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Migraine is not just a bad headache — it is a neurological condition affecting one in seven people. Most sufferers treat attacks and never discuss prevention, which is where the real gains are.
How migraine differs from tension headache
Migraine is typically one-sided, throbbing or pulsating, moderate to severe, worsened by routine physical activity, and lasts four to seventy-two hours. It is usually accompanied by nausea, and by sensitivity to light and sound severe enough that the person seeks a dark, quiet room.
Tension headache, by contrast, is bilateral, pressing or tightening rather than throbbing, mild to moderate, and not worsened by ordinary activity. Distinguishing the two matters because the treatments differ.
Common triggers
- Skipped or delayed meals — one of the most common and most fixable
- Dehydration
- Irregular sleep, including sleeping in on weekends
- Stress, and the relaxation period after stress
- Menstrual hormonal changes
- Bright light, glare, loud noise and strong smells
- Specific foods in some people: aged cheese, chocolate, processed meat, MSG, red wine
- Weather changes and heat exposure
- Excessive or withdrawn caffeine
- Prolonged screen use without breaks
Worth knowing
Keep a headache diary for eight weeks recording date, timing, severity, what preceded it, what you had eaten, sleep and menstrual cycle. Patterns emerge that are impossible to see from memory alone.
Treating an attack
Take medication early — at the first sign, not after waiting to see whether it becomes severe. Migraine medication works far better before central sensitisation sets in. Rest in a dark, quiet room, apply a cold compress to the head and stay hydrated.
Simple analgesics work for mild attacks; triptans are the specific class for moderate to severe migraine and are highly effective when taken early. An anti-nausea medicine taken alongside helps both the nausea and the absorption of the painkiller.
Medication overuse headache
Taking painkillers for headache on more than ten to fifteen days a month causes a new, constant daily headache that is driven by the medication itself. This is extremely common and almost never recognised by the patient, who takes more painkillers as the headache worsens.
The only treatment is stopping the offending medication, which causes a difficult one to two weeks before improvement begins. If you are taking headache medication more than twice a week, discuss preventive treatment instead.
Prevention
- Preventive medication is worth considering if you have four or more migraine days a month, or attacks that are disabling
- Options include beta blockers, certain antidepressants, anti-epileptics and, in selected cases, newer CGRP-targeting drugs
- Preventives take six to eight weeks to show effect — do not abandon them early
- Regular sleep and meal timing, consistent hydration and regular exercise all reduce frequency
- Magnesium and riboflavin have modest supporting evidence
Headaches that need urgent assessment
- Sudden severe headache reaching maximum intensity within a minute
- Headache with fever and neck stiffness
- Headache with weakness, numbness, confusion or visual loss
- New headache after the age of 50
- Headache that wakes you from sleep or is worse on coughing or bending
- A clear change in the pattern of a long-standing headache
Key takeaways
- Take migraine medication at the very first sign, not after the pain has escalated.
- A headache diary reveals triggers that memory cannot.
- Painkillers on more than 10–15 days a month cause medication overuse headache.
- Four or more migraine days a month justifies discussing preventive treatment.
A note on medical advice
This article is general health education written and reviewed by the Department of Neurology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
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