The Four Phases of Migraine
| Phase | Duration | Symptoms |
|---|---|---|
| Prodrome | Hours–days before | Mood changes, food cravings, yawning, fatigue |
| Aura | Up to 60 minutes | Visual (zigzag lines, blind spot), sensory tingling, speech changes — in 30% |
| Headache | 4–72 hours | Unilateral pulsating pain; nausea; photo/phonophobia; worse with movement |
| Postdrome | Hours–days after | 'Migraine hangover' — fatigue, concentration problems, mood change |
Acute Treatment
| Severity | Treatment |
|---|---|
| Mild | NSAIDs (ibuprofen 400–600 mg) or paracetamol + antiemetic (metoclopramide) |
| Moderate | Triptan (sumatriptan, rizatriptan, eletriptan) ± NSAID |
| Severe / refractory | Triptan; consider subcutaneous sumatriptan; IV antiemetic in ED |
| Medication overuse warning | Limit triptans/NSAIDs to ≤10–15 days/month — avoid MOH |
Preventive Treatment
- Topiramate (50–100 mg/day) — effective but cognitive side effects
- Amitriptyline — low dose (10–75 mg) at night; good for tension-type overlap
- Beta-blockers (propranolol 80–160 mg) — widely used; avoid in asthma
- Sodium valproate — effective but avoid in women of childbearing age (teratogenic)
- CGRP monoclonal antibodies (erenumab, fremanezumab) — highly effective; subcutaneous monthly injection; available on NHS for chronic migraine (≥15 headache days/month)
Migraine DiaryRecord: date, time, duration, severity, possible triggers, medications used, and response. After 3 months, patterns emerge that guide trigger avoidance and preventive choice. The Migraine Trust diary app is free.
What is a triptan and how does it work?
Triptans are serotonin (5-HT1B/1D) receptor agonists that constrict cranial blood vessels and block pain pathways. They work best if taken early in the attack (within the first hour). They are not analgesics — they specifically target migraine.
Can caffeine help or hurt migraines?
Caffeine is a double-edged sword. It can provide acute migraine relief (it's in some combination analgesics). But regular caffeine intake raises the migraine threshold — withdrawal triggers migraines. Limit to 1–2 cups/day and be consistent.
What is chronic migraine?
Headache on ≥15 days per month for ≥3 months, of which ≥8 are migrainous. It's often associated with medication overuse. Treatment: preventive medication, withdrawal of overused analgesics, CGRP antibodies.
Are CGRP inhibitors better than traditional preventives?
CGRP inhibitors (erenumab, fremanezumab, galcanezumab, eptinezumab) are generally better tolerated and more effective than older preventives. They have no significant drug interactions and once-monthly subcutaneous dosing improves compliance.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.