A Working Checklist for Migraine

A neurological condition causing recurrent headache with nausea or sensory sensitivity, sometimes with aura. It is disabling, underdiagnosed and undertreated, and the commonest reason treatment fails is taking painkillers too late or too often.

Key takeaways

• Typical features: one-sided pulsating pain, nausea, light and sound sensitivity
• Aura: affects about a third of people with migraine
• Most useful single change: Take acute treatment at the very start of an attack.
• Commonest mistake: Taking painkillers on more than 10 to 15 days a month.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

Do

• Take acute treatment at the very start of an attack
• Keep a headache diary to identify patterns and count medication days
• Ask about preventive treatment if you have attacks several times a month
• Keep regular sleep, meals and hydration

Do not

• Taking painkillers on more than 10 to 15 days a month
• Combined hormonal contraception if you have migraine with aura
• Waiting until an attack is established before treating it

The numbers behind the list

Every item above comes from these figures, published in the guidance listed at the foot of the page.

If you change one thing

Take acute treatment at the very start of an attack. That is the opening item above. Doing only that is still doing something.

Where to go next

• Migraine: The Quick Reference
• Migraine: What the Evidence Actually Says
• Migraine — the reference entry
• Concussion: What Published Guidance Supports
• What the Guidance Really Says About Sleep and the Brain

When to speak to a doctor

Call 999 for a sudden severe headache reaching maximum intensity within seconds to minutes, headache with fever and a stiff neck or a rash that does not fade, or headache with weakness, numbness, confusion or vision loss. See a GP for a new headache over 50, headache worse on lying down or coughing, or any change in your usual pattern.

Where this comes from

• NICE — Headaches in over 12s
• The Migraine Trust — treatment

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.