Migraine

What is migraine?

Migraine is a primary neurological disorder characterised by recurrent attacks of moderate to severe head pain, typically one-sided and pulsating, lasting 4–72 hours. It is associated with nausea, vomiting, and profound sensitivity to light (photophobia) and sound (phonophobia). Around one third of people experience aura — transient neurological symptoms including visual disturbance, tingling, or speech difficulties that precede the headache.

Migraine is significantly underdiagnosed and undertreated — many sufferers manage attacks with over-the-counter painkillers that are insufficiently effective and can cause medication overuse headache with frequent use.

Symptoms & phases

The four phases of migraine

• Prodrome (hours to days before) — yawning, food cravings, mood changes, neck stiffness, or increased urination
• Aura (in ~30% of migraineurs) — visual disturbances such as zigzag lines or blind spots, tingling, numbness, or speech difficulty; typically lasts 20–60 minutes
• Headache phase — moderate to severe throbbing pain, usually one-sided; nausea, vomiting, photophobia, and phonophobia; worsened by physical activity
• Postdrome ("migraine hangover") — fatigue, brain fog, and sensitivity lasting up to 24 hours after the headache resolves

Common triggers

• Hormonal changes — menstruation is one of the most powerful triggers in women
• Stress and emotional upset — including post-stress "let-down" migraines at weekends
• Sleep disruption — too much or too little sleep
• Dietary triggers — skipped meals, dehydration, alcohol (particularly red wine), and caffeine changes
• Sensory triggers — bright or flickering lights, strong smells, loud sounds
• Weather changes and barometric pressure changes

When to see a doctor

See a doctor if migraines are frequent, severely disabling, or not responding to over-the-counter analgesia. Anyone having more than 4 migraine days per month should be assessed for preventative treatment. If the pattern of your headaches changes significantly, always seek medical review.

Treatment options

Acute treatment

• Triptans (e.g. sumatriptan, rizatriptan) — the gold-standard acute treatment; taken at onset of headache, highly effective
• NSAIDs and aspirin — effective for mild to moderate attacks when taken early
• Anti-emetics — for nausea and to improve absorption of oral medication
• Gepants (e.g. ubrogepant) — newer CGRP receptor antagonists for acute treatment

Preventative treatment

• Beta-blockers (propranolol) — first-line preventative for most patients
• Topiramate and amitriptyline — effective alternatives
• CGRP monoclonal antibodies (erenumab, fremanezumab) — highly effective injectable preventatives for frequent migraine
• Botulinum toxin (Botox) — for chronic migraine (15+ headache days/month)

How eMedClinic can help

Our neurologists provide thorough migraine assessments, prescribe triptans and preventative medication, and advise on trigger identification and lifestyle modification. We also support expats who have moved abroad and need to continue their migraine management — including prescription renewals and treatment upgrades where current therapy is not providing sufficient control.