National Migraine & Headache Awareness Month: Everything You Need to Know

June is National Migraine & Headache Awareness Month – a time dedicated to raising awareness for one of the most common and least understood medical conditions. Whether you have just been diagnosed with migraines, struggle with finding treatment that works or are unsure if a treatment option recommended for you is the right choice, understanding migraines is the first step in regaining your quality of life.

What is a Migraine?

Far more than just a bad headache, a migraine is a neurological disorder that involves recurrent episodes of a moderately severe, often pulsating, headache, typically on one side of the head, accompanied by several other symptoms, including nausea, vomiting, and extreme sensitivity to light and sound, which can make even the most mundane activities impossible to undertake. Episodes typically last for between 4 to 72 hours. Migraines are one of the most common neurological conditions globally and yet remain underdiagnosed and undertreated, with many patients struggling for years without receiving an accurate diagnosis or a treatment plan.

Patients experiencing persistent headaches may benefit from a comprehensive assessment to establish an accurate migraine diagnosis and rule out other neurological conditions.

Causes & Types of Migraine:

The causes of migraines are not fully understood, but it is thought that an abnormality in the brain’s nervous system pathways can cause fluctuations in a group of nerve signals called trigeminal nerve, chemicals called neurotransmitters, and blood vessels. Genetic factors also play a role; migraines can sometimes be familial.

Understanding genetic risk factors for migraine may help individuals and families better understand their susceptibility and treatment options.

The main types of migraine that have been identified are:The main types of migraine that have been identified are:

Migraine Without Aura (Common Migraine)

This is the most common type, accounting for approximately 75% of all migraines. It is characterized by a pulsating headache of moderate to severe intensity, associated with nausea, and sensitivity to light and sound. The headache itself is not preceded by any preceding sensory symptoms.

Migraine With Aura (Classic Migraine)

This type occurs in around 25-30% of migraines and is characterized by an aura—a reversible neurological symptom or set of symptoms such as flashing lights, zig-zag lines, a blind spot, and a lack of sensation on one side of the body or in an extremity, lasting between 20 and 60 minutes – preceding the onset of the headache phase.

Chronic Migraine

This condition is defined as a frequency of 15 or more headache days a month for at least three months, with at least eight days of this frequency involving migraine symptoms. Chronic migraine severely interferes with activities of daily living and leads to the greatest level of disability among sufferers.

Vestibular Migraine

This subtype is characterized by recurring attacks of vertigo (a spinning sensation), with or without dizziness and balance problems, with or without head pain. This is one of the most common causes of vertigo among the adult population and often misdiagnosed as an inner ear condition.

A specialist evaluation for recurring vertigo symptoms can help distinguish vestibular migraine from other neurological or inner-ear disorders.

Hemiplegic Migraine

This is a rare subtype of migraine that involves unilateral motor weakness and/or paralysis on one side of the body. It can mimic stroke symptoms and must be evaluated carefully by a specialist.

A comprehensive neurological assessment for stroke-like symptoms is essential to ensure an accurate diagnosis and timely care

Menstrual Migraine

Menstrual migraine is a specific type of migraine that occurs around the time of menstruation, thought to be caused by the drop in oestrogen levels. The condition is generally more severe and longer-lasting than migraines at other times, and often less responsive to acute treatments.

Signs & Symptoms:

Migraines typically have up to four distinct stages, though not everyone experiences every one:

Prodrome (minutes to hours or days before): mood changes, food cravings, neck stiffness, excessive yawning, feeling extra thirsty

Aura (only present in migraines with aura): Visual disturbances such as bright zig-zags of light, flashing dots or lines, temporary loss of vision, tingling or numbness, and difficulty speaking.

Headache phase: throbbing, pulsating head pain, which is typically only felt on one side of the head; nausea and/or vomiting and extreme sensitivity to light, sound and smell.

Postdrome (‘migraine hangover’) (can last for up to 24 hours): fatigue, confusion and mental cloudiness.

The most common causes of migraines include stress, hormonal changes, lack of sleep, certain foods and drinks such as alcohol, caffeine and aged cheese, bright lights and strong smells, and weather changes. Identifying your individual trigger is a vital part of managing your migraines effectively.

A structured migraine symptom assessment and trigger evaluation can help identify patterns that influence attack frequency and severity

Diagnosis & Assessment:

There is no definitive test for a migraine.

A comprehensive headache assessment often combines symptom review, medical history, and diagnostic tools to distinguish migraine from other headache disorders.

They are diagnosed on the basis of history and symptoms, with one or more criteria to establish this:

ICHD-3 Diagnostic Criteria: A system used by the International Headache Society to diagnose migraines, among others. Accurate diagnosis requires careful consideration of symptoms in conjunction with this system.

Headache Diary: Patients will be asked to record their headaches, including duration, severity and location; what triggered it, and what treatments were effective, in a diary. This is incredibly valuable in making the diagnosis and in choosing the right course of treatment.

Ongoing migraine monitoring and treatment assessment can help clinicians identify trends and optimize long-term management strategies.

Neuroimaging (MRI or CT Scan): These may be requested if a doctor has reasons to suspect other possible underlying causes of a headache such as a tumour or other vascular anomaly. The most important reason for this is if symptoms deviate significantly from a person’s usual headache pattern.

An advanced neurological imaging assessment may be recommended when symptoms change unexpectedly or suggest an alternative diagnosis.

HIT-6 and MIDAS scores:Validated questionnaires are used to evaluate the overall impact of headache on your life and its disabling effects, helping the doctor determine the best course of treatment and measure its efficacy.

A migraine disability and impact assessment can provide valuable insight into how headaches affect daily functioning and quality of life.

Treatment Options

Migraine treatment falls into two categories – treatment aimed at acute (abortive) treatment at the time of the attack and the long-term treatment of prophylactic (preventative) treatment on an ongoing basis to prevent attacks.

1. Acute treatment:

Mild attacks may respond to over-the-counter medications such as paracetamol, ibuprofen and aspirin. Triptans such as sumatriptan or rizatriptan are generally prescribed for moderate to severe attacks and function by restricting the blood vessels and blocking pain pathways.Anti-sickness medications are also available. It is essential not to over-treat these headaches with medication,

When medication choices become complex or symptoms remain uncontrolled, an expert review of migraine treatment options may help clarify the most appropriate approach.

taking medication more than 10-15 days a month can potentially lead to a chronic daily headache.

2. Preventive treatment:

This is where a prescription is taken daily on a long-term basis

Developing a personalized migraine prevention strategy may help match treatment choices to an individual’s symptoms, health profile, and treatment goals

and is generally only recommended if there is evidence of more than 4 attacks a month that are difficult to treat, severely impact the patient, or respond poorly to abortive treatment.

Beta-blockers (e.g. Propanolol, metoprolol)are commonly used first-line preventatives.

Tricyclic antidepressants (e.g. Amitriptyline) can be helpful in patients who also suffer from insomnia and/or depression.

Anticonvulsants (e.g. Topiramate, valproate) can be effective treatments, though require careful monitoring for possible side effects.

Individualized migraine medication planning may help balance effectiveness with potential side effects and patient preferences.

CGRP monoclonal antibodies are a relatively new class of drug used for prevention and target a particular type of receptor in the brain; sufferers are reported to experience very good relief from even chronic symptoms.

Personalized biologic treatment for chronic migraine may be considered when conventional preventive therapies have not provided adequate relief.

BotulinumtoxinA (Botox) is used to prevent chronic migraines when treatments are unsuccessful, injections are typically required every 12 weeks.

3. Non-pharmacological therapies:

These may play an important role in complementing prescribed treatment, particularly CBT for stress management, biofeedback training, regular sleep routines, identifying and avoiding triggers and adjusting dietary habits. Neuromodulation devices such as transcranial magnetic stimulation and vagus nerve stimulators are available to patients who are unable to tolerate medication or have an insufficient response to pharmacological therapies.

An individualized migraine management plan often combines medical therapies, lifestyle modifications, and supportive interventions tailored to each patient’s needs.

Migraine is also highly individualized and clinically complex. Deciding on the dividing line between episodic and chronic migraine, selecting a preventive treatment, or choosing a specialist treatment strategy will inevitably call for an expert clinical decision, and the opinion may be divided amongst clinicians.

Seeking a specialist second opinion for complex migraine cases can provide additional clarity when treatment recommendations differ or symptoms remain difficult to manage.

Migraine Awareness Month: Key Facts

This June, share these important statistics to help raise awareness:

Migraine affects approximately 1 billion people worldwide — making it the third most prevalent illness globally
It is the second leading cause of disability worldwide, and the leading cause among neurological disorders
Women are three times more likely than men to experience migraines, largely due to hormonal influences
Migraine most commonly develops between the ages of 15 and 55
Almost 50% of migraine sufferers have never received a formal diagnosis

Access to a formal migraine diagnosis and specialist evaluation can significantly improve treatment outcomes and quality of life.

Only around 13% of people with migraine currently receive preventive treatment

The global economic cost of migraine — through lost productivity and healthcare — runs into hundreds of billions annually

For More Information About Migraine:

For additional information visit

This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider regarding any medical condition or concerns.

A contribution by Dr. Taiba Ahmed
@TheKnowHow