Pain is only one part of the condition. Nausea, sensitivity to light or sound, visual disturbances and difficulty concentrating can all accompany an attack, and symptoms may last for hours or sometimes considerably longer.
For people who experience migraine regularly, having a clear treatment plan can make attacks easier to manage.
That means knowing what to do when symptoms begin, which medicines are appropriate, how to avoid relying too heavily on acute treatment and when recurring migraine deserves further medical review.
Recognise when an attack is beginning
Migraine does not always start with severe pain.
Some people notice changes beforehand, including tiredness, food cravings, difficulty concentrating or changes in mood. Others experience aura, which can cause temporary visual disturbances, tingling or speech changes before the headache develops.
Not everybody experiences these warning symptoms.
The headache itself is often moderate to severe and may have a pulsating or throbbing quality. It commonly affects one side of the head, although this is not universal.
Movement can make symptoms worse, while nausea and sensitivity to light or sound are also common.
Understanding your usual pattern can make it easier to distinguish migraine from an occasional everyday headache and to begin appropriate treatment once the attack starts.
Have an acute treatment plan ready
Trying to decide what to do while already experiencing a severe migraine is rarely ideal.
Keeping suitable medication available and knowing how it should be used can make attacks easier to manage.
NICE guidance recommends several options for acute migraine treatment depending on individual circumstances. These can include a triptan together with either an NSAID or paracetamol, while some people may prefer to use one appropriate medicine alone.
An anti sickness medicine may also be considered, including in some circumstances where nausea is not the main symptom.
The appropriate approach depends on medical history, other medicines and individual risk factors, so treatment should be selected with professional advice where necessary.
“Having a treatment plan before the next migraine develops can make a real difference,” says Ana Carolina Goncalves, Superintendent Pharmacist at Pharmica online pharmacy. “People should know which treatment is appropriate for them, when to take it and what to do if their migraines start becoming more frequent or their usual pattern changes.”
Understand where triptans fit
Triptans are medicines developed specifically for the acute treatment of migraine.
They work differently from ordinary painkillers and can be considered when clinically appropriate for migraine with or without aura.
Sumatriptan is one commonly used triptan.
For suitable adults, Sumatriptan tablets can be used to treat an established migraine attack. They are intended for acute treatment rather than for preventing future migraines.
Current UK product information recommends taking oral sumatriptan as early as possible after the migraine headache begins, although it can still be effective when taken later during the attack.
A commonly recommended oral dose is 50 mg, although some patients may require 100 mg depending on clinical advice and the particular product being used.
If the first dose works but the migraine subsequently returns, another dose may sometimes be taken after the minimum interval specified in the product information.
However, if the first prescribed dose does not improve the attack, another sumatriptan dose should not simply be taken for the same migraine in an attempt to make it work.
Following the instructions supplied with the medicine is important.
Triptans are not appropriate for everybody
Migraine treatments that work well for one person may be unsuitable for another.
Sumatriptan should not be used by certain people with cardiovascular or cerebrovascular conditions, including those with a history of some forms of heart disease, stroke or transient ischaemic attack.
There are also important interactions and contraindications involving some other medicines.
This is why suitability should be assessed rather than assuming that a migraine medicine is appropriate simply because somebody else uses it successfully.
People with significant cardiovascular risk factors may also require additional consideration before triptan treatment is recommended.
Create the right environment while treatment works
Medication is only one part of managing an attack.
Many people find that reducing stimulation helps while they wait for symptoms to improve.
A dark, quiet room can make light and sound sensitivity more tolerable. Resting may also help when movement aggravates the headache.
Keeping fluids available is sensible, particularly when nausea has reduced normal food or drink intake.
Some people find a cool compress comfortable, while others prefer warmth around the neck or shoulders. These approaches do not treat the neurological process causing migraine, but they can make the period during an attack more manageable.
There is no need to force food if nausea is significant, although prolonged vomiting or an inability to keep fluids down deserves medical attention.
Do not assume more medication is always better
When a treatment does not work quickly enough, it can be tempting to continue taking additional medicines.
That is not always safe or effective.
Different migraine medicines have maximum doses and restrictions around how frequently they can be used.
Taking acute headache medication too often can also create a separate problem known as medication overuse headache.
NICE advises clinicians to consider this possibility when headaches develop or worsen in someone using triptans or certain combination headache medicines on 10 days per month or more for at least three months.
For paracetamol, aspirin or NSAIDs, the relevant threshold in NICE guidance is 15 days per month or more.
This does not mean people should avoid treating genuine migraine attacks.
It means that needing acute medication very frequently can be a sign that the overall migraine management plan needs reviewing.
Keep a record if migraines are becoming frequent
Memory is not always reliable when headaches occur repeatedly.
A migraine diary can help reveal how frequently attacks are actually happening and whether treatment is consistently effective.
Useful details can include when the migraine started, how long it lasted, whether aura occurred, which medicine was taken and whether symptoms returned later.
Patterns around sleep, menstruation, stress or other circumstances may also become clearer over time.
The purpose is not to document every detail of daily life.
A concise record gives a healthcare professional more useful information when deciding whether the diagnosis or treatment plan needs to change.
Frequent migraine may require prevention as well as treatment
Acute treatment deals with individual attacks.
For people experiencing frequent or particularly disruptive migraines, preventing future attacks may become another priority.
Several preventive treatments are available, with suitability depending on factors including migraine frequency, medical history and previous treatment.
Preventive medicines are taken differently from acute treatments such as sumatriptan.
They are intended to reduce how often migraines occur or make them less severe over time rather than stopping an individual attack once it has started.
People who find themselves repeatedly organising their lives around the possibility of another migraine should therefore discuss whether prevention needs to become part of the treatment strategy.
Be cautious when the headache feels different
People who have experienced migraine for years can become familiar with their usual pattern.
A significant departure from that pattern deserves attention.
A sudden and extremely severe headache, headache following a significant head injury, or headache associated with new neurological symptoms should be assessed urgently.
Changes such as persistent weakness, confusion, loss of consciousness or neurological symptoms that are substantially different from a person's established migraine aura should not simply be assumed to be another routine attack.
New or unusual headaches during pregnancy, or headaches accompanied by symptoms suggesting serious illness, also warrant appropriate medical assessment.
Treat the pattern, not just the individual attack
Effective migraine management is not about finding one medicine and using it indefinitely without review.
The right strategy can change.
An occasional migraine that responds reliably to acute treatment is different from headaches occurring several times each week. An established migraine pattern is also different from a new headache that suddenly behaves in an unfamiliar way.
For people with recurrent migraine, it helps to know what to take, when to take it and how frequently acute medication is being required.
Treatment should make migraine easier to live with rather than becoming another source of uncertainty.
Having an appropriate acute treatment plan, recognising medication overuse and seeking further advice when attacks become frequent or change in character can all make migraine management more effective over the long term.
