Migraine
Migraine is not simply a bad headache but a disorder of how the brain works, arriving in attacks: the pain lasts hours or days, and along with it light, sound…
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Medicines commonly prescribed for Migraine
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: TABLET, 1 g paracetamolActive substance: paracetamolManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Mabo Farma S.A.Prescription required
Migraine is not simply a bad headache but a disorder of how the brain works, arriving in attacks: the pain lasts hours or days, and along with it light, sound and smell become unbearable. An attack takes a person out of everything they were doing, and that is its defining mark — with an ordinary headache life carries on; with a migraine you want to close the curtains and lie down. It can almost always be brought under control, but not with one painkiller and not in a single appointment.
How an attack unfolds
Classic migraine pain throbs, spreads into the eye or temple, usually settles on one side of the head and worsens with any movement: climbing stairs or bending down becomes hard work. Nausea comes with it, sometimes vomiting, along with a strong aversion to light, loud noise and sharp smells. Untreated, an attack lasts from a few hours to three days.
Strictly one half of the head is not a requirement. In children and teenagers migraine often hurts on both sides and across the forehead, attacks are shorter, and nausea, pallor and sleepiness come to the fore.
A day or two before the pain many people notice warning signs: yawning, flatness, craving sweet things, a stiff neck, irritability or, on the contrary, an unusual burst of energy. Anyone who learns to recognise them gains a few hours and meets the attack prepared. And once the pain has gone, a day of "migraine hangover" follows — dullness and a foggy head; that is part of the attack, not a separate problem.
Aura: what comes before the pain
In roughly a third of people the attack is preceded by aura, a brief and reversible disturbance in the working of the brain's cortex. Most often it is visual: a shimmering patch or a zigzag of bright light appears in the field of vision, creeps slowly sideways and leaves a blind area behind it. Less often there is numbness and tingling that travels from the fingers up the forearm and into one side of the face, or difficulty speaking, with words tangling or the right one refusing to come.
Aura builds up gradually, lasts between five minutes and an hour and passes without trace, and then the headache begins. Sometimes it happens on its own with no pain at all — this occurs in older people and is thoroughly disconcerting.
The key difference from a stroke lies precisely in that gradual onset and full recovery. In a stroke the changes appear all at once, at full strength, and do not go away. If symptoms come on together, last more than an hour, always affect the same side, or the aura appears for the first time in later life, that is looked into separately and not put down to migraine.
What sets attacks off
Migraine runs in families: most patients have a close relative who also suffered headaches. The predisposition alone does not cause an attack — what triggers it is a change in the usual rhythm.
The commonest triggers are a missed meal, too little sleep or, equally, a long lie-in at the weekend, dehydration, alcohol, an abrupt change in how much coffee is drunk, menstruation, flickering light, strong smells and shifts in the weather. It is worth noting that the pain often arrives not at the height of stress but as it eases — on a Friday evening or the first day of a holiday.
Trying to track triggers from memory does not work: there are usually several and they add up. A diary helps — the date, how long it lasted, how bad the pain was, what was eaten and how you slept the night before, which medicine was taken and how long it took to work. Within two or three months the patterns show, and with that diary a doctor finds it far easier to tailor treatment. What is not worth doing is cutting out foods from internet lists: strict diets impoverish life more than they cut down attacks.
What to do once an attack starts
Speed decides everything. Medicine taken in the first hour, while the pain is still mild, works noticeably better than the same medicine taken at the peak: at the height of an attack the stomach slows down and the tablet is simply absorbed less well. Waiting to see whether it passes is the worst strategy.
After that, anything that removes stimulation helps: a quiet dark room, a cool compress on the forehead or the back of the neck, sleep. For many people relief comes precisely once they manage to drop off. Drink water and try to eat something if the nausea allows. Coffee very early on sometimes cuts an attack short, but relying on it daily brings new headaches of its own.
If attacks are frequent, agree a plan with your doctor in advance: what to take first, what to do if nothing has happened after two hours, and when a dose may be repeated. Carrying that plan in your pocket is far calmer than deciding afresh every time.
Medicines and the painkiller trap
Treatment usually starts with simple things: non-steroidal anti-inflammatory drugs or paracetamol at an adequate dose. Aspirin is not given to children and teenagers. If nausea gets in the way, an anti-sickness medicine is added, which not only settles the stomach but speeds up absorption of the painkiller.
When that is not enough, triptans are prescribed — medicines that act on the mechanism of the attack itself rather than on the pain alone. They are taken at the first sign of pain, but not during the aura. Triptans do not suit everyone: they are not given in uncontrolled high blood pressure, in coronary heart disease or after a stroke, and this calls for a conversation with a doctor rather than advice across a counter. There is also a newer class, the gepants, which block the CGRP protein and are used when triptans have not worked out.
Painkillers containing codeine and other opioids are best avoided in migraine: they work poorly and quickly draw people into a vicious circle — medication-overuse headache, in which frequent painkillers begin to sustain the pain themselves. The rule of thumb is simple: if pain has to be treated more than two days a week over several months, it is the treatment that needs changing, not the dose. Coming off such medicines is done with a doctor, because the first weeks afterwards are usually worse than before.
When preventive treatment is needed
Preventive treatment means taking a medicine every day not to stop an attack but to make attacks less frequent. It comes up when the pain strikes several times a month, when attacks are severe and knock you out of work, when painkillers are needed too often, or when they cannot be taken at all.
The choice is wide and is largely shaped by what else the person has: beta blockers and other blood-pressure-lowering medicines, some anti-epileptic drugs, antidepressants at low doses and, in frequent stubborn migraine, injectable medicines against CGRP and injections of botulinum toxin. Women who could become pregnant are not given certain anti-epileptic drugs because of harm to the baby, which is why the question is asked in advance.
The main thing to know beforehand is that prevention does not work straight away. It is worth judging after six to eight weeks at a settled dose, and success means roughly halving the number of attacks, not abolishing them. A course runs for several months, after which the medicine is tapered off. Among non-drug measures, regular sleep, movement and work on stress are the ones that pay off.
Migraine, periods and contraception
In many women attacks are tied to the cycle and fall on the days before a period and the first days of bleeding. These attacks tend to be more severe and respond less well to the usual remedies, but they are predictable: knowing your cycle, treatment can be started ahead of time, and a doctor will work out a plan for those few days.
Hormonal contraception deserves a separate and important word. Migraine with aura slightly raises the risk of ischaemic stroke on its own, and combined contraceptives containing oestrogen raise it further. For that reason combined pills, patches and rings are generally not used in migraine with aura; what remains are progestogen-only methods, the coil and non-hormonal options. Smoking multiplies that risk again. If aura appears for the first time while already on a combined contraceptive, it is stopped and a doctor consulted.
During pregnancy migraine eases in most women, particularly after the first months. But the medicines change too: some of the usual ones are unsuitable in pregnancy, so the plan is reviewed before conception rather than after the event. There are options while breastfeeding as well; they are simply different ones.
When an ambulance and tests are needed
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine, single number 112) if:
- the pain came on suddenly and peaked within seconds, like a blow to the head — this is the most dangerous of all headaches;
- the pain is accompanied by weakness in an arm or leg, a drooping face, slurred speech, loss of vision, a seizure, confusion, or the person cannot be woken;
- a high temperature comes with being unable to put the chin on the chest, intolerance of light, or a rash that does not fade under pressure;
- severe headache started after a blow to the head or a fall.
Do not drive yourself and do not wait until morning.
Make an appointment with a doctor — without panic, but do not put it off — if attacks have become more frequent or changed their usual character, if the head hurts in the morning with vomiting, worsens on lying down, coughing or straining, or if a severe headache appears for the first time in later life. Over the age of fifty, headache together with a tender scalp and a jaw that tires while chewing points to inflammation of the arteries, which can cost the sight if untreated. And a headache in the second half of pregnancy or soon after birth calls for a blood pressure reading the same day.
No test or scan confirms migraine: the diagnosis is made from the history, the attack diary and an examination that includes blood pressure and a neurological check. Scans are not ordered just in case, but when the picture is atypical or warning signs are present. A normal scan neither rules migraine out nor takes the place of treatment.
Online consultation
Migraine is one of the subjects where talking to a doctor at a distance is almost as good as in person: the diagnosis here rests on what you describe rather than on examination. The consultation goes through the attack diary, separates migraine from tension-type headache and from medication-overuse headache, explains why the tablet that always worked has stopped working, and sets out a plan: what to take at the start, what to do if it fails, and whether prevention is due.
Online is also a good place for the things people forget to ask in the surgery: how migraine fits with contraception, planning a pregnancy, how attacks behave with flights and shift work, and how to come off daily painkillers safely. The limits are clear: examining the back of the eye and assessing neurological function cannot be done on screen, and for a sudden, unprecedented, worst-ever headache or new neurological symptoms what is needed is not a call but an ambulance.
This material is for information only and does not replace medical advice.
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