Patient information · Neurology and urgent care
Migraine and headache
treating attacks early, and the headaches that are not migraine
Most headaches are tension-type or migraine and are not dangerous, however severe they feel. A small number of patterns point to something else entirely, and those are recognised by how the headache began and what comes with it rather than by how much it hurts.
Call 999 or go to an emergency department if a headache
- came on suddenly and reached maximum intensity within a minute or two — a thunderclap headache
- comes with a stiff neck, fever, or a rash that does not fade under a glass
- follows a head injury, or comes with drowsiness, confusion or repeated vomiting
- comes with weakness, numbness, slurred speech or a drooping face
- comes with loss of vision, double vision, or a red painful eye with halos around lights
- is accompanied by a seizure, or by a change in personality or behaviour
Arrange assessment within a few days rather than waiting if a headache is new and persistent over the age of 50, is consistently worse first thing in the morning or on lying down, coughing or straining, is worsening steadily week by week, or occurs in someone with cancer, HIV or a suppressed immune system. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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
- 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.
- Start with a full dose of a simple painkiller — aspirin 900mg, ibuprofen 400–600mg or paracetamol 1g. Soluble or dispersible forms are absorbed faster.
- Add an anti-sickness medicine if nausea is a feature. It settles the stomach and helps other medicines absorb.
- 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.
- Lie down somewhere dark and quiet and sleep if you can — sleep aborts many attacks.
Medication overuse headache
Taking painkillers or triptans too often causes a daily or near-daily headache that is indistinguishable from the original problem — and the treatment is stopping the medicines, not taking more. The thresholds are roughly 15 days a month for paracetamol or anti-inflammatories, and 10 days a month for triptans, codeine or combination painkillers, sustained over three months. If you are using painkillers on more days than not, this is very likely part of what is happening. Do not simply stop codeine-containing medicines abruptly — come and talk to us first.
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.
Migraine, the combined pill and stroke risk
Migraine with aura increases stroke risk slightly, and the combined oral contraceptive pill increases it further. The combined pill is generally not recommended if you have migraine with aura. If you have aura and take a combined pill, please raise it with us — there are alternatives that carry no such concern.
Book an appointment if your headache pattern has changed, attacks are becoming more frequent, you are using painkillers on more than ten days a month, current treatment is not working, or you need a preventive plan. We can examine you, arrange imaging where it is genuinely indicated, and refer to neurology where needed.
Seen today, not next week
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.