Migraine is much more than a bad headache. The neurological condition affects roughly 1 in 7 adults and is one of the leading causes of disability in working-age people. UK clinicians treat it on two tracks — acute treatment to stop individual attacks, and preventive treatment to reduce how often they happen. This article walks through both.
What migraine is
Migraine is a recurrent neurological disorder, typically presenting as moderate-to-severe unilateral throbbing headache lasting 4 to 72 hours, often with nausea, vomiting, sensitivity to light and sound, and sometimes a preceding aura (visual disturbance, sensory changes). Triggers vary by individual: stress, sleep changes, missed meals, hormonal changes, alcohol, specific foods, weather changes.
Acute treatment: stopping an attack
The goal of acute treatment is to abort the attack quickly. The standard UK options are layered:
- Simple analgesia — paracetamol or NSAIDs (ibuprofen, naproxen) taken at the first sign of headache. For many people with mild-to-moderate migraine, this is enough.
- Triptans — sumatriptan, rizatriptan, zolmitriptan and others — are migraine-specific medications that work on serotonin receptors. They are most effective taken early in an attack. Different triptans have different speeds and durations; a clinician can suggest which to try first.
- Anti-emetics — metoclopramide or prochlorperazine — for nausea, and to improve absorption of oral medication.
- Combination products — like Suvexx (triptan + NSAID) — for patients who consistently need both.
An important caution: overuse of acute treatment causes medication overuse headache. Using triptans on more than 10 days a month or simple analgesia on more than 15 days a month over an extended period can paradoxically increase headache frequency.
Prevention: reducing how often attacks happen
Preventive treatment is offered when attacks are frequent (typically 4 or more per month), disabling, or when acute treatment is failing. Options include:
- Beta-blockers (propranolol) — well established, often first-line.
- Topiramate — effective but with cognitive and weight side effects to consider.
- Amitriptyline — low-dose tricyclic, useful when migraine coexists with sleep disturbance or tension headache.
- Candesartan — well-tolerated and increasingly used.
- CGRP monoclonal antibodies (e.g. Emgality) — newer injectable preventives that block the CGRP pathway. Effective for chronic migraine and offered through specialist pathways.
- Botulinum toxin injections — for chronic migraine, delivered by specialist services.
Preventives take 6 to 12 weeks at a therapeutic dose before efficacy can be judged. Trialling and switching is often part of the process.
Triggers and lifestyle measures
Identifying and managing triggers is part of every plan. A simple migraine diary — date, severity, suspected triggers, treatment used — over a few months often reveals patterns. Regular sleep, regular meals, hydration and stress management aren't dramatic interventions but they reduce attack frequency in most patients.
Some patients identify clear dietary triggers (alcohol, aged cheese, certain processed foods); others find no specific food triggers. Don't restrict broadly without evidence — quality of life matters too.
Red flags that aren't migraine
Headache features that warrant urgent assessment rather than migraine treatment:
- Sudden severe "worst headache of life" (thunderclap)
- New headache pattern over age 50
- Headache with fever and neck stiffness
- Headache with neurological deficit (weakness, speech change, vision loss not typical of aura)
- Headache worse with exertion, coughing, lying down
- Headache with cancer history or recent head injury
Working with your Farmeci clinician
A consultation typically covers attack frequency and pattern, what acute treatment you currently use, whether you've tried prevention, and any red flags. From there, your clinician can prescribe an appropriate triptan, suggest a preventive trial, or refer if specialist input is needed.