Migraine Explained: Causes, Symptoms and Treatment

What migraine actually is

Migraine is a condition of the brain and its nerves, not simply a headache caused by tension or tiredness. During an attack, waves of altered activity spread across the brain, nerve pathways involved in pain become over-sensitive, and blood vessels and chemical signals change. A key player is a chemical called CGRP, which is released and drives inflammation and pain around the brain's coverings. This is why migraine can bring nausea, sensitivity to light, sound and smell, and why ordinary movement makes it worse. It also explains why migraine runs in families: people can inherit a brain that is more easily tipped into an attack by triggers, so it is a genuine biological condition, not a sign of weakness.

The phases and aura

A migraine attack can unfold in stages, though not everyone has all of them. First may come warning signs a day or two before, such as tiredness, mood changes, food cravings or a stiff neck. Some people then get an aura: temporary nerve symptoms lasting up to an hour, most often flickering lights, zigzag lines or blind spots in vision, and sometimes pins and needles or trouble speaking. Next comes the headache itself, often throbbing, frequently on one side, with nausea and sensitivity to light and sound, lasting from a few hours to three days. Finally there is a recovery phase, where people feel drained, foggy or washed out. Recognising these stages can help people act early and cope better.

Triggers and keeping a diary

Migraine attacks are often set off by triggers, and these vary from person to person. Common ones include stress or, tellingly, the let-down after stress, missed meals, dehydration, poor or changed sleep, bright or flickering lights, strong smells, alcohol, and hormonal changes around periods. Weather shifts and certain foods can play a part for some people. Because triggers are so individual, keeping a headache diary is one of the most useful things you can do. Noting when attacks happen, what you ate, your sleep, your stress and, for women, your menstrual cycle can reveal patterns over a few weeks. Once triggers are identified, steady routines around sleep, meals, hydration and stress can genuinely reduce how often attacks strike.

Treating an attack

Treatment of a migraine attack aims to stop it quickly and comfortably. Many people find relief by resting in a quiet, dark room and using simple pain relievers available from a pharmacist, taken as early in the attack as possible. Anti-sickness medicines can help both the nausea and the headache. When simple painkillers are not enough, GPs can prescribe a group of migraine-specific medicines called triptans, which act on the pathways involved. A pharmacist is a good first port of call for advice and over-the-counter options. Importantly, using painkillers too often, more than a couple of days most weeks, can cause medication-overuse headache, a rebound problem, so it is wise to track how frequently you reach for them.

Preventing frequent migraines

When migraines are frequent or disabling, the focus shifts to prevention rather than only treating attacks. GPs may suggest lifestyle steps first: regular sleep, meals and exercise, good hydration, and managing stress, sometimes with relaxation or talking therapies. If attacks remain frequent, several preventive medicines can be prescribed, some originally developed for other conditions, taken daily to make attacks less common. Newer treatments that block the CGRP chemical, given by injection, are available through specialist services for people who have not responded to other options. Some people benefit from referral to a neurologist. Supplements such as riboflavin help some sufferers. The goal of prevention is fewer, milder attacks and a return to normal daily life.