Migraine Types, Triggers & Treatments

First, it’s important to understand that there are many different types of migraines and understanding the difference between them all is imperative to getting the right treatment.

As well as covering migraines related to vision which we normally focus on, we’ll explore each of the most prevalent migraine categories, common symptoms, and best possible treatments. Their causes and effects tend to overlap so if you are having problems with your vision as well as migraines (pre or post laser eye surgery) it is worth knowing about all the different migraine types, triggers and treatments.

What Sort of Migraine Am I Suffering From?

From heading to bed when you feel the onset of a migraine starting to take hold to getting flashes across your vision, migraines can have a huge impact on your day-to-day life.

But you’re not alone.

Statistics indicate that around 1 in 7 people will suffer from migraines, which makes them the third most common disease worldwide. Migraines often starts around puberty and is most prevalent among those aged between 35 and 45 years but it can also effect younger children unfortunately. There is also a big difference between genders with three times as many women as men being effected which is most likely due to hormonal differences.

However, migraines themselves are not created equal. Yours could be very different to someone else’s migraine – and here’s why.

Migraines can be divided into two major categories (with a third minor one which we’ll also touch upon):

Migraine with Aura: These present warning signs, such as flashing lights or seeing lines and shapes, before the migraine begins. Sometimes, you may even lose your vision for up to 30 minutes. You could also feel tingling in your legs and arms, with your speech, touch or taste being affected. This type accounts for around 1 in 4 migraine sufferers. Migraine without Aura: This migraine begins without any specific signs beforehand and is the most common type. Aura without Migraine: Often referred to as the ‘silent migraine’, these rare migraines occur when there is no headache but other migraine symptoms or auras are experienced. You may suffer from any of these types of migraines frequently, even as often as several times a week. There are also further sub-types that these migraines can be categorised into, including:

Menstrual Migraines: Often occurring anywhere from 2 days before a woman’s period to 3 days after it starts, these migraines tend to be without aura. Women who get these migraines may also suffer from other types of headaches at various other times of the month.
Ocular (or Retinal) Migraines: A very rare form of migraine, an ocular migraine is one with aura, causing the sufferer to see flashing lights, colours and various other visual disturbances, including the loss of some sight or all sight in one eye. This vision loss tends to be followed by a migraine and should only last 30 minutes or less.

Chronic Migraines: This headache lasts over 15 days a month for at least 3 months. On 8 of the days each month it includes migraine symptoms.
Hemiplegic Migraines: Hemiplegic translates as ‘paralysis to one side of the body’, meaning the aura that comes with this migraine is weakness to one side that lasts less than 72 hours.
Brainstem Aura: Symptoms include speech, sensory and/or visual ones and at least 2 of these further symptoms: unsteadiness, tinnitus (a ringing in your ears), vertigo, double vision, severe sensitivity to sound and slurred speech.
Vestibular Migraines: This migraine may also cause the onset of vertigo (where you experience a spinning sensation for several minutes or even hours), balance issues, acute motion sensitivity, ataxia, sensitivity to sound, nausea and vomiting.

What Are the Symptoms of a Migraine?

The majority of migraines will start when you’re a child, an adolescent or during early adulthood. Migraines can also pass through several different stages but you might not notice symptoms at each of these points.

Here are some of the signs you could be suffering from a migraine:

Before Your Migraine (Prodrome)

These tend to arise 1-2 days before your migraine, giving you a subtle warning that one’s on its way:

Stiffness in your neck
Frequent yawning
Food cravings
Increased thirst and subsequent urination
Mood changes, from happiness to depression
Constipation

Aura – Before and/or During Your Migraine

Even though most people won’t have an aura with a migraine, those who do will notice the following symptoms:

Vision disturbances, such as flashes of light, bright lights and various shapes
Vision loss
Numbness or weakness in one side of the body or the face
Pins and needles in a leg or arm
Hearing music or noises
Difficulty speaking
Uncontrollable jerking – or other similar movements

Each of these will start off gradually, building up to last for 20-60 minutes. They can also be associated with hemiplegic migraine (limb weakness).

The Migraine Attack

If untreated, a migraine tends to last from 4-72 hours, and how frequent these are will vary with each individual case. During your migraine, you may notice:

Blurred vision
Nausea and vomiting
Pain that’s pulsating or throbbing
Pain on both or one side of your head
Sensitivity to sounds, light and sometimes touch and smell
Lightheadedness, which can result in fainting

After Your Migraine (Postdrome)

As your migraine starts to ease off you enter the postdrome phase. Now you may feel elated or you could feel drained and washed out. For about 24 hours after, some people also find they experience:

Weakness
Moodiness
Dizziness
Confusion
Sensitivity to sound and light

What Triggers a Migraine?

These triggers vary and it isn’t unusual to have more than one of these – but understanding and noting what may be triggering your migraine will help you avoid them (if possible).

Food: Aged food, e.g. salami or cheese, and salty foods could cause a migraine, as can heavily processed foods. Skipping meals should also be avoided if you have migraines.
Drink: Caffeine and alcohol may cause migraines.
Sweeteners and Preservatives: Certain preservatives (e.g. monosodium glutamate – MSG) and artificial sweeteners (e.g. aspartame) are known to trigger migraines. Always check food labels so you can avoid these foods.
Sensory Stimulation: Unusually strong smells, loud noises or bright lights may induce a migraine – common triggers include cigarette smoke, bright sunlight, paint, flashlights and perfume.
Hormonal Changes: For women, the natural shift in their hormones can trigger a migraine. Some women will suffer from migraines just before or during their period, others will suffer from migraines during menopause or pregnancy (often during the postpartum period). The latter is due to the changes in oestrogen levels. Hormone medications (e.g. hormone replacement therapies and birth control) can also worsen migraines – but, in some cases, they may make them better.
Stress: Migraines can arise when there’s constant stress in your life. Work and home are the two most common places for stress, and, over time, this stress can have a detrimental impact on your body.
Physical Exertion: Sometimes, extreme physical exertion, exercise and even sex can cause a migraine.
Changes to Sleep Cycles: If your sleep pattern is disturbed, your migraines may occur more frequently. And making up for any lost sleep is a pointless exercise, as getting too much sleep can have the same adverse effect as lack of sleep.
Changes to the Weather: A migraine can be triggered by shifts in barometric pressure and changes in weather

What Increases Your Risk of Developing Migraines?

The above triggers won’t cause everyone to develop a headache – but some people will have certain sensitivities to these triggers that cause the onset of a migraine.

There are several risk factors that can predetermine whether or not you may suffer from migraines. These include:

Age: Although migraines can arise at any age, most will notice them beginning during adolescence. The good news is – migraines often start to improve when you’re over 30.
Genes: As mentioned previously, if you have a close family member who has migraines, it’s more likely you’ll suffer from them too. In fact, 90% of patients with migraines will have a family history of this same condition with parents being the best indicator. And if both your parents have or have had migraines, the risk is even higher.
Gender: Boys are more likely to suffer from migraines during childhood while women are more likely to develop migraines after puberty.

How Are Migraines Diagnosed?

Migraines aren’t diagnosed through a specific test. Rather, your doctor will need to see the pattern of headaches that you’ve been having along with any of the symptoms they cause. Understandably, migraines are often very unpredictable, sometimes occurring without any other clear symptoms. Therefore, it may take a while to come to an accurate conclusion. On your first visit to the GP, they may ask you numerous questions about your migraines, including where they occur, how often they occur and what they’re accompanied with, e.g. sensitivity to light or noise and nausea/vomiting. You may find it beneficial to start a migraine diary, noting what date and time the attacks happen, how long they last for, what you’d been doing before it started, what symptoms you had and what medication you took (if any). For women, it’s also worthwhile noting the start and end of your period. Your doctor may be able to provide you with helpful advice on lifestyle factors and/or medication that will help with your migraine. Or they may want to refer you to a specialist. A neurologist is someone who specialises in conditions that affect the nervous system and brain, and your doctor may feel it’s necessary for them to carry out further assessments if your migraines are chronic, your diagnosis is unclear or treatments aren’t helping

How Can Migraines Be Treated?

Sadly, there is no precise cure for migraines. However, there is a range of treatments available that may help lessen your symptoms and help you control your migraine attacks.

You may need to try several different medications or a mixture of some before you find the right treatment for you. And if over-the-counter (OTC) medication doesn’t work, your doctor may need to prescribe something stronger for you.

During an Attack

When a migraine attack occurs, most people find that lying or sleeping in a dark room helps ease it. Or you may find that eating helps, or that you feel better after you’ve been sick.

Over-the-Counter Painkillers

The majority of people with migraines can reduce their symptoms using OTC medication, such as ibuprofen, paracetamol and aspirin. These tend to be more effective if they’re taken as soon as you feel like the migraine is starting – rather than when the pain becomes too unbearable.

By taking them early on in your attack it allows the tablets to be absorbed into your bloodstream, easing your symptoms before they get worse. If you don’t, the medication will often be ineffective because it’s too late for it to have a beneficial effect. However, soluble painkillers that you dissolve in a glass of water are better in these cases because they are absorbed quickly into your bloodstream.

There is a number of cautions that come with taking these types of painkillers, especially on a regular basis. So you should always read the instructions carefully, avoiding ibuprofen and aspirin if you have a history of kidney or liver problems or a stomach ulcer. Aspirin isn’t suitable for children under 16, either.

Furthermore, taking any type of painkiller on a regular basis can make your symptoms worse. This is what’s known as a ‘painkiller headache’ or ‘medication overuse headache’. If you are taking painkillers on a regular basis you should speak to your GP.

Triptans

When OTC medication doesn’t work, a doctor may recommend triptans. These medicines are specific to migraines and are thought to help reverse the changes that occur in your brain, causing the migraine.

This medication is available as a nasal spray, injection or tablet, but does come with some side effects, including:

Flushing
Tingling
Tightness
Warm sensations
Heaviness in the chest, limbs or face

Some people may also experience drowsiness, nausea and dry mouth. These tend to be mild, though, and will disappear on their own.

Again, overuse of this medication can lead to painkiller headaches.

Anti-Sickness Medication

Also known as anti-emetics, anti-sickness medicines can often help treat migraines even if sickness or nausea aren’t one of the symptoms you experience. These may be prescribed alongside the triptans or painkillers and will work better if taken at the start of your migraine.

Side effects include diarrhoea and drowsiness.

Combination Medication

Your local pharmacy will stock some combination medications that are targeted at relieving migraines – and you won’t need a prescription for these. These tablets combine anti-emetics with painkillers.

Equally, you may find combining triptan with another OTC painkiller works best.

In most cases, these combined pills are more convenient. But sometimes, the doses won’t be high enough to completely eradicate your migraine attack, so you may find it better to take the anti-emetics and painkillers separately so you can control the dose.

Acupuncture

Want to try a drug-free approach to your treatment?

Then you may want to try acupuncture.

According to the National Institute for Health and Care Excellence (NICE), up to 10 sessions of acupuncture over a 5-8 week period may benefit some patients.

Transcranial Magnetic Stimulation

If you’re referred to a specialist, they may recommend transcranial magnetic stimulation. This was approved by NICE in 2014 and involves delivering magnetic impulses through your skin and into your head.

While it isn’t known exactly how this works, there have been some suggestions that it can reduce how severe migraines are – but it won’t cure them. Evidence also suggests that it’s more beneficial for people who have migraine with aura and the long-term effects of this treatment are still relatively unknown.

Some side effects include irritability, muscle tremor, tiredness and drowsiness and slight dizziness.

Treatment for Women Who Are Pregnant or Breastfeeding

In general, migraine treatment should be limited if you’re pregnant or breastfeeding. And the triggers of your migraine should instead be identified and, where possible, avoided.

If medication is required, you will need to speak to your doctor first.

How Can You Prevent Migraines?

Trying to prevent a migraine revolves around avoiding the triggers you’ve identified. If you can pinpoint what causes the onset of your migraines, you should be able to take some great steps towards removing these or reducing these factors, e.g. stress, noise, light and so on.

Here are some lifestyle changes you can make to help try and keep your migraine at bay:

Sleep: Getting into a regular pattern with your sleep, even when you’re on holiday or resting at the weekend can help reduce headaches.
Regular Exercise: You may be worried that exercise may cause the onset of a migraine but moderate aerobic exercise may help reduce the severity and length of your migraine. This also helps keep your stress levels in check – reducing another potential trigger.
Eat Regular Meals: A migraine can start when your blood sugar levels drop so don’t skip meals and keep yourself hydrated by drinking plenty of water.
Reduce Stress: Sometimes, this is easier said than done but try to limit the stress in your life by meditating, doing yoga, taking a short walk or listening to calming music.
Look After Your Eyes: Although poor eyesight and migraines aren’t directly linked, straining your eyes can lead to aches and pains around your eyes and may add another factor to your migraine. Getting the right glasses/contact lense prescription or undergoing laser eye surgery can eliminate this additional problem. Your optician will also be able to rule out any other vision problems that may be causing halos, flashing lights or shapes in your vision if your suffering from migraine with aura or aura without migraine.
Avoid Loud Noises and Bright Lights: These stimuli may trigger your migraine and while they may be difficult to avoid in some cases, you could try not to do certain things too frequently, especially if you feel as though a migraine may be on its way. Driving at night, being in a club or sitting in the full glare of the sun are all potential triggers, as is sitting at a computer for long periods of time. Always take a break from your screen to give your eyes a rest.

There are also other prevention medications available, including topiramate, propranolol and botulinum toxin type A. However, just like any other type of medication, these do come with side effects. So if your migraine can be controlled by monitoring potential triggers and making the aforementioned changes, this is recommended instead

When Should You Seek Medical Advice for Your Migraine?

If you are experiencing severe or frequent migraine attacks, you should seek medical attention straight away.

Some over-the-counter painkillers, e.g. ibuprofen and paracetamol may ease your migraine. However, you shouldn’t take too many of these as it may make it harder for you to treat headaches in the future.

You should also make an appointment with your GP if your migraines are frequent (five or more days per month), even if you have been able to control them with the aforementioned medication. You may benefit from other types of treatment that prevent your migraines.

In severe cases, you should dial 999. This includes if you or someone you’re with has:

Weakness or paralysis in one or both arms – or to the side of their face.
Garbled or slurred speech.
Headache alongside a rash, double vision, seizures, confusion, a stiff neck and a high temperature.
A sudden headache that’s blindingly painful and isn’t something they’ve experienced before.

These signs could indicate there’s something more serious wrong, e.g. meningitis or a stroke. You can see other conditions effecting eye health here.

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