Migraines

Warning
Warning:

This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What do we mean by migraine?

Not all headaches are the same:

What causes migraine?

Scientists see migraine as a sort of electrical reaction in the nerves in the brain. When something sets this reaction off, the arteries on the brain surface expand. This sensitivity is partly inherited, so you are more likely to get migraines if a close relative gets them.

As a migraine attack comes on, sensitivity to pain signals increases. This is why, for most migraine sufferers, anti-migraine drugs work only in the early stages of the attack. For this reason, you should always take pain-relieving medication within 20 minutes of an attack and while the migraine pain is still mild.

Migraine triggers are highly individual, and the things that affect one person probably won't apply to someone else. For most people there could be a combination of trigger factors. On there own they might be tolerated but it's when they come occur together that migraine is triggered.

Hormonal changes in women

It is usually a drop in the hormone oestrogen that triggers a migraine attack. This may happen at puberty, during a period, when you are ovulating, or when you get pregnant. (Migraine may start up or stop during pregnancy.) The menopause, taking oral contraceptives or using hormone replacement therapy (HRT) can all cause migraine.

Psychological stress

It may seem strange but some people say that being able to relax after a stressful time will bring on a migraine, often at a weekend or at the start of a holiday. More often, it will be feeling unable to cope easily with worries, conflicts, major life changes or work pressures that brings on a migraine. The pressure might also come from unresolved problems from the past, emotions you can't express, or feelings that lead to anxiety or depression. Seek advice from a health professional if you feel this sort of emotional stress is making your migraines worse.

Other triggers

Other triggers can include:

Preventing migraine attacks

Don't worry - you won't have to avoid all these possible triggers! To find out which ones affect you personally, it's a good idea to keep a migraine diary. For a month or so, make a note not just of what you eat and drink, but also of your physical activities, stress and moods, and anything unusual in your surroundings (such as lights, noise and unusually hot, cold, stormy, wet or dry weather). If something triggers a migraine, it will usually happen within 12 hours (or 24 at the most).

Prevention should start with non-drug approaches, including keeping a diary to identify your triggers, using relaxation techniques and making lifestyle changes. But if you are getting weekly attacks, your GP will probably recommend trying preventive medication. When used appropriately, medication can provide quick relief from sickness and pain during an attack.

What other information might be helpful?

When to see your doctor

Immediately:

If you have other symptoms as well as problems with headaches, or a medical condition that seems to be worsening, it is important to see your doctor. Pain in the head or neck, from toothache, sinusitis or a blocked nose, can trigger an attack. If you take diabetic medicines, low blood sugar might bring on an attack. Very occasionally, being low in vitamin B12 can be a cause of migraine.

If you have recently started taking new medication, speak to your pharmacist about whether this might be the cause of your problems. Medications that can trigger migraine include ibuprofen (Nurofen) if overused, interferon-beta, GTN for angina, high doses of niacin (vitamin B3) or vitamin A (more than 25,000 IU daily).

simplechangesMake Some Simple Changes


pencil Eating a healthy diet

OverviewBig meals, especially if they are very sugary or starchy, can trigger a migraine. Skipping meals and not drinking enough can also bring on an attack. So you need to eat regular, healthy, moderate-sized meals and remember to drink frequently, even if you don't always feel thirsty.

It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. The Food Standards Agency has eight tips for eating well:

1 Base your meals on starchy foods.
2 Eat lots of fruit and vegetables.
3 Eat more fish.
4 Cut down on saturated fat and sugar.
5 Try to eat less salt - no more than 6 g a day.
6 Get active and try to keep to a healthy weight.
7 Drink plenty of water.
8 Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing.

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simplechanges Avoiding trigger foods

OverviewThere is no special 'anti-migraine diet'. But avoiding certain foods does help some people prevent attacks. Various surveys have found that the most commonly reported food triggers are cheese, chocolate, alcohol, bananas and citrus fruit.

According to the USA's National Institute of Neurological Disorders and Strokes, 50% of migraine headaches are triggered by foods or food additives. These triggers include aspartame, caffeine (and caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats.

Keeping a diet diary may help you spot your own food triggers. You should list everything you eat every day, the time you ate it and whether you get a migraine within 12 to 24 hours. If you think you have found any trigger foods, avoiding them could reduce the frequency of your migraine attacks.
EvidenceThere is no single diet that will help. Research into special diets suggests that avoiding particular kinds of foods is not useful for everyone who gets migraine. This is probably because the 'trigger foods' vary so much from one person to the next.
SafetyIt can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
CostEating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice.
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simplechanges Cutting down caffeine

OverviewIf you are a big coffee drinker suddenly stopping it can cause a rebound headache for a few days. Caffeine seems to be one of the commonest triggers for a migraine. Oddly, some people find their acute migraines are helped by taking caffeine.

Note: A very small amount of caffeine is sometimes included in pain medications such as Panadol Extra and Anadin Extra. The aim of this is to make the painkiller slightly more effective. But if you are taking a lot of them, the caffeine could trigger a migraine.
EvidenceResearch has shown that drinking a lot of coffee may make any headache more likely. Reducing caffeine and improving sleep may make migraine less likely.
SafetySuddenly cutting out caffeine can cause a withdrawal headache for a few days. It is better to reduce it gradually over a few days.
CostThere are no costs. In fact you will save money.
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simplechanges Exercise

OverviewA few people find that physical exertion triggers a migraine attack. But if you can exercise without it causing a headache, then being more active will do more than just keep you fit. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates blood circulation to your brain and internal organs, boosts your immune system, helps protect against osteoporosis, and triggers brain chemicals that lift your mood and can generate a real sense of well-being. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems.

Compared to 100 years ago - when people didn't have cars, washing machines or TV - most of us don't do much physical work these days. Science tells us that our relatively lazy modern lifestyle is bad for our health.

Exercise can include aerobics such as cycling, stepping and walking, strengthening exercises such as lifting weights or using resistance machines, and stretching for flexibility.
EvidenceExercising while you have a migraine may make it worse, although regular exercise might prevent migraines. It is difficult to work out whether exercise generally helps with headaches, as most of the research has looked at exercise along with other things such as relaxation.
SafetyIf you are really unfit, start off with walking every day, gradually going further and a bit faster each week. Once you are used to being more active, you can get advice on the best exercises to do from a trainer at your local leisure centre. Supervised exercise programmes are safe for most people. But at first you might feel more tired. If you're not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn't helping or that you're getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and get advice from a healthcare professional.
CostYou can exercise at home for nothing - walking and gardening is all exercise. There will probably be a small cost (£5-£8 a class), if you join an organised programme.
Find out moreNatural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.
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simplechanges Meditation

OverviewMeditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a 'relaxation response'. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don't need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.
EvidenceMindfulness (a particular form of meditation) may improve your health generally and help you to cope with pain. Not enough studies have looked at whether meditation helps with migraine headaches but research is underway and we should know more soon.
SafetyThere are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.
CostMeditation involves certain (simple) techniques, which can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially. Once you have learned how to meditate, there are no ongoing costs.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets. Also see the information about Yoga in the 'Classes' section.
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simplechanges Relaxation techniques

OverviewRelaxation techniques such as progressive muscular relaxation (PMR) can be learned from a book, tape or during exercise classes such as yoga classes, and then be easily practised at home.
EvidenceRelaxing after stress seems to help prevent migraine. Relaxation therapy combined with exercise also seems to be helpful. It is not clear whether just using progressive muscular relaxation on its own helps with migraines.
SafetyThere are no safety problems with relaxation techniques.
CostRelaxation techniques are easily practised at home.
Find out moreThere are many books and audio aids available and some people find it useful to join a class initially. See also Yoga in the Classes section and the leaflet on Stress and Anxiety. Visit The British Holistic Medical Association for podcasts and leaflets.
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buysomethingBuy Something


pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

pencil Herbal remedies and food supplements

OverviewMany modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousands of years. We think these 'natural medicines' work by improving the functioning of the nerves, muscles, brain and digestion.

pencil Over-the-counter medicines

OverviewSee below for the different types of medication that can be bought over the counter that may help migraine.

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buysomething B vitamins

OverviewB vitamins are a traditional remedy for stress-related problems, so perhaps that's why some people feel they prevent their migraines. We could not find much evidence for this. However, Australian researchers recently found that a B-vitamin combination reduced the amount of homocysteine in the blood. Homocysteine is thought to irritate the blood vessel lining in some people, and can therefore trigger migraine.
EvidenceIn a 2009 study, 52 migraine sufferers were given B vitamins for six months and the results showed that they experienced half the number of migraine attacks.
SafetyB vitamins are generally safe but large doses can turn your urine bright yellow. Don't be alarmed if this happens!
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buysomething Butterbur (Petasites hybridus)

OverviewThe leaves and roots of a shrub called butterbur have long been used as a remedy for headaches and inflammation. Researchers have discovered that extracts of butterbur contain active ingredients that can prevent migraine.
EvidenceSeveral studies have shown that butterbur may be effective in preventing migraine. It is not clear what dose gives the best preventive effect, but at least 75 mg is needed.
SafetyThere have been very few problems with taking butterbur in ordinary doses. As with any medication, always ensure you take the recommended dose.
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buysomething Coenzyme Q10

OverviewCo-enzyme Q10 is a health-promoting substance that is naturally produced in the body, but production falls as we get older. It is also found in certain foods, particularly beef, spinach, sardines, albacore tuna and peanuts, but cooking and processing tends to destroy it.
EvidenceSome recent research suggests that taking co-enzyme Q10 might help prevent migraines.
SafetyCo-enzyme Q10 may thin the blood a little. If you are taking warfarin or any other blood-thinning medication, consult your doctor first.
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buysomething Feverfew (Tanacetum parthenium L)

OverviewFeverfew is a traditional medicinal herb found in many old gardens, and is also occasionally grown for ornament. It has citrus-scented leaves with daisy-like flowers. It is a widely used herbal remedy for migraine.
EvidenceSeveral studies have shown that feverfew may be effective in preventing migraine. Other studies have shown no effects. It may be that some products work better than others or that only the fresh leaves are effective.
SafetyFeverfew may cause allergic reactions in people who are allergic to chrysanthemums, daisies, marigolds, or other members of the Compositae family, including ragweed. There have been many reports of allergic skin rashes after contact with feverfew. But few side-effects have been reported and they are usually mild and reversible. Feverfew should not be used during pregnancy or by women who are taking oral contraceptives.
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buysomething Magnesium

OverviewOur bodies need the mineral magnesium for all sorts of reasons. For instance, it strengthens our blood vessels and it's good for nerve and muscle function. The richest food sources of magnesium are green leafy vegetables (such as spinach) and nuts. Other good sources include wholemeal bread, fish, meat and dairy foods, kelp (a type of seaweed), wheat bran, almonds, cashews, blackstrap molasses and brewer's yeast.
EvidenceIt is not clear whether magnesium supplements help with migraines. Some studies say yes, others not. But it is worth making sure that you are getting enough magnesium in your diet.
SafetyLarge doses of magnesium supplements can give you diarrhoea.
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buysomething Painkillers and anti-sickness medication

OverviewIn some people, migraine headache can be accompanied by nausea and vomiting. If applies to you, an anti-sickness (anti-emetic) drug, with or without painkillers, can be useful. Both painkillers and anti-sickness medicines are more effective if you take them as soon as you feel the attack beginning.
EvidenceResearch shows that simple painkillers such as aspirin and ibuprofen are effective in treating migraines if you take them as soon as the headache starts to develop. Paracetamol is not as effective but it can be helpful in mild headaches, and has fewer side-effects.
SafetyIf used in the correct dose, painkillers are generally safe, but taking painkillers (whether prescription or over-the-counter) every day can cause headaches. Anti-inflammatory painkillers, such as aspirin and ibuprofen, can irritate the stomach, liver and kidneys. Ibuprofen can cause indigestion, and even stomach ulcers or bleeding. Stop taking them if you start getting indigestion or stomach pain, and tell your GP or pharmacist. Around 15% of people taking oral anti-inflammatory medication experience this type of reaction. Paracetamol can be dangerous in doses of more than 4g a day (2 tablets, 4 times per day).
CostThese types of medication are generally fairly inexpensive.
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buysomething Sumatriptan (Imigran)

OverviewSumatriptan relieves migraines by stimulating serotonin receptors in the brain. This makes the muscles in the brain contract and narrow the blood vessels. At the same time, it reduces pain signals in the nerves that go to the brain. It will be more effective if you take it as soon as you feel the attack beginning.
EvidenceSumatriptan (sold over the counter as Imigran Recovery) is effective for people who have migraines that have not been helped by painkillers such as aspirin and ibuprofen.
SafetyIf used correctly, according to the prescribed dose, this medication is generally safe. But an overdose can be dangerous, and requires immediate medical attention.
CostThese types of medication are generally fairly inexpensive.
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attendvisitAttend Classes / Visit Practitioner


attendvisitTreatment Options:


attendvisit Acupuncture

OverviewAcupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.
EvidenceThere has been quite a lot of research suggesting that acupuncture is likely to help reduce the number and severity of migraine attacks.
SafetyAcupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreIt is important to find a practitioner who is registered with one of the following professional organisations:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit Homeopathy

OverviewThe basic principle of homeopathy is that 'like cures like'. So it uses tiny amounts of medicine which are supposed to jolt the body's self-healing processes into action. Homeopathy has been called unscientific because its remedies are sometimes so watered down that no detectable trace of medicine remains.

EvidenceThere have been several research studies but the results are confusing, so we don't have much evidence to recommend homeopathy as a treatment for migraine. But it is safe, the remedies themselves are relatively inexpensive, and some people are sure that they get relief from homeopathy.
SafetyHomeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms at first but this generally only lasts a short time.
CostThe monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £20-£50.
Find out moreThere are a number of organisations representing registered medical and non-medical homeopathic practitioners:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths
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attendvisit Massage

OverviewThere are many different types of massage, some more vigorous and going deeper into the muscles than others. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Massage has traditionally been used for relaxation. It can help reduce muscle tension, and this may be important where migraines and tension headaches are concerned. Deep massage pressure on tight sore 'knots' in the shoulders and at the back of the neck can help relieve headaches. Aromatherapy massage involves the use of pleasant-smelling essential oils.
EvidenceTwo small studies have shown that massage reduced the number of migraine attack for three weeks after having massages. It seems likely that massage could play a useful part in self-care for migraine.
SafetyMassage is safe if carried out by a qualified massage therapist and rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Find out moreIt is important to find a qualified practitioner such as one registered with The General Council for Massage Therapies
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attendvisit Psychological therapies

OverviewSome people find their migraines are directly triggered by stress, conflicts or emotional distress. Psychological approaches may be useful to help you deal with this.

When people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural'). For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

EvidenceSeveral small studies have indicated that CBT helped people to manage their headaches better, though this has not been proven in large studies. But CBT may help some people manage stress better and so prevent migraine attacks or cope with them better so that they don't last so long.
SafetyCBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Spinal manipulation (including chiropractic and osteopathy)

OverviewOsteopathy and chiropractic are hands-on approaches to diagnosis and treatment that focus on the way the muscles and joints work. They are both based on the idea that pain often comes from physical strains and tensions in the body, rather than from inflammation or damage caused by disease. Treatment by an osteopath or a chiropractor often involves spinal manipulation. If tender points in your neck seem to affect your migraine attacks, these approaches might help relieve the pain.

EvidenceThere have only been a few research studies. But there is evidence that spinal manipulation may have a short-term effect that is as good as a commonly used preventive drug (amitriptyline).
SafetySide-effects are rare and mainly linked to manipulation of the neck. Some people experience mild after-effects (aches) from the treatment but they usually last less than 48 hours.
Cost
Find out moreAll properly qualified osteopaths are registered with The
General Osteopathic Council


All chiropractors have to be registered with The General Chiropractic Council
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.
EvidenceTwo studies suggest that yoga can help prevent migraine. Better studies are needed to be certain. But yoga should help with relaxation and reducing stress, which often causes migraines.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
CostOnce you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas both by private tutors and by adult education services.

To find a qualified teacher near you see also the [The Yoga Alliance
and the The British Wheel of Yoga.
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