Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Migraine: Causes, Attack Phases & UK Treatment Overview
A clinically reviewed guide to what migraine is, how it differs from a headache, the four attack phases, and the prescription treatments available in the UK.
When to get urgent help: Call 999 or go to A&E if you have a sudden, severe headache peaking within a minute, headache with fever and stiff neck or a non-fading rash, new weakness, slurred speech, vision loss or confusion, a seizure, or headache after head injury. Contact NHS 111 or your GP (same day if possible) if you have a new headache after 50, a worsening headache, one triggered by coughing, straining or posture, first-ever aura or aura over an hour, or headaches on 15+ days a month.
▶ What is a migraine?
Migraine is a neurological condition affecting over 10 million people in the UK. It is not simply a severe headache — it has distinct phases, a specific neurological mechanism, and multiple evidence-based prescription treatments. Three times more common in women than men.
10M
People affected in the UK (Migraine Trust)
3:1
Women to men ratio
4
Attack phases: prodrome, aura, headache, postdrome
25–30%
Of attacks involve aura
Migraine vs Headache: How to Tell the Difference
The key distinction is that migraine is a neurological condition — not a headache disorder. The headache is one symptom of a migraine attack, not the condition itself. Many people with migraine experience attacks that cause significant disability and prevent normal activity.
| Feature | Tension Headache | Migraine |
|---|---|---|
| Pain quality | Pressing, tightening — like a band around the head | Throbbing or pulsating, worsening with movement |
| Location | Both sides of the head | Usually one side (can be bilateral) |
| Duration | 30 minutes to 7 days | 4 to 72 hours |
| Nausea / vomiting | Absent | Common |
| Light / sound sensitivity | Mild at most | Severe — often disabling |
| Aura | Not present | Present in 25–30% of attacks |
| Effect on activity | Can continue activities | Often disabling — rest required |
What Causes Migraines?
Migraine involves dysfunction of the trigeminovascular system — a network of nerve fibres connecting the trigeminal nerve to blood vessels in the brain. During an attack, this system is activated, releasing inflammatory neuropeptides including CGRP (calcitonin gene-related peptide) that dilate cranial blood vessels and sensitise pain receptors.
A phenomenon called cortical spreading depression (CSD) — a slow wave of neuronal depolarisation spreading across the cortex — is believed to underlie migraine aura and trigger the trigeminovascular activation that causes headache pain.
Genetic susceptibility: Migraine has a strong hereditary component. If both parents have migraine, their children have a 70% chance of developing it. First-degree relatives of people with migraine are 2–3 times more likely to be affected.
Attacks are precipitated by individual triggers. Common triggers include: stress, hormonal changes, disrupted sleep, dehydration, certain foods, alcohol, and sensory stimuli. Most people have 3–4 identifiable triggers, and attacks often require multiple triggers coinciding.
The Four Phases of a Migraine Attack
Not every person experiences all four phases, and not every attack follows the same pattern. Understanding the phases helps with both recognition and timely treatment.
| Phase | When | Key features |
|---|---|---|
| 1. Prodrome | Hours to days before | Mood changes, food cravings, yawning, neck stiffness, fatigue. Full prodrome guide → |
| 2. Aura | 20–60 minutes before or during headache | Visual, sensory or speech symptoms in 25–30% of attacks. Builds gradually over minutes. Full aura symptoms → · Aura type guide → |
| 3. Headache phase | 4–72 hours | Moderate to severe throbbing pain (usually one-sided), nausea, photophobia and phonophobia. Full headache phase guide → |
| 4. Postdrome | Hours to 2 days after | Fatigue, brain fog, mood changes — the “migraine hangover”. Full postdrome guide → |
For a complete phase-by-phase breakdown of every symptom at each stage of a migraine attack, see the migraine symptoms guide →
UK Treatment Overview
Treatment falls into two categories: acute treatments taken during an attack, and preventive treatments taken daily to reduce attack frequency. The right choice depends on attack severity, frequency, and individual response.
Acute treatments (taken during an attack)
| Treatment | Best for | Guide |
|---|---|---|
| Triptans (sumatriptan, rizatriptan, zolmitriptan) | Moderate to severe migraine — first-line prescription treatment | Triptans guide → · Sumatriptan → · Rizatriptan → |
| NSAIDs (naproxen 500mg, ibuprofen) | Mild to moderate migraine; anti-inflammatory component; menstrual migraine | Naproxen for migraine → |
| Paracetamol 1g | Mild attacks; can be combined with an anti-emetic | — |
| Anti-emetics (prochlorperazine, metoclopramide) | Nausea and vomiting; improve oral drug absorption during attack | — |
Preventive treatments (taken daily)
NICE recommends preventive treatment if migraines occur on 4 or more days per month, or significantly affect quality of life. Options include propranolol (beta-blocker, reduces frequency 40–50%), topiramate, and amitriptyline. See the migraine prevention guide for full detail.
Get Prescription Migraine Treatment Online
Access Doctor provides triptans, naproxen and preventive migraine treatments. GPhC-registered pharmacist independent prescribers. Discreet next-day delivery. GPhC pharmacy #9011198.
View Migraine Treatments →When to Seek Medical Help
Contact your GP if migraines occur more than 4 times per month, are getting progressively worse, or significantly impact daily life. Online prescribers at Access Doctor can assess your migraine history and prescribe appropriate treatment.
Seek emergency care (call 999 or attend A&E) if you experience: sudden severe “thunderclap” headache (worst of your life) · headache with fever, stiff neck, rash · new neurological symptoms (weakness, vision loss, speech difficulty, confusion) · headache after head injury. These symptoms require urgent investigation to rule out serious causes.
UK Safety and Prescribing Information
Key UK points for the medicines most often used for migraine:
- Legal status: triptans are prescription-only medicines (POM), except a small pharmacy pack of sumatriptan 50 mg for adults aged 18–65 with diagnosed migraine. Naproxen is POM for migraine. Paracetamol, ibuprofen and aspirin are sold without a prescription.
- Age: most triptans are licensed for adults aged 18–65; sumatriptan nasal spray can be used from age 12 on specialist advice.
- Maximum doses: adults should take no more than 4 g of paracetamol in 24 hours (8 × 500 mg tablets).
- Medication-overuse headache: use triptans, opioids (such as codeine) or combination painkillers on fewer than 10 days a month, and paracetamol, aspirin or NSAIDs on fewer than 15.
- Interactions: tell your prescriber about antidepressants (SSRIs, SNRIs, MAOIs), or St John’s wort — serotonin syndrome with triptans is rare but serious. If you take propranolol, tell your prescriber, as a lower dose of rizatriptan is needed.
- Supply: Access Doctor supplies MHRA-licensed UK medicines, dispensed by a GPhC-registered pharmacy (#9011198) after a prescriber’s assessment. Buying prescription-only medicines without a prescription is illegal in the UK.
Pregnancy and breastfeeding: Paracetamol is the first-choice painkiller in pregnancy. Avoid NSAIDs such as naproxen unless a doctor advises, and do not use them in the third trimester. Triptans are only used in pregnancy on medical advice. Sumatriptan is generally considered compatible with breastfeeding (the manufacturer suggests avoiding feeds for 12 hours after a dose) — check with your GP, midwife or pharmacist. A severe headache in pregnancy or after birth, especially with vision problems or sudden swelling, can signal pre-eclampsia: contact your midwife or NHS 111 straight away.
Driving and machinery: triptans and some anti-sickness medicines can cause drowsiness or dizziness. Do not drive or use machinery until you know how a medicine affects you and your symptoms have passed.
NHS: migraine medicines are available on NHS prescription. Charges apply in England unless you are exempt; prescriptions are free in Scotland, Wales and Northern Ireland.
Frequently Asked Questions
What is the difference between a migraine and a headache?
A migraine is a neurological condition, not simply a severe headache. Migraines cause moderate to severe throbbing pain (usually one-sided), lasting 4 to 72 hours, with nausea, vomiting and extreme sensitivity to light and sound. A tension headache causes diffuse pressing pain on both sides without nausea or aura.
What are the four phases of a migraine?
Up to four phases occur: prodrome (warning signs hours to days before), aura (neurological symptoms in 25–30% of attacks), the headache phase (the main attack), and postdrome (the recovery phase — often called the migraine hangover). Not every attack involves all four.
What causes migraines?
Migraine involves dysregulation of the trigeminovascular system and cortical spreading depression. Attacks are triggered by individual factors including stress, hormonal changes, disrupted sleep, dehydration, certain foods, and sensory stimuli. Genetic susceptibility is significant.
When should I see a doctor about migraines?
See a doctor if migraines occur more than 4 times per month, are getting progressively worse, or significantly affect your quality of life. Seek emergency care for thunderclap headache, headache with fever and stiff neck, or new neurological symptoms.
What prescription treatments are available for migraine?
Triptans (sumatriptan, rizatriptan, zolmitriptan) are first-line for moderate to severe migraine. NSAIDs such as naproxen are effective for mild to moderate attacks. For 4+ migraine days per month, preventive treatments including propranolol and topiramate can significantly reduce frequency.
Are triptans prescription-only in the UK?
Yes, almost all triptans are prescription-only medicines in the UK. The one exception is a small pack of sumatriptan 50mg tablets that a pharmacist can sell to adults aged 18 to 65 who already have a diagnosis of migraine. Other triptans, strengths and forms need a prescription from your GP or a registered online prescriber after a clinical assessment.
References
- NICE. Headaches in over 12s: diagnosis and management. CG150. 2012 (updated 2021). nice.org.uk/guidance/cg150
- NHS. Migraine. nhs.uk/conditions/migraine
- Migraine Trust. Migraine facts and statistics. migrainetrust.org
- BASH. Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication overuse headache. 4th ed. 2010.
- Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card: report a suspected side effect. yellowcard.mhra.gov.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Prescription migraine treatments require a clinical consultation. Always consult a qualified healthcare professional. In a medical emergency, call 999.
Report suspected side effects of any medicine to the MHRA through the Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app). Reporting helps the MHRA keep medicines safe for everyone in the UK.