened sensitivity to light and sound.

There are three distinct types of migraines:

• Migraines with aura - a type of migraine accompanied by visual disturbances, causing the affected individual to see flashing lights, zig-zag patterns, or blind spots. Migraines with aura can also cause additional sensory symptoms such as tingling or numbness before the migraine starts.
• Migraines with aura, but no headache (acephalgic migraines) - a type of migraine that results in aura symptoms such as visual or sensory disturbances, without causing a headache. This type of migraine is also known as a ‘silent migraine’ and may result in additional symptoms such as nausea or sensitivity to light.
• Migraines without aura - the most widespread type of migraine, which results in intense head pain but without any preceding warning signs, such as an aura.

The three types of migraines discussed above can be either acute or chronic in nature:

• Acute migraines are isolated (one-off) migraines that occur in response to specific triggers such as stress, certain foods, changes in sleep patterns, or environmental factors. Acute migraines are typically infrequent and can last anywhere from a few hours to a few days.
• Chronic migraines are more frequent and severe than acute migraines. Individuals may be diagnosed with chronic migraines if they experience migraine attacks on 15 or more days per month, with at least 8 of those days resulting in severe symptoms such as throbbing pain, nausea, or sensitivity to light and sound. This pattern of frequent headaches must persist for 3 months or longer to be classified as a chronic condition.

Migraines often progress through four distinct phases, though not everyone experiences all of them:

• Prodrome - can occur up to two days before the aura and/or attack phases of a migraine. Symptoms may include mood changes, food cravings, fatigue, neck stiffness, frequent yawning, increased thirst, urination and/or constipation. The prodrome phase can last anywhere from a few hours to several days.
• Aura - typically occurs immediately before an attack and causes visual disturbances such as flashing lights, the appearance of zig-zag patterns, and/or blind spots, as well as sensory symptoms such as tingling or numbness. The aura phase of a migraine typically lasts 20 to 60 minutes.
• Attack - typically starts within 60 minutes of the aura’s onset and is characterised by intense, throbbing pain on one side of the head, often accompanied by nausea, vomiting, and sensory sensitivity. This phase can last from a few hours to several days.
• Postdrome - occurs immediately after the attack phase, presenting symptoms such as confusion, fatigue, vertigo, and dizziness. This phase can last from several hours to days.

Migraines can last anywhere between 4 to 72 hours depending on four essential factors:

• The type of migraine - migraines with aura typically last longer than migraines without aura as aura symptoms precede the attack phase of the migraine and can extend the overall length of the migraine episode. It is important to note that the exact duration of a migraine can vary depending on factors such as stress levels or the extent of exposure to triggers, irrespective of the type of migraine experienced.
• The extent of exposure to triggers - the duration of a migraine typically varies depending on how many triggers are involved. Exposure to multiple triggers can increase the probability of experiencing a longer-lasting migraine, as each trigger activates different pain pathways in the brain. Conversely, if only one trigger is present, symptoms may resolve more quickly.
• Individual responses to treatment - each individual's brain responds differently to the complex chain of events that trigger migraines. The brain’s response to factors such as hormonal changes, nerve signals, blood flow and chemical imbalances varies from person to person. These differences can affect how quickly the symptoms escalate and how long the migraine lasts.
• Hydration levels - when the body is dehydrated, blood vessels can constrict, reducing blood flow to the brain and triggering a migraine which can last for as long as the individual remains dehydrated. Adequate hydration helps maintain optimal blood flow, supports neurotransmitter function and aids in flushing out toxins, which can help alleviate migraine symptoms more quickly.

Migraines are often considered hereditary, with research indicating that individuals who have a family history of migraines are at a higher risk of experiencing them. This is thought to result from genetic factors that heighten the sensitivity of neurons in the brain. Individuals with a family history of migraines typically demonstrate an exaggerated response to migraine triggers, making them more susceptible to experiencing migraine symptoms.

Moreover, specific genetic mutations can affect the brain's pain-processing pathways, especially in the brainstem, leading to overactive pain responses. This increased sensitivity makes individuals more prone to migraines, where even minor internal or external changes can trigger an episode.

Migraines can be treated using a class of medication known as 'triptans' which affect the brain's levels of a neurotransmitter known as serotonin:

• Sumatriptan - a migraine treatment containing the active ingredient ‘sumatriptan succinate’, which helps constrict blood vessels in the head and prevents the release of inflammatory proteins called CGRPs into the bloodstream. These mechanisms prevent the onset of a migraine.
• Migraitan and Imigran - migraine treatments that are medically identical to Sumatriptan as they contain the same active ingredient, sumatriptan succinate. All three treatments are classified as serotonin receptor (5-HT1) agonists which function identically and are equally effective at treating migraines. However, Imigran and Migraitan are branded treatments, while Sumatriptan is a generic treatment that is available at a lower price.
• Rizatriptan - a migraine treatment containing 10mg of a selective serotonin 5-HT receptor agonist known as ‘rizatriptan benzoate’. Rizatriptan treats the headache and head pain caused by the swelling of blood vessels surrounding the brain during a migraine attack.
• Maxalt - a branded version of Rizatriptan containing 10mg of the active ingredient ‘rizatriptan benzoate’. Maxalt is medically identical to Rizatriptan, which means it works in the same way as Rizatriptan and is equally effective at treating migraine headaches. The only difference between these migraine treatments is the brand - Maxalt is a branded treatment, which is why it is more expensive than Rizatriptan.
• Zolmitriptan - a migraine treatment containing 5mg of the active ingredient 'zolmitriptan' which targets 5-HT1B and 5-HT1D receptors to aid in the constriction of blood vessels in the brain. Zolmitriptan also facilitates the production of a compound known as N-desmethyl metabolite, which further enhances the effects of this treatment to alleviate migraine symptoms. It is important to note that Zolmitriptan only works when a migraine attack has started and cannot prevent a migraine. In contrast, Sumatriptan and Rizatriptan can prevent the onset of a migraine. Zolmitriptan is typically prescribed for the treatment of menstrual migraines.
• Zomig - a branded version of Zolmitriptan containing 5mg of the active ingredient ‘zolmitriptan’. Zomig and Zolmitriptan are medically identical, which means they contain the same strength of the same active ingredient and are therefore equally effective at treating migraines. The only difference between these treatments is the brand - Zomig is more expensive, as it is a branded treatment, while Zolmitriptan is cheaper, as it is a generic treatment.
• Zomig Nasal Spray - a nasal spray version of Zomig that contains the active ingredient 'zolmitriptan' suspended in a liquid. Zomig Nasal Spray has a faster course of action than Zomig tablets, as it is absorbed directly into the bloodstream through the nasal mucosa, bypassing the digestive system.
• Nurofen Maximum Strength Migraine Caplets - a non-steroidal anti-inflammatory drug (NSAID) containing the active ingredient ‘ibuprofen lysine’. Nurofen Maximum Strength inhibits the activity of enzymes that produce prostaglandins, a neurochemical that causes inflammation and blood vessel dilation in the brain. It is worth noting that NSAIDs are specifically formulated to alleviate pain and are not suitable for treating additional migraine symptoms such as nausea or sensory sensitivity.

The right migraine treatment depends on the severity of the migraine, the type of migraine experienced and whether you wish to prevent a migraine or treat symptoms after a migraine has already begun:

• Sumatriptan, Rizatriptan and Zolmitriptan can help alleviate migraine symptoms during the attack phase. Please note that these treatments are only effective after a migraine attack has commenced and should only be used to treat symptoms, as opposed to preventing migraines.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Nurofen Maximum Strength Migraine Caplets, can reduce the production of an inflammatory substance called prostaglandin, relieving the head pain associated with migraines.

We recommend consulting our pharmacists or speaking with your GP to find the most suitable treatment based on your specific symptoms and triggers.

Seasonal changes can cause sudden shifts in air pressure, temperature and/or humidity. Each of these environmental factors can trigger a migraine in susceptible individuals:

• Air pressure changes can cause the sudden narrowing and subsequent widening of blood vessels in the brain, triggering migraines.
• Air temperature changes can trigger stress responses in some individuals, prompting the release of inflammatory mediators that contribute to migraines.
• Changes in air humidity levels can cause dehydration and disrupt the body’s electrolyte balance, resulting in increased sensitivity and a higher probability of experiencing a migraine.

For more information, refer to our expert guides on how to manage summer migraines and winter migraines.

Migraines and headaches differ in terms of symptom severity, duration and treatment:

• Severity - migraines can cause a range of severe symptoms, including throbbing pain affecting one side of the head, nausea and sensory sensitivity. Migraines with aura may also cause visual disturbances, such as the appearance of zig-zag patterns or flashing lights. In contrast, headaches typically affect the entire head and the pain is normally milder than migraines.
• Duration - migraines typically last between 4 to 72 hours as they involve complex neurological processes involving nerve pathways, blood flow changes in the brain, and the release of inflammatory chemicals. In contrast, headaches only last for a few hours as they are caused by factors such as muscle tension that can be treated quickly.
• Treatment - migraine treatment involves the use of triptans, such as Sumatriptan, which are formulated to help constrict blood vessels and relieve symptoms by acting on serotonin receptors in the brain. In contrast, headaches are milder and may be treated using over-the-counter pain relief medication, such as Paracetamol. Non-steroidal anti-inflammatory drugs, such as Ibuprofen, can help reduce pain and inflammation during a migraine and may also be prescribed to treat more severe headaches.