Only a few people, if any, can say they have never experienced a headache since they were born. The word ‘Migraine’ is derived from the word ‘hemicrania’ meaning a one-sided headache, although the migraine headache can be generalized. Migraine is a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system

symptoms. People who suffer from migraine are called migraineurs. The major symptom of migraine is not necessarily a headache. Some migraine attacks are preceded by visual disturbances. Other symptoms are nausea, vomiting, sensitivity to light, noise and smell, vertigo, loose motions, lethargy and so on.

stages of migrain


There are five distinct phases of migraine:

1. Premonitory

2. Aura

3. Headache

4. Resolution

5. Postdromal (recovery)

In the premonitory phase, symptoms to watch for may include mood changes, behavioural changes such as hyperactivity, clumsiness, lethargy, obsession, neurological symptoms such as tiredness, sensitivity to light, sound and smell, muscular aches and pains, nausea, food cravings and changes in fluid balance. In the aural phase, the vision is majorly affected. Speech and sensation are less commonly affected. Aural visual symptoms may include blind spots, difficulty in focusing, flashing lights and an impression of the image being viewed through a shattered mirror. These symptoms usually follow each other in succession. The third phase (headache) can last for up to three days. The headache is usually one sided but it can also affect both sides of the head. It is usually worsened by physical activity.

The resolution phase is the phase in which the attack comes to an end. The recovery phase is the phase encountered after the headache has gone. It may include symptoms such as a feeling of being drained or washed out, euphoric or even being energetic.


The two most common types of migraine are:

1. Migraine with aura (classical migraine) in which the headache is preceded

by visual or neurological symptoms.

2. Migraine without aura (common migraine)


Other types of migraine are:

 Migraine aura without headache

 Status migrainosus, a term used to describe attacks of migraine that may last for longer than 72hours.

 Chronic migraine in which additional headaches develop after typical episodes of migraine attacks. This is most commonly caused by medication overuse.

 Basilar-type migraine whose symptoms are controlled by the brainstem and may include difficulty in articulating words, vertigo (an illusion that the environment is in a constant motion), tinnitus (ringing in the ears), diplopia (double vision) and so on.

 Hemiplegic migraine in which the attacks of migraine are associated with weakness or paralysis of one side of the body, affecting both the arm and leg.

 Ophthalmoplegic migraine in which the migraine is associated with the paralysis of one or more of the eye muscles.

 Migrainous infarction which may involve a permanent blind spot in one eye due to an infarct (a death of a tissue as a result of an inadequate supply of blood).

 Retinal migraine in which the migraine is associated with blind spots that affect vision in one eye only.

It is important to note that these other types of migraine are extremely rare though migraine aura without headache, status migrainosus and chronic migraine are less common but not as rare as the rest. These are the things that can provoke a migraine attack. They are many and same as those that trigger headaches in non-migrainous people. They are not the same for everyone and may even not be the same for different attacks in the same  person. They can be grouped into the following:


These include:

 Delaying a meal

 Missing a meal

 Inadequate quantity of food

 Dehydration

 Food allergy (foods implicated include cheese, chocolate, citrus fruits, pickled foods, and even Chinese food)

 Alcohol



These include:

 Bright or flickering lights

 Over-exertion / vigorous exercise

 Travel

 Weather changes

 Strong smells

 Bright sunlight

 Smoke-filled rooms



 Menstruation

 Oral contraception

 Pregnancy

 Menopause

 Hormone Replacement Therapy (HRT)



 A viral infection such as cold or flu can also trigger a migraine attack.



 Oversleeping

 Lack of sleep



 Argument

 Excitement

 Stress



 Eye pain

 Neck pain

 Toothache

 Jaw pain and so on





Compiled by Pharm Mufeedah Kareem-Sulaiman

Vanguard Pharmacy Ltd