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Migraine

Not just a bad headache — a treatable neurological condition.

Migraine is a recurrent neurological disorder characterised by throbbing, often one-sided headaches lasting 4-72 hours, typically with nausea, light and sound sensitivity, and sometimes aura. Modern treatment separates acute relief from prevention.

Causes & risk factors

  • Genetic predisposition
  • Hormonal fluctuations (menstrual migraine)
  • Sleep disruption
  • Certain foods (aged cheese, red wine, chocolate)
  • Stress and post-stress letdown
  • Bright lights, strong smells, weather changes

Symptoms

  • Throbbing one-sided headache
  • Nausea and vomiting
  • Light and sound sensitivity
  • Visual aura (flashes, zigzags) in 25%
  • Tingling or speech changes with complex aura
  • Exhaustion for 24 hours after

How it's diagnosed

  • Clinical — based on pattern of attacks
  • Headache diary noting frequency, triggers, response
  • MRI only if red flags or atypical features

Evidence-based treatment

  • Acute: triptans, NSAIDs, anti-emetics, gepants
  • Prevention: propranolol, topiramate, amitriptyline
  • CGRP antagonists (erenumab, galcanezumab) for frequent migraine
  • Botox for chronic migraine
  • Lifestyle: sleep hygiene, hydration, trigger avoidance

Prevention

  • Consistent sleep and meal times
  • Hydration through the day
  • Limit caffeine to under 200mg
  • Identify and avoid personal triggers

Related symptoms

Migraine — FAQ

When should I see a neurologist for migraine?

If attacks are more than 4 per month, if acute treatment isn't working, or if features are atypical (new in middle age, with neurological signs, worst-ever).

Are migraines hereditary?

Yes. If one parent has migraine, your risk roughly doubles; both parents, it triples.