Migraine

Main

• Migraine is an inherited feature of the nervous system: the excitation threshold is lower than usual, so the brain reacts more sharply to light, sound and movement.
• An attack lasts from four hours to three days: the pain is pulsating, more often one-sided, and worsens with walking and bending.
• An aura occurs in about a third of people: zigzags, loss of part of the visual field, numbness of half the face or arm pass within an hour.
• Triggers are individual for everyone: lack of sleep, skipped meals, dehydration, red wine, cheeses, caffeine, weather and flickering light.
• A diary of attacks over one to two months is the main document at an appointment with a neurologist: from it the doctor assesses the frequency and conditions of the episodes.

What is migraine

Migraine is a disease of the nervous system in its own right, not a consequence of tiredness or problems with the blood vessels. Attacks manifest as a pulsating headache, more often on one side, and are made worse by light, sound and movement.

What happens in the body

Migraine is based on an inherited feature of how the nervous system works, in which the threshold of excitation turns out to be lower than usual. Because of this, the brain reacts more sharply to familiar stimuli that do not cause any sensations in other people. When such a stimulus acts, a chain of changes is triggered in the workings of nerve cells and their connections with one another. A person notices this as a growing pulsation, more often on one side of the head, and as a sharp intolerance of light, sound and movement. An attack can last for hours, and during this time ordinary tasks become almost impossible to carry out. Between attacks, wellbeing usually remains normal, and this distinguishes the condition from constant malaise. Therefore it is important to notice what exactly precedes an attack and to write down these circumstances.

What causes it to develop

• Too little sleep and too much sleep: a lack of sleep and, which is less often expected, sleeping too long at the weekend disrupt the usual routine and trigger an attack.
• Skipping meals and dehydration: long gaps between meals and a lack of fluid change the workings of the body and become a trigger for an attack.
• Hormonal fluctuations of the cycle: changes in hormonal levels on different days of the cycle in many women coincide in time with the onset of an attack.
• Red wine, aged cheeses, caffeine: these products trigger an attack in some people, and abruptly stopping habitual caffeine has the same effect.
• Weather and flickering light: a sharp change in the weather and bright flickering light overload the nervous system and can be the last straw.
• Conclusion: each person's trigger is their own, so it is useful to track what exactly an attack starts after and to keep records.

Who experiences this more often

This condition is more often experienced by people whose close relatives have also noted similar attacks, since the feature is passed down through inheritance. In women, attacks often coincide with certain days of the cycle, and then a link with hormonal fluctuations can be traced. In children and adolescents the condition also occurs, although it is harder to recognise because of vague complaints. The frequency is also influenced by lifestyle: irregular sleep, skipped meals and constant tension make attacks more frequent. It has been noted that in some people attacks occur rarely, while in others they recur far more often under similar circumstances. This is because the threshold of excitation is different for each person and changes under the influence of stress. It is useful to notice during which periods attacks become more frequent and to discuss these observations with a specialist.

What symptoms can there be?

Migraine is recognised by recurring attacks of headache with nausea and intolerance of light, and sometimes it is preceded by a short visual aura. Below is an analysis of how to recognise the onset of an attack and in which cases help is needed immediately.

How it is noticed at the very beginning

Migraine often begins with warning signs that a person puts down to tiredness or lack of sleep. In about a third of people, an aura appears before the attack: visual zigzags, loss of part of the visual field, numbness of half of the face or an arm. Such an aura lasts from five minutes to an hour and passes on its own, after which the pain itself unfolds. The pain is moderate or severe, more often one-sided, throbbing, and worsens with ordinary physical exertion. Climbing stairs or walking a block becomes difficult, so the person looks for a reason to stay at home. The attack lasts from four hours to three days, and throughout this time the ability to work drops noticeably. If such episodes recur, it is worth writing them down in a diary and showing the notes to a doctor.

Symptoms that occur most often

• Nausea, sometimes vomiting: appears at the height of the pain and worsens with movement, which makes it hard to eat and drink.
• Intolerance of light and loud sounds: an ordinary lamp and conversation nearby are irritating, so the person dims the light and asks for silence.
• A wish to lie down in a dark, quiet room: at rest and without irritants the pain is easier to bear, and this is a noticeable sign of migraine specifically.
• Worsening of pain from bending over and walking: even a short movement of the head or body makes the pain sharper, so any tasks are put off.
• One-sided throbbing pain: it covers half of the head and throbs in time with the heartbeat, which distinguishes it from ordinary tension.

When to seek help urgently

Examinations and tests

Examination for migraine is built around questioning and a observation diary, not around scans. Below is a breakdown of what happens at an appointment, which investigations are actually used and what is worth bringing with you.

How the examination begins

Migraine belongs to conditions that are recognised by the description of attacks, so the appointment begins with a detailed conversation about the nature of the headache. The doctor clarifies where it hurts, how long the attack lasts, what precedes it and what accompanies it. Separately, it is established how often the episodes occur and how much they interfere with ordinary activities. Then the specialist collects information about past illnesses, head injuries and how close relatives suffered. The examination includes measuring blood pressure, checking vision, sensation and reflexes in order to exclude other causes of the complaints. With a typical picture, tomography is not required and adds no additional information. If, however, the doctor notices unusual signs, he may refer for additional investigations. A headache diary kept for one to two months remains the main document of such an appointment.

What is prescribed and what it shows

What is worth preparing for the appointment

• Attack diary: records for one to two months with dates, duration and circumstances, because the doctor assesses the picture from them.
• List of medications taken: everything you take regularly, including what other specialists have prescribed, in order to avoid incompatible combinations.
• Discharge summaries and reports: the results of previous examinations and investigations, if there were any, so as not to repeat what has already been done.
• Description of the attack: where it hurts, what precedes it, what accompanies it and what helps, since details are more important than general words.
• Questions for the doctor: points written down in advance about causes, further steps and monitoring, so as not to forget anything in the conversation.

Which doctor should I see?

Choosing a doctor for migraine usually comes down to a neurologist, but if such a specialist is not available nearby, the initial appointment is conducted by a general practitioner. This section explains what happens during a consultation and what areas of care make up the treatment.

Which specialist manages this condition

Migraine is managed by a neurologist, since it concerns the functioning of the nervous system rather than a random episode of headache. If there is no neurologist nearby, you can start with a general practitioner: they will assess your overall condition and advise where to go next. At the first appointment, the doctor asks in detail about the nature of the attacks, their frequency and accompanying signs such as nausea or sensitivity to light. A diary of observations noticeably helps the conversation, because details are usually lost and confused when recalled from memory. The doctor clarifies which painkillers the person has already taken and how often this happened during the month. Separately, it is established what changes in how you feel before the pain and how long recovery after it takes. If the attacks are frequent, the neurologist assesses whether preventive support is needed and arranges a follow-up visit for monitoring.

What the treatment consists of

• Stop the attack early: help in the first half hour of pain works noticeably better than a late turn to painkillers.
• Limit the frequency of use: do not exceed ten days of painkiller use per month, otherwise the pain may worsen.
• Discuss prevention: it is considered for four or more attacks per month, and the result is assessed after three months of observation.
• Establish a routine: regular sleep and meals on schedule support your condition no worse than some treatment prescriptions.

What depends on the patient themselves

Regular follow-up with a doctor largely determines how manageable migraine will be in everyday life. A person who keeps records of attacks brings a concrete picture to the appointment, rather than vague memories of bad days. Such notes show how often the pain occurs and what precedes it, helping the doctor build care more precisely. Keeping to a sleep and meal routine requires discipline, but noticeably affects how you feel between episodes. It is important to honestly report how many painkillers are used per month, because exceeding this amount changes the approach. If the attacks have become more frequent or changed in character, this should be mentioned at the nearest visit, without waiting for the scheduled date. Consistency in observation and following agreements with the doctor gives more than one-off efforts.

What helps prevent an exacerbation?

Preventing migraine attacks largely depends on a person's own everyday decisions. Below is a breakdown of which habits, observations and regular doctor's visits reduce the frequency of attacks.

What to change in your habits

Sleep and meal patterns directly affect how often migraine attacks occur. A sharp change in waking time at the weekend often triggers an attack by the evening. Skipping breakfast or a long gap between meals also becomes a trigger for many people. Dehydration makes headaches worse, so it is worth keeping water to hand throughout the day. Bright light and loud sounds trigger an attack in some people, and this is noticeable when entering a noisy room. A diary of observations helps to see the link between a habit and an attack that cannot be seen from within the attack itself. After two months of notes a pattern usually emerges, and it is worth discussing it with a doctor.

What is worth keeping under control

• Attack diary: record the start time, duration and accompanying symptoms so you can see a recurring rhythm.
• Sleep: note what time you go to bed and get up, because a disrupted schedule often coincides with an attack.
• Diet: record missed meals and the amount of water drunk, as hunger and thirst make an attack worse.
• Workload and stress: track periods of overwork and intense strain, as they often precede an attack.
• External triggers: notice your reaction to bright light, strong smells and loud sounds so you can avoid them in advance.
• Summary of observations: bring your notes to the appointment, as they help the doctor assess the course of the condition more accurately.

How often to see a doctor

Regular visits to a doctor are needed even when attacks have not troubled you for a long time. The condition changes over time, and what helped before may stop working for no external reason. At the appointment the doctor compares the diary notes with your account and notices shifts that are invisible to the person themselves. If attacks have become more frequent or their character has changed, this should be reported without waiting for a scheduled visit. Frequent use of painkillers without discussing it with a doctor can make headaches worse, so this point should also be talked through. Monitoring helps to adjust the approach in time and not let the condition progress to severe attacks. Keep the diary to hand and take it to every appointment, so that the conversation is based on facts rather than memory.

What is worth remembering

Migraine is not just a severe headache, but a recurring condition with clear signs and its own patterns. Understanding how an attack works and what influences its onset helps a person react more calmly to what is happening and get the right help in time.

Key takeaways

Migraine remains a condition in which pain recurs and noticeably disrupts a person's usual life. An attack is often accompanied by nausea, intolerance to light and sound, and sometimes temporary visual or sensory disturbances. Such signs help distinguish migraine from an ordinary episode of tension headache. Many people notice that an attack is triggered by lack of sleep, hunger, a sudden change in weather or severe stress. Keeping a diary, in which the date, time and circumstances of an attack are noted, gives the doctor valuable information about the course of the illness. If attacks become more frequent or change in character, this is a reason not to postpone a visit to a neurologist. Concomitant conditions and lifestyle features are also worth discussing with the doctor, as this influences the choice of approach.