Migraine
A clinical overview of migraine — what it is, the four phases of an attack, types of migraine, common triggers, red flag symptoms, and what treatment options exist.
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Migraine UK: Symptoms, Types, Causes & When to Seek Help
A clinical overview of migraine — what it is, the four phases of an attack, types of migraine, common triggers, red flag symptoms, and what treatment options exist.
Key fact: Migraine is a neurological condition, not just a bad headache. It affects around 1 in 7 people in the UK and is approximately three times more common in women. Most migraine can be well managed with the right combination of acute treatment, preventive treatment where needed, and trigger management.
What Is Migraine?
Migraine is a neurological condition involving recurrent attacks of moderate-to-severe headache, typically pulsating, often one-sided, and usually accompanied by nausea, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). Routine activity tends to make the pain worse.
The underlying mechanism involves changes in the brain’s pain-processing pathways and the trigeminal nerve system, which controls sensation in the head and face. During an attack, this system becomes hypersensitive, amplifying signals that would not normally cause pain.
Migraine is not the same as a tension headache. Tension headaches typically cause mild-to-moderate pressure-like pain across both sides of the head, without nausea or light sensitivity. Migraine attacks are usually more severe, often interfere with daily activities, and have a distinct symptom pattern.
The Four Phases of a Migraine Attack
Migraine attacks often (though not always) follow a recognisable pattern with up to four phases. Not everyone experiences every phase, and the phases can vary between attacks in the same person.
1. Prodrome (hours to days before)
Subtle warning signs: mood changes, irritability, food cravings, frequent yawning, neck stiffness, tiredness, or increased thirst. Some people can predict an attack from these signs.
2. Aura (about 1 in 3 people)
A 5 to 60 minute reversible neurological event before the headache. Most commonly visual — zigzag lines, flashing lights, blind spots, or shimmering patterns. Can also be sensory (tingling, numbness) or affect speech.
3. Headache (4 to 72 hours)
Moderate-to-severe pulsating pain, often one-sided. Accompanied by nausea or vomiting, photophobia, and phonophobia. Made worse by routine activity. Many people need to lie down in a dark, quiet room.
4. Postdrome (up to a day after)
The “migraine hangover”. Fatigue, difficulty concentrating, mild residual head pain, and feeling drained or low. Can last hours to a day after the headache resolves.
Types of Migraine
| Type | Key features | Notes |
|---|---|---|
| Migraine without aura | Most common type. Headache attacks without preceding neurological symptoms. | ~70% of people with migraine |
| Migraine with aura | Headache preceded (or accompanied) by reversible neurological symptoms — usually visual. | ~30% of people with migraine |
| Chronic migraine | Headache on 15 or more days a month, of which at least 8 are migraine, for more than 3 months. | Usually requires preventive treatment and specialist input |
| Menstrual migraine | Migraine attacks linked to the menstrual cycle, typically around the start of a period. | Often more severe and longer than non-menstrual attacks |
| Migraine aura without headache | Aura symptoms occur without subsequent headache. | More common in older adults; needs assessment to rule out other causes |
| Hemiplegic migraine | Aura includes temporary weakness on one side of the body. | Rare. Symptoms can mimic stroke — always needs urgent assessment first time |
Migraine Symptoms
The core symptoms of a migraine attack are:
- Moderate-to-severe headache — usually pulsating or throbbing, often (but not always) one-sided
- Nausea and/or vomiting
- Photophobia (sensitivity to light) — bright light makes the pain worse
- Phonophobia (sensitivity to sound) — even moderate noise can be intolerable
- Worsened by routine activity — movement, climbing stairs, bending
- Visual symptoms in those with aura — flashing lights, zigzag lines, blind spots
- Sensory symptoms in some with aura — tingling or numbness, typically starting in the hand and moving up the arm
- Speech difficulty in some with aura — usually mild and short-lived
Causes and Triggers
The exact cause of migraine is not fully understood, but it is known to involve genetic factors and changes in the brain’s pain-processing pathways. About 60% of people with migraine have a close relative who also has it.
While the underlying tendency is genetic, individual attacks are usually set off by triggers. Most people have a combination of triggers rather than a single one, and trigger thresholds can change over time.
Hormonal
Menstrual cycle, combined contraceptive pill, perimenopause. Strongest single trigger for many women.
Stress (and stress release)
Both stress and the “letdown” after stress (weekend migraine) commonly trigger attacks.
Sleep
Both too little and too much sleep can trigger attacks. Regular sleep timing helps.
Missed meals and dehydration
Skipping meals, low blood sugar, or inadequate fluid intake.
Sensory
Bright or flickering lights, strong smells (perfume, smoke), loud noises.
Foods and drinks
Common culprits: aged cheese, chocolate, processed meats, MSG, caffeine withdrawal, alcohol (especially red wine).
Weather changes
Pressure changes, very hot weather, bright sunshine.
Medication overuse
Using acute painkillers or triptans more than 10 days a month can cause medication-overuse headache.
Red Flags — When to Seek Emergency Care
Call 999 or go to A&E immediately for any of these symptoms with a headache:
- Sudden severe headache that reaches maximum intensity within seconds (“thunderclap”)
- Headache with fever and a stiff neck
- Headache after a head injury
- Headache with confusion, drowsiness, or seizure
- Headache with sudden weakness, numbness, vision loss, or speech problems that persist or do not match your usual aura pattern
- A new, severe headache in anyone over 50
- Headache that is progressively worsening over days
See your GP for non-emergency assessment if you have:
- Frequent headaches that affect daily life, work, or school
- Headaches that are getting worse over time
- Need to use acute painkillers more than 2 days a week
- Migraine that is not responding to over-the-counter treatment
- A first-ever migraine-like attack — particularly if over 50
- Migraine with aura, particularly if considering hormonal contraception
Migraine Treatment Overview
Migraine treatment has two strands. Acute treatment is taken at the onset of an attack to stop or reduce symptoms. Preventive treatment is taken daily to reduce the frequency and severity of attacks in people who have frequent migraine.
Acute treatment
NICE NG150 recommends a combination of a triptan (a migraine-specific medicine) plus an NSAID such as naproxen or paracetamol for acute attacks. Triptans work by activating serotonin receptors that reduce inflammation and constrict dilated blood vessels involved in migraine pain. Anti-sickness medicines may be added if nausea is significant.
Preventive treatment
For people with frequent migraine (usually 4 or more attack days per month, or fewer but very disabling attacks), daily preventive medication can substantially reduce attack frequency. Options include beta-blockers (propranolol), tricyclic antidepressants (amitriptyline) used at low doses, and anti-epileptic medicines (topiramate). Each has specific considerations — topiramate, for example, has strict MHRA pregnancy-prevention requirements due to its teratogenic risk.
Lifestyle and trigger management
Identifying and managing triggers is an essential part of migraine care, alongside medication. A migraine diary can help spot personal patterns. Regular sleep, meals, and hydration; managing stress; and limiting medication-overuse risk all reduce attack frequency.
Explore Migraine Treatment Options
Access Doctor provides prescription migraine treatments online — including triptans for acute attacks and preventive medication — following a short consultation with GPhC-registered pharmacist independent prescribers. See the full range and consultation details on the migraine treatment page.
View Migraine Treatments →Related Conditions
Migraine sits alongside other headache disorders and pain conditions. For more on specific related topics:
Pain
Generalised overview of pain — types, causes, and when to seek help.
Period Pain
Period pain and dysmenorrhoea — relevant for menstrual migraine.
Migraine Guides
In-depth guides on specific aspects of migraine:
Frequently Asked Questions
What is migraine?
Migraine is a neurological condition, not just a bad headache. Attacks typically involve moderate-to-severe one-sided throbbing head pain lasting 4 to 72 hours, usually with nausea, light sensitivity (photophobia) and sound sensitivity (phonophobia). About one in three people with migraine also experience an aura — temporary visual, sensory, or speech changes before the headache. Migraine affects around 1 in 7 people in the UK and is approximately three times more common in women than men.
What are the four phases of a migraine attack?
Migraine attacks often follow four phases. The prodrome (hours to days before) can cause mood changes, food cravings, neck stiffness, and tiredness. The aura (about a third of people) is a 5 to 60 minute reversible neurological event — typically visual disturbances such as zigzag lines or blind spots. The headache phase lasts 4 to 72 hours with moderate-to-severe pulsating pain. The postdrome (‘migraine hangover’) can last up to a day, with fatigue and difficulty concentrating. Not everyone experiences every phase.
What is the difference between migraine and a tension headache?
Tension headaches typically cause mild-to-moderate band-like pressure across the head and do not usually cause nausea or sensitivity to light and sound. Migraine attacks are usually one-sided, throbbing, and moderate-to-severe, and are typically accompanied by nausea, photophobia, and phonophobia. Migraine attacks often interfere with daily activities; tension headaches usually do not. Routine activity tends to make migraine pain worse, but does not significantly affect tension headache.
What triggers migraine attacks?
Common migraine triggers include hormonal changes (particularly the menstrual cycle), stress, missed meals, dehydration, lack of sleep or oversleeping, bright or flickering lights, strong smells, certain foods (often aged cheese, chocolate, or processed meats), and alcohol (especially red wine). Many people have a personal pattern of triggers, and attacks usually need a combination of factors. Keeping a migraine diary can help identify individual triggers.
When should I see a doctor about migraine?
See your GP if you have frequent headaches that affect daily life, headaches that are worsening, attacks not responding to over-the-counter treatment, or if you need painkillers more than 2 days a week (medication overuse headache risk). Seek emergency care (call 999 or go to A&E) for sudden severe ‘thunderclap’ headache, headache with fever and neck stiffness, headache with confusion, weakness, loss of vision, speech difficulty, or after a head injury — these may indicate serious conditions, not migraine.
Can migraine be cured?
Migraine cannot currently be cured, but it can be very well managed. Acute treatments (triptans, NSAIDs) treat attacks once started, and preventive medicines (taken daily) can reduce attack frequency and severity in those with frequent migraine. Lifestyle measures — regular sleep, hydration, meals, and trigger management — form a critical part of management. For many people, the right combination of treatment substantially reduces the impact of migraine on daily life.
Is migraine dangerous?
Migraine itself is not life-threatening, but it can be severely disabling and significantly affect quality of life. There is a small increased risk of stroke in people who have migraine with aura, particularly women who smoke or use combined hormonal contraception. This is why combined oral contraceptives are not recommended in women with migraine with aura. Always tell your prescriber if you have migraine when discussing contraception.
Speak to a UK Prescriber About Your Migraine
If migraine is affecting your daily life, a short online consultation with our GPhC-registered pharmacist independent prescribers can help you access the right treatment.
View Migraine Treatments →References
- NICE NG150. Headaches in over 12s: diagnosis and management. nice.org.uk/guidance/ng150
- NICE CKS. Migraine. Clinical Knowledge Summaries. cks.nice.org.uk/topics/migraine
- NHS. Migraine. nhs.uk/conditions/migraine
- The Migraine Trust. About migraine. migrainetrust.org
- MHRA. Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme. gov.uk/drug-safety-update
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
