Migraine

Migraine is not a bad headache but a neurological disease with a typical course. An attack typically brings throbbing pain, often on one side of the head, moderate to severe, which gets worse with physical activity. It is accompanied by nausea and sensitivity to light, sound and sometimes smells.

Without treatment, an attack lasts from a few hours to three days. Many people cannot work during this time and withdraw to a dark, quiet room. After the attack there is often a day of exhaustion and poorer concentration.

Some people have an aura before the pain: zigzag shimmering lines, flickering spots, loss of part of the field of vision or tingling that spreads over a few minutes along the arm towards the face. The aura usually lasts up to an hour and passes before the pain develops or as it begins.

What triggers attacks

Triggers are personal and vary considerably between people. Common ones are irregular or too little sleep, a skipped meal, too little fluid, hormonal fluctuations in women, alcohol, strong smells, changes in the weather and bright light.

Stress works in two ways. Some attacks come during it, but considerably more often in the first hours of relaxation afterwards, for example on a Friday evening or on the first day of a holiday.

General lists of foods that supposedly trigger migraine are mostly of no use. A diary of attacks reveals your triggers more reliably than any diet.

Medication overuse headache

Regularly taking painkillers can keep headaches going and increase how often they occur. This happens when they are taken on more than a few days a month, month after month.

The condition is common, but people almost never recognise it themselves, because the medicines are the only thing that helps. This is exactly why information about how often you take them is among the most important things a doctor hears.

The good news is that the condition can be resolved. A plan for withdrawing the medicines must be led by a doctor, as the first few days can be unpleasant.

When a headache is not migraine and needs action immediately

A sudden, extremely severe headache that peaks within seconds is an emergency. Call 112, even if it later eases.

Also call 112 immediately with a headache accompanied by weakness or numbness of one side of the body, a drooping corner of the mouth, a speech disturbance, confusion, a seizure or loss of consciousness.

You need an urgent assessment with a headache accompanied by fever and a stiff neck, a headache after a blow to the head, and a headache with a visual disturbance and eye pain with blurred vision.

A quicker examination, but not emergency help, is warranted for a headache that appears for the first time after the age of fifty, a headache that gets worse week by week, a headache that regularly wakes you at night, and a new headache in pregnancy or with a weakened immune system.

How care proceeds

Migraine is diagnosed on the basis of the course of symptoms and a neurological examination, not with imaging. The doctor wants to know when the headaches started, how often they occur, how long they last, what triggers them, which medicines you have tried and how often you take them.

Before the visit, keep a diary for a few weeks: date, time of onset, duration, intensity, accompanying symptoms, what you were doing that day, which medicine you took and whether it helped. This record often changes the assessment more than any test.

Imaging is not needed for typical migraine with a normal neurological examination. It makes sense with an unusual course, a change in the character of the headaches or abnormalities on examination. The doctor will tell you at the examination where to have it done.

Treatment has two parts: medicines to stop an attack, which are most effective when taken early and at the right dose, and preventive treatment, when attacks are frequent or seriously interfere with daily life. Both are supported by regularity in sleep, meals and physical activity.

Neurological care at Medicinski center Ljubljana is self-pay; you do not need a referral. Appointments are booked with the clinic that runs the service.