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Migraine Q&As

Published by Bupa's health information team, June 2009.

Answers to questions about migraine

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

What are the most common migraine triggers?

You may find that your migraines are triggered by particular foods, drinks, smells, lights, noises or situations (such as stressful situations). Often you will only get a migraine if a number of triggers happen at the same time. The type, number and combination of migraine triggers vary greatly from one person to another.

Explanation

The most common migraine triggers can be divided into several groups: emotional, hormonal, dietary, environmental and sleep.

Emotional triggers

It's possible that your migraines may be triggered in response to particular emotions. Common emotional triggers include:

  • stress
  • anxiety
  • depression
  • shock
  • relief (for example, at the end of a stressful time)
  • anger
  • grief

Hormonal triggers

For many women, hormones play an important role in migraine. Hormonal changes that occur during the menstrual cycle, or as a result of taking oral contraceptives/hormone replacement therapy, pregnancy and menopause can all affect the frequency and severity of migraines in some women.

Women may have their first migraine in the same year as their first menstrual period and their migraines may happen more frequently in the days before, during, or immediately after their period. For some women, taking an oral contraceptive will make their migraines worse, while for others, it will make them better. If your migraines are hormone-related, your GP may prescribe medicines that will reduce the duration and severity of your period or may suggest that you take a different oral contraceptive (or start taking one if you aren't already).

It's very important to tell your GP if you have auras with your migraines.

Many women find that migraines get worse as they reach the menopause. Some find that hormone replacement therapy helps, but for others it makes them worse.

Around three-quarters of women report that their migraines improve during pregnancy - particularly during the last three months. However, migraines during pregnancy most often occur in the first three months, at which time most migraine medicines are unsuitable. This is because the risk of harm to the unborn baby is greatest at this time in pregnancy.

If you have migraines and you're pregnant, breastfeeding or trying to get pregnant, talk to your GP before taking any medicines for your migraine (even if they were prescribed for you previously) as they may be harmful for your baby.

Dietary triggers

You can get migraines if you don't eat enough, or don't have a regular eating routine. Also eating particular types of food can trigger migraine. Common food triggers include:

  • chocolate
  • cheese and other dairy products
  • nuts
  • citrus fruits
  • fried or fatty foods
  • foods containing additives, such as tyramine and monosodium glutamate

Drinks that are known to trigger migraines include alcohol (especially red wine) and drinks containing caffeine, such as tea or coffee.

Environmental triggers

You may find your migraines are triggered by particular smells (such as strong perfume or cigarette smoke), lights or noises, or by changes in air pressure, weather conditions and the seasons.

Sleep

It's possible that changes in sleep patterns, for example, because of shift work or long-distance travel, may trigger your migraines. If you're overtired either mentally or physically, this may also trigger migraine.

Further information

Sources

  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:600-601
  • Headache triggers. Migraine Action Association. www.migraine.org.uk, accessed 22 October 2008
  • Avoiding attacks. Migraine Trust. www.migrainetrust.org, accessed 22 October 2008
  • Who gets migraine. Migraine Action Association. www.migraine.org.uk, accessed 22 October 2008
  • Marcus DA. Managing headache during pregnancy and lactation. Expert Rev Neurotherapeutics 2008; 8:385-395. www.expert-reviews.com
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I have migraines - am I at risk of having a stroke?

The most common types of migraine are classic migraine (migraine with aura) and common migraine (migraine without aura). Migraine, especially with aura, is associated with an increased risk of having a stroke.

Explanation

Migraine symptoms occur when too much of a chemical in your brain (a 'neurotransmitter') causes changes in the blood vessels and the blood flow in your brain.

A stroke is damage to your brain caused by a loss of blood supply. The two main types of stroke are called an ischaemic stroke and a haemorrhagic stroke. An ischaemic stroke is when an artery in your brain becomes blocked, for example by a blood clot. A haemorrhagic stroke is when there is a bleed in your brain caused by a blood vessel bursting (this is usually caused by high blood pressure). Scientific research has shown that if you have migraine with aura, you're at an increased risk of having an ischaemic stroke but not a haemorrhagic stroke.

It's not known why you're at an increased risk of having a stroke if you suffer from migraines.

Your age is the most important risk factor for stroke. In people under 45, the risk of having a stroke is very low, even if you have migraine with aura.

Some medical conditions, including antiphospholipid syndrome and subarachnoid haemorrhage (bleeding on the brain), are associated with an increased risk of stroke and can also cause migraine or migraine-like symptoms. However, these conditions are rare.

Your risk of having a stroke is increased if you smoke. If you do smoke, you should try to stop. Ask your GP for advice about giving up smoking.

Your risk of having a stroke is also increased if you take oral hormone contraceptives. If you're diagnosed with migraine with aura, your GP may recommend that you use a hormone contraceptive that has a low oestrogen content or contains only progesterone.

Talk to your GP if you have migraines and are worried about an increased risk of stroke.

Further information

Sources

  • Kurth T, Schürks M, Logroscino G, et al. Migraine, vascular risk and cardiovascular events in women: prospective cohort study. BMJ 2008; 337:a636. www.bmj.com
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:600-601
  • Cardiovascular risk - assessment and management - background information - stroke. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 28 October 2008
  • Migraine - background information - complications. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 28 October 2008
  • Etminan M, Takkouche B, Isorna FC, et al. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ 2005; 330:63-65. www.bmj.com
  • Boudreau G, Leroux E. The complications of migraine classified under the International Classification of Headache Disorders: a review. Headache Care 2006; 3:85-90. www.librapharm.com
  • Thomas DJ. Migraine and ischaemic stroke. BMJ 2005; 330:54-55. www.bmj.com
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Are migraines in children the same as migraines in adults, and how can they be treated?

Migraine symptoms in children are often the same as those in adults. Migraine attacks can be shorter in children than in adults and last between one and two hours. In adults a migraine attack usually lasts between four and 72 hours. Talk to your GP if your child has any migraine symptoms.

Explanation

Both adults and children who have migraines are completely symptom-free between attacks. In adults, a common migraine (migraine without aura) causes a persistent and severe throbbing or pounding pain, usually on one side of the head. In children, the pain is often felt on both sides or in the middle of the head.

Sometimes, your child may suffer from pain in his/her abdomen (tummy) and may feel sick or vomit. Even though adults can also suffer from these symptoms, the regular pattern of attacks can help your child to be diagnosed with migraine. It's not always easy to diagnose migraines in children as your child may find it difficult to accurately describe his/her symptoms. Children with migraine are often also travel sick.

Treatment of migraines in children

Self-help

Lack of food or long gaps between eating is a common trigger of migraines in children. You may be able to prevent your child's migraine attack by giving him/her small, regular meals.

During a migraine, it's best for your child to sit quietly or lie down in a darkened room.

Over-the-counter medicines

The over-the-counter painkillers paracetamol and ibuprofen (children under 12 shouldn't take aspirin) may be effective in treating your child's headache symptoms.

Your GP may recommend your child takes a medicine called a triptan, which is available for children over 12 years as a nasal spray called sumatriptan (Imigran). This medicine can be bought without a prescription following a consultation with a pharmacist.

Always read the patient information leaflet that comes with your child's medicine and if you have any questions, ask your pharmacist for advice.

Prescription-only medicines

If over-the-counter medicines don't improve your child's migraine symptoms, there are other treatments that your GP can prescribe for him/her.

Medicines called anti-emetics (eg domperidone) may stop your child feeling sick and vomiting and help his/her body absorb the painkillers more quickly and efficiently.

These medicines aren't suitable for everybody and can cause side-effects in some children. Always ask your GP for advice and read the patient information leaflet that comes with your child's medicine.

Further information

Sources

  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - report of an EFNS task force. Eur J Neurol 2006; 13:560-572. www.efns.org
  • Headache types. Migraine Action Association. www.migraine.org.uk, accessed 28 October 2008
  • Migraine - making a diagnosis - migraine in children. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 28 October 2008
  • Migraine in children. Migraine Action Association. www.migraine.org.uk, accessed 28 October 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:600-601
  • Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:241-246
  • News & Press - latest news - first OTC triptan. Migraine Action Association. www.migraine.org.uk, accessed 22 October 2008
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2009

 

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