Migraine

Overview

Migraine causes attacks of headaches, often making you feel sick or causing you to be sick. Treatment options include avoiding possible triggers, painkillers, anti-inflammatory painkillers, anti-sickness medicines, and triptan medicines. A medicine to prevent migraine attacks is an option if the attacks are frequent or severe.

Migraine is a condition that causes attacks (episodes) of headaches. Other symptoms such as feeling sick (nausea) or being sick (vomiting) are also common. Between migraine attacks, the symptoms go completely.

Causes

The cause is not clear. A theory that used to be popular was that blood vessels in parts of the brain become narrower (go into spasm) which accounted for the aura. The blood vessels were then thought to open wide (dilate) soon afterwards, which accounted for the headache. However, this theory is not the whole story and, indeed, may not even be a main factor. It is now thought that some chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms. The exact changes in brain chemicals are not known. It is also not clear why people with migraine should develop these changes. However, something may trigger a change in activity of some brain chemicals to set off a migraine attack.

The cause of, or trigger to, menstrual migraine is thought to be the fall of the level of oestrogen that occurs at this time in the cycle. Oestrogen is one of the chemicals (hormones) that control the menstrual cycle. The blood level of oestrogen falls just before a period. It is not a low level of oestrogen that is thought to be the trigger, but the drop in the level of oestrogen from one level to another.

Migraine is not classed as an inherited condition. However, it often occurs in several members of the same family. So, there is probably some genetic factor involved. Therefore, you are more likely to develop migraine if you have one or more close relatives who have migraine.

Risks

Migraines are associated with a small increased risk of ischaemic strokes, and a very small increased risk of mental health problems. 

An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. Studies have shown that people who experience migraines (particularly migraine with aura) have about twice the risk of having an ischaemic stroke at some point compared to people without migraines. However, this risk is still small. It is unclear why ischaemic strokes are linked to migraine.

The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill. Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill. Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors such as high blood pressure or a family history of cardiovascular disease. If you take the combined contraceptive pill and you experience aura symptoms, talk to your GP about alternative forms of contraception.