Different Types Of Migraines

“Migraine is an inherited tendency to have headaches with sensory disturbance.

It’s an instability in the way the brain deals with incoming sensory information, and that instability can become influenced by physiological changes like sleep, exercise and hunger.” According to Professor Peter Goadsby, Professor of Neurology,


The Journal of Headache and Pain described migraine as the third most common disease in the world (behind dental caries and tension-type headache) with an estimated global prevalence of 14.7% (that’s around 1 in 7 people).
A migraine attack starts suddenly with severe pain on only one side of your head.
It is important to notice that the headaches are only considered to be migraines if the typical symptoms have occured at least five times.
An older theory on the causation of migraine included that migraine is primarily a disease of the blood vessels. It is now accepted that migraine is not related to any vascular pathology and brain mechanisms are more likely involved in the development of migraine attacks.
Migraine can have an enormous impact on your work, family and social life.


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When do migraines start?

Migraine often begins at puberty and affects most of those aged between 35 and 45 years, but it can trouble also younger people including children. It is estimated that the UK population loses 25 million days from work or school each year because of migraine.


How long do migraines last?

Migraine symptoms vary from person to person. Your attacks may differ in length and frequency. They usually last from 4 to 72 hours and most people are free from symptoms between attacks. The range of time someone is affected by an attack is actually longer than the migraine itself, as there is a pre-monitory, or build-up phase, and a post-drome that can last one to two days.


Migraines symptoms

Before the migraine begins –

A day or two before a migraine starts you may feel:

  • Depressed or cranky;
  • Very happy, very awake, or full of energy;
  • Restless or nervous;
  • Very sleepy;
  • Thirsty or hungry, or you may not feel like eating.

When the headache starts:

  • Feeling pain on one side of the head. But you can have pain on both sides;
  • Pain behind one of your eyes;
  • The pain level is moderate to very bad. It may be so bad that you can’t do any of your usual activities;
  • Pain that gets worse with routine physical activity;
  • Nausea, vomiting, or both;
  • Pain that gets worse when you’re around light and noise.

After the migraine:

After the migraine stops, you may have muscle aches or feel tired. These symptoms may last up to a day after the migraine ends.

What you should do if you experience migraine symptoms:

  • Follow each migraine attack in a journal;
  • Write down any migraine symptoms you experience;
  • Write down what makes your migraine symptoms improve and what makes them worsen;
  • Does your migraine journal show a pattern? For example, are there certain foods that trigger migraines?
  • Try avoiding any migraine triggers you identified, to see if the migraines go away;
  • Find out if anyone in your immediate family is a migraine sufferer, since migraines tend to run in families;
  • If the migraines continue, take all of the information you’ve gathered to a specialist.

What increases your risk for migraine?

Your risks for migraines are higher if you:

  • Have a family history of migraines;
  • Are female. Women are 3 times more likely than men to get migraines;
  • Are a teenager or young adult. Migraine often starts at puberty and affects mostly those aged between 35 and 45 years, but it can trouble also younger people including children;
  • Have depression, anxiety, asthma, or epilepsy.

a poor girl suffering from the pain

Types of migraines

There are two major types of migraines:

  • without aura or common migraine;
  • with aura or complicated migraine.

Migraine without aura:

Aura is a series of sensory disturbances that happen shortly before a migraine attack. Practically, aura is a warning sign of a migraine. These disturbances range from seeing sparks, bright dots, and zig zags to an inability to speak clearly. Aura usually begin about 30 minutes before the headache starts and last 20-60 minutes.
A migraine without aura is the most common type of migraine headache. 70-90% of people with migraine experience this type. Another name you might hear is “common migraine.” It doesn’t have the early symptoms, called an aura, that some people have before a migraine begins. You might also have any of these other symptoms:

  • Nausea;
  • Vomiting;
  • Yawning;
  • Irritability;
  • Low blood pressure;
  • Feeling “hyper”;
  • Sensitivity to light, sounds, or motion;
  • Dark circles under your eyes.

The International Headache Society recommends the „5, 4, 3, 2, 1” criteria to diagnose migraines without aura.

This stands for:

  • Five or more attacks with a duration of 4 hours to 3 days;
  • At least two of the following qualities: Occurring on one side of the head, a pulsating quality, moderate-to-severe pain, and aggravation by routine physical activity;
  • At least one additional symptom, such as nausea, vomiting, sensitivity to light, or sensitivity to sound.


Migraine with aura

Specialists says that 10-30% of people with migraine experience this type.
People who experience migraine with aura will have many or all the symptoms of a migraine without aura and additional neurological symptoms which develop over a 5 to 20 minute period and last less than an hour.

Other types of migraines are:

  • chronic migraine;
  • hemiplegic migraine;
  • migraine with brainstem aura;
  • retinal migraine.

Chronic Migraine

A headache that occurs 15 or more days per month for more than 3 months, showing the characteristics of migraine headache (occurring in a patient who has had at least five attacks) at least 8 days a month.


Hemiplegic Migraine

Migraine with aura including motor weakness. Motor symptoms generally last less than 72 hours but, in some patients, motor weakness may persist for weeks.


Migraine with brainstem aura

Migraine with aura symptoms clearly originating from the brainstem with at least two of the following fully reversible brainstem symptoms:

  • Vertigo (a medical condition where a person feels as if they or the objects around them are moving when they are not);
  • Dysarthria (a motor speech disorder);
  • Tinnitus (the hearing of sound when no external sound is present);
  • Hypacusis (partial or total inability to hear);
  • Diplopia (double vision);
  • Ataxia (lack of voluntary coordination of muscle movements);
  • Decreased level of consciousness.
  • Retinal Migraine

Repeated attacks of monocular visual disturbance, including blindness, associated with migraine headache with at least two of the following:

  • Spreading gradually over ≥5 minutes;
  • Symptoms last 5-60 minutes;
  • Accompanied, or followed within 60 minutes, by headache.


Retinal migraine

is an extremely rare cause of transient monocular visual loss. Some patients who complain of monocular visual disturbance in fact have hemianopia.


Scientists aren’t sure what causes migraines. They think that at least two brain chemicals, serotonin and dopamine, play a role. The theory is that something goes wrong in the way these chemicals regulate how the brain works, which makes the brain and the body’s immune system overreact. When that happens, a flood of immune cells flows through the blood vessels to the brain. The brain’s blood vessels open wider to accommodate these cells. The vessels open and constrict. Then a severe, sometimes throbbing headache results.
Also certain things called triggers can bring on a migraine. This triggers are not the same for all the persons. Having several triggers increases the chances of having migraines.12

Common triggers

Food triggers

Different studies have proven only a few foods, or substances in foods, seem to bring on headaches in a lot of people:

  • Alcohol – causes more blood to rush to your head, which may cause head pain;
  • Caffeine – in small doses it can help you ease the pain but two cups of coffee a day, you can get a migraine from withdrawal when you drink less;
  • Monosodium glutamate – added to some foods to make them taste better;
  • Nitrates and nitrites – used to keep the meats fresh;
  • Aged cheese – high in tyramine, a natural chemical. If you have a sensibility to it, it can launch a migraine;
  • Chocolate;
  • Figs, raisins and avocados;
  • Yeast bread, doughnuts and other pastries.

It is important to watch also your overall health and to:

  • Eat small and frequent meals;
  • Stay hydrated;
  • Choose high fiber foods and keep your blood sugar levels stable;
  • Get regular exercise;
  • Manage stress.


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Sumatriptan should be taken when lifestyle changes and analgesics such as paracetamol, aspirin, ibuprofen, (or those analgesics combined with codeine) haven’t worked. It cannot be used to prevent a migraine, only to treat one.

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What is Sumatriptan?

Sumatriptan (otherwise know under the brand name Imigran) is a popular treatment for migraines and belongs to a class of medicines known as ‘triptans.’  Triptans work differently to painkillers as they work by stimulating 5HT (serotonin) receptors in the brain to reverse the temporary widening of the blood vessels there which are though to contribute to a migraine attack. As well as treating the cause of the migraine, they also help to reduce associated symptoms such as headache, nausea, vomiting and sensitivity to light or sound.

Sumatriptan should be taken when lifestyle changes and analgesics such as paracetamol, aspirin, ibuprofen, (or those analgesics combined with codeine) haven’t worked. It cannot be used to prevent a migraine, only to treat one.

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50mg, 100mg


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How are migraines diagnosed?

Unfortunately, there is no actual test to diagnose migraine. To make a firm diagnosis, information from two sources need to be compared:

A detailed history of the headaches and/or other symptoms is taken. This history includes analysing:

  • The features of the headaches (for example, how often they happen, how severe the pain is, what symptoms go with them);
  • The effect the headaches have on your everyday activities;
  • The family history of headaches.

A thorough examination is carried out, including a complete neurological assessment.

You may have heard of techniques such as CAT (Computerized Axial Tomography) or MRI (Magnetic Resonance Imaging) scans, where a picture is taken of your brain. Although these tests will help rule out other causes of headache, they cannot be used to diagnose migraine.

Treatment Options

There are a huge range of medications available to treat migraine. It is useful to have some background information to help you make informed choices about which drug may be best for you.
Whilst drugs may be necessary to treat your attack, an important factor in the overall management of migraine is finding out what may be causing it and other ways you can manage it. Here at Assured Pharmacy we sell medication to treat migraines, but for further peace of mind take a look at this article.
There are two groups of drugs for treating migraine:

  1. acute medicines: treatment taken when the migraine starts;
  2. prophylactic / preventive medicines: treatment to prevent an attack.


Acute medicines for migraines


The most commonly used contain aspirin or paracetamol combined with codeine, caffeine and/or an anti-emetic. Combinations specifically licensed for migraine include:

  • Migraleve. Pink tablets that contains codeine, paracetamol and buclizin, and yellow tablets: codeine and paracetamol;
  • MigraMax: Aspirin and metroclopramide;
  • Paramax: Paracetamol and metoclopramide.

Specific anti-migraine drugs:

Selective 5-HT1 agonists relieve pain by narrowing blood vessels in the head and blocking the transmission of pain in sensory nerves supplying the skin and structures of the face: Sumatriptan, Almotriptan, Eletriptan etc. If one triptan doesn’t work for you then it is worth trying a different one.


Anti-emetics relieve the nausea associated with migraine attacks.
Metoclopramide and domperidone also promote normal activity of the gut and can accelerate the absorption of analgesics.
Anti-emetics should be taken before or at the same time as analgesics.

Preventive medicines for migrainesmigraine

In the past few years the use of preventive treatments has fallen. This may be due to the fact that some prophylactics have side effects such as weight gain and may take some time before they start to show a beneficial effect. Also acute medication has improved for migraine. However, if you have at least four migraine attacks per month you can try to discuss about preventive medication with your doctor.
It could take up to three months for the preventative effect of the drug to be felt.
Preventive medicines include:16

  • Beta blockers such as Metoprolol, Atenolol and Timolol;
  • Anti-serotonergic such as Pizotifen;
  • Anti-convulsants like Sodium Valproate and Topiramate.

Natural remedies for migraine

A few years ago, in a clinical research has been demonstrated the effectiveness of the Butterbur (Petasites hybridus) herbal treatment in preventing migraines.17
Another herb, Feverfew (Tanacetum Parthenium), is also widely used and demonstrated to be safe and possibly effective for migraine prevention. A variety of other complimentary & alternative medicine techniques are not supported by solid scientific data, but they may be perceived to be of benefit to patients. A few techniques commonly practiced for headache relief include body work (eg, chiropractic, massage), creative arts (eg, dance, music), nutritional/herbal supplements (eg, vitamins, herbs), Eastern medicine (eg, yoga), acupressure and acupuncture, and Ayurveda (a medical science of Ancient India. It deals with matters relating to health, day-to-day life and longevity (long life).18


Is remission possible?

If you had at least two migraines you’re probably wonder if you’ll ever be free of them.
There is not step by step plan to make them stop, but it is possible to go into a remission (stop having migraines).
If you have migraines at least 15 days a month you have chronic migraine and if you have fewer than 15 a month but more than one a year you have occasional migraine.
In some cases, these attacks can go in partial or full remission.
Partial remission happens when people with chronic migraine suddenly get fewer of them. If you have one 10 days or less a month instead of 15 days, your doctor may say your chronic migraine has gone into remission.
Full remission happens when people with occasional migraine go an entire year without one.

Causes of Remission

Physicians don’t know why some people with migraine go into remission. But research shows that certain things may make it more likely:

  • Age: The number of migraine attacks you have each month is likely to decrease over time. This is true for people over 40 years.
  • Being a man: Men are less susceptible to migraines overall. But men who get them are more likely than women to go into remission.
  • Your reaction to touch: Some people who get migraines become so sensitive to touch during an attack that feeling their clothing against their skin is uncomfortable or even painful. If this doesn’t happen when you have a migraine, you’re more likely to go into remission.
  • Headaches per month: Clinical trials show that if you have chronic migraine, you’re more likely to get partial remission if you have fewer attacks. That means closer to 15 per month than 30.

Some research suggests that drugs that treat migraines don’t lead to remission. But they can lead to milder symptoms and less frequent attacks. So they can be useful in helping control migraines, even if they don’t stop them.
In the future, researchers may study whether any drugs can help lower the number of monthly attacks to the point of remission.


The National Institute for Health and Care Excellence (NICE) guideline recommendations for migraine

The guideline recommends that for relief from a migraine attack, a healthcare professional should recommend first a triptan together with either a non-steroidal anti-inflammatory drug (NSAID) or paracetamol to help relieve migraine.
If it is preferred to take only one drug, then take a triptan, an NSAID, highdose aspirin or paracetamol. You can add also an anti-sickness medicine. It is not recommended to administer an ergot or an opioid to treat migraine, and those aged under 16 should not aminister aspirin.



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Steiner TJ et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013, 14:1;
Migraine -overview https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072557/;
Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P (2015) Headache disorders are third cause of disability worldwide. J Headache Pain 16:58;
Goadsby PJ et al. Neurobiology of migraine. Neuroscience 2009; 161(2): 327-41;
World Health Organization. Online Q&A: How common are headaches? 2014;
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808;
Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A;
Amrish Saxena. Migraine: A Review.


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