Migraine

What migraine is

Migraine is a common, complex brain condition. People with migraine have repeated attacks, usually a throbbing headache on one side of the head, along with other symptoms such as feeling or being sick and finding light, sound and smells hard to bear.

It is most common between the ages of 25 and 55, but it can start at any age, including in childhood. In girls it often starts around puberty, and it is two to three times more common in women than men.

Migraine is one of the most disabling conditions in the world, and the effect on work is huge. A 2018 Work Foundation report estimated it costs the UK £8.8 billion a year, with 86 million working days lost through sick days and working while unwell.

The stages of an attack

A migraine attack often has four stages. Not everyone goes through all of them, and they can overlap.

1. Hours to days before

   Warning stage

   Also called the prodrome. Tiredness, yawning, food cravings, a stiff neck, mood changes, thirst and needing to pass urine more often.

2. 5 to 60 minutes

   Aura

   Up to 1 in 3 people. Zigzag lines, flashing lights or blind spots, pins and needles or numbness, or difficulty speaking. It usually builds over about 5 minutes.

3. 4 to 72 hours

   Headache

   Throbbing pain, often on one side and worse with movement. Feeling or being sick, and sensitivity to light, sound and smells. For 12 to 17 year olds, attacks can be as short as 1 hour.

4. Hours to days after

   Recovery stage

   Also called the postdrome or "migraine hangover". Exhaustion, poor concentration, low mood and still being sensitive to light and sound.

Timings are typical ranges, not exact rules. An attack lasting more than 72 hours needs medical advice.

Types of migraine

Doctors describe migraine in a few different ways. You may have more than one type.

When to get urgent help

Triggers and keeping a diary

Attacks can be set off by things around you or changes in your body. Often it is not one trigger but two or three together that tip you into an attack. Common triggers include:

• Hormone changes and periods
• Stress, or stress easing at weekends
• Too little or too much sleep
• Missed meals
• Not drinking enough water
• Caffeine, or stopping it suddenly
• Alcohol
• Bright or flickering light and screens
• Loud noise and strong smells
• Changes in the weather

Some things that look like triggers are really early signs of an attack. For example, craving chocolate can be part of the warning stage. Trying to avoid every possible trigger can be stressful and isn't usually needed. Steady routines for sleep, meals and drinking water help most.

Diagnosis and referral

Your GP can diagnose migraine from your symptoms, your history and an examination. There is no blood test or scan for migraine. Scans are only used to rule out other causes when there are unusual signs.

Your GP can refer you to a neurologist or NHS headache clinic if the diagnosis is unclear, if a rarer type is suspected, or if treatments aren't working. You can't refer yourself to an NHS headache clinic.

Treating an attack

Medicines taken during an attack are called acute treatments. They work best taken early, while the pain is still mild. If you have aura, triptans should be taken when the headache starts, not during the aura.

As a rule, try not to take acute migraine medicines on more than 2 days a week. If you need them more often, ask your GP about preventive treatment.

Medication overuse headache

Taking painkillers or triptans too often can cause a dull headache on most days, with migraine attacks on top. This is called medication overuse headache. It develops when these medicines are taken on this many days a month for 3 months or more:

It is treated by stopping the overused medicines for at least a month, with support from your GP. Headaches usually get worse before they get better, and your GP should review you 4 to 8 weeks later. Preventive treatment may be started at the same time. Gepants do not seem to cause medication overuse headache.

Preventing attacks

Preventive treatment aims to make attacks less frequent and less severe. It is usually considered if you have 4 or more migraine days a month, if attacks badly affect your life, or if acute medicines aren't working or are needed on more than 2 days a week.

On the NHS, treatments are usually tried in this order:

1. Preventive tablets

   Allow up to 8 weeks to work, and at least 3 months before deciding

   Usually prescribed by your GP. NICE suggests trying propranolol, topiramate or amitriptyline first. Others include candesartan and pizotifen. If a medicine works, it is usually continued for 6 to 12 months before trying to stop.

   Pregnancy warning: topiramate and sodium valproate can harm an unborn baby. Anyone who could become pregnant must follow a Pregnancy Prevention Programme while taking them.

2. Specialist treatments

   Usually after at least 3 preventive medicines haven't worked

   CGRP antibody injections: erenumab (Aimovig), galcanezumab (Emgality) and fremanezumab (Ajovy) are self-injected monthly, or fremanezumab every 3 months. Eptinezumab (Vyepti) is a drip in hospital every 3 months. NICE approves them for adults with at least 4 migraine days a month.

   Preventive gepants: atogepant (Aquipta), a daily tablet, for episodic or chronic migraine, and rimegepant (Vydura) for episodic migraine.

   These are reviewed after 12 weeks. They are stopped if attacks haven't fallen by at least half (episodic migraine) or by at least 30% (chronic migraine).

3. Botox for chronic migraine

   31 to 39 small injections every 12 weeks

   For adults with chronic migraine whose medication overuse has been treated and who have tried at least 3 preventive medicines. Given by a specialist into the head and neck. NICE says it should stop if headache days haven't fallen by at least 30% after 2 rounds.

4. Other options

   Varies

   Nerve block injections at the back of the head can give relief for weeks. Acupuncture, up to 10 sessions over 5 to 8 weeks, is supported by NICE but rarely available on the NHS. Nerve stimulation devices such as Cefaly and gammaCore aren't currently available on the NHS for migraine. NICE also says riboflavin (vitamin B2) may help some people.

Self-help

Migraine and work

Migraine can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has more than a minor effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that come and go count. The law looks at how you would be without treatment, so well-controlled migraine can still qualify.

If it does, and your employer knows or should know about it, they must make reasonable adjustments. What is reasonable depends on the job and the employer, but adjustments might include:

• Changing harsh or flickering lighting
• Anti-glare screen filters
• An ergonomic, well-set-up workstation
• A quiet space to rest during an attack
• Flexible hours and regular breaks
• Working from home when needed
• Time off for appointments
• Flexibility on migraine-related absence

Access to Work is a government grant that can pay for equipment and support at work. For advice on your rights, contact Acas or Citizens Advice.

Benefits

Depending on how migraine affects you, you may be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, Universal Credit, Employment and Support Allowance or Statutory Sick Pay. You may also qualify for a Disabled Persons Railcard, help with prescription costs or help with travel to NHS appointments. Turn2us and Citizens Advice can help you check.

Support and sources

Last reviewed: October 2026.