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Recognising migraine

Migraine is typically a throbbing pain on one side, moderate to severe, made worse by movement, and lasting anywhere from four hours to three days. Most people feel sick, and light and noise become intolerable. Around a third get an aura beforehand — usually visual, with zigzag lines, flickering or a blind spot spreading over 20 to 60 minutes, sometimes with tingling in one hand or difficulty finding words.

Tension-type headache is different: pressing or tightening rather than throbbing, on both sides, mild to moderate, and not made worse by ordinary activity.

Treating an attack

1. Take treatment as early as you can. Migraine medicines work far better taken in the first few minutes than an hour in, once nausea has slowed the stomach down.
2. Start with a full dose of a simple painkiller — aspirin 900mg, ibuprofen 400–600mg or paracetamol 1g. Soluble or dispersible forms are absorbed faster.
3. Add an anti-sickness medicine if nausea is a feature. It settles the stomach and helps other medicines absorb.
4. If that is not enough, a triptan is the specific migraine treatment. Take it at the onset of the headache rather than during the aura.
5. Lie down somewhere dark and quiet and sleep if you can — sleep aborts many attacks.

Finding your triggers

Triggers are usually cumulative rather than absolute — one alone may do nothing, three together set off an attack. A diary kept for two months is more useful than any test.

• irregular sleep, including lie-ins at weekends
• skipped meals and dehydration
• stress, and the let-down period afterwards — migraines often arrive on the first day of a holiday
• hormonal changes around periods
• alcohol, particularly red wine; caffeine, and caffeine withdrawal
• bright or flickering light, and long screen sessions without breaks

Preventing attacks

If you have migraine on more than a few days a month, or attacks are disabling, preventive treatment is worth discussing. Several daily medicines reduce attack frequency substantially, and newer injectable treatments are available for people who have not responded to them. Riboflavin and magnesium have modest evidence and are reasonable to try alongside.

Regular sleep, regular meals, regular exercise and steady caffeine intake are not trivial advice — they are among the most effective preventive measures there are.