Migraine is not just a bad headache. It is a complex neurological disorder affecting approximately 1 in 7 people in the UK — making it the third most common disease in the world and the leading cause of disability in adults under 50. Despite this, it remains undertreated: most migraine sufferers manage without any specific treatment, often because they don’t know that effective treatments exist.
What Happens During a Migraine
Migraine involves a cascade of neurological events. Prodrome (hours to days before): mood changes, fatigue, food cravings, neck stiffness, frequent yawning — driven by hypothalamic activation. Aura (30% of migraineurs): reversible neurological symptoms typically lasting 20–60 minutes — visual aura (zigzag lines, blind spots) most common; sensory, speech, or motor aura also occur. Aura results from cortical spreading depression — a wave of neuronal depolarisation spreading across the cortex at 3mm/min. Headache phase: typically unilateral, throbbing, moderate-severe intensity, worsened by movement, with nausea/vomiting and sensitivity to light and sound. Postdrome: “migraine hangover” — fatigue, difficulty concentrating, persisting 24–48 hours after headache resolves.
Identifying and Managing Your Triggers
Triggers don’t directly cause migraine — they lower the threshold for attacks in susceptible individuals. Common triggers: irregular sleep (both too much and too little), skipping meals, dehydration, hormonal fluctuations (particularly oestrogen withdrawal — explains perimenstrual migraine), alcohol (especially red wine and beer), stress (and the “let-down” after stress), bright or flickering lights, strong smells, weather changes. A headache diary (paper or app — Migraine Buddy is popular) for 8–12 weeks is essential for identifying personal triggers — impressionistic recall is unreliable. The goal is reducing the overall trigger load below the threshold, not identifying one “cause.”
Acute Treatment
Treatment is most effective when taken early — within 30 minutes of headache onset, not after it’s fully established. First-line OTC: aspirin 900mg (highest-evidenced analgesic for acute migraine), ibuprofen 400mg, or paracetamol 1000mg — combined with an antiemetic (metoclopramide or domperidone, from pharmacist or GP) which improves gastric emptying and analgesic absorption and reduces nausea. Migraine-specific: triptans (sumatriptan, available OTC as Imigran, Sumatriptan 50mg from pharmacies) — serotonin receptor agonists that abort the migraine cascade. Highly effective; first-line if simple analgesia fails. Key principle: limit acute treatment to no more than 10–15 days per month (depending on medication type) to avoid medication overuse headache — the most common cause of daily headache in migraine sufferers.
Frequently Asked Questions About Migraine
When should I consider preventive migraine treatment?
Discuss preventive treatment with your GP if: migraines occur ≥4 days/month; attacks are severely disabling; acute medication is contraindicated or ineffective; you’re using acute medication >10 days/month. First-line preventives: propranolol, amitriptyline, topiramate, valproate (not for women of childbearing potential). Newer CGRP antagonist/monoclonal antibodies (rimegepant, ubrogepant, fremanezumab) are NICE-approved for high-frequency migraine and are highly effective.
Does caffeine help or worsen migraine?
Both. Caffeine potentiates analgesics (which is why it’s included in many headache combination products) and can abort a migraine when taken at onset. However, regular daily caffeine intake creates physical dependence — caffeine withdrawal (even mild, from sleeping longer at weekends) is a very common migraine trigger. Keeping caffeine intake consistent (same amount, same time each day, or eliminating it) removes this trigger.
Browse migraine treatments including sumatriptan and ibuprofen at Huncoat Pharmacy. Related: Pain Relief Guide, Magnesium for Migraine.
At Huncoat Pharmacy: Pharmacy First, Private prescription for migraine treatment, Browse migraine relief.