When to worry about a migraine
Reviewed by our clinical team
Migraines are much more than just bad headaches; they can be a real pain, both physically and mentally.
For the 6 million people in the UK who live with them, migraines can come with a range of symptoms like throbbing pain, sensitivity to light, and sometimes even nausea. Although they can sometimes be disabling, like with chronic or cluster migraines, they aren’t usually a sign of anything more serious.
However, migraine symptoms can sometimes be a cause for concern. In this article, we’ll take a look at when migraines might be a sign of something deeper, helping you better understand your migraine and when it’s time to worry.
When to worry about a headache
Almost everyone gets the odd headache now and then, and they’re rarely a cause for concern. Most headaches are down to an imbalance of chemicals in the brain, stress, or even muscle stiffness.
However, some headaches might need a bit more attention, and can potentially be a symptom of another condition.
Recurring headaches
If you're getting headaches very regularly, or more often than usual, you could in fact be experiencing chronic migraines. Migraines and headaches are different, but chronic migraines are a very specific type of migraine. If your head’s hurting more than 15 days out of the month, or if it’s accompanied by visual disturbances like flashing lights or spots, it's time to talk to a doctor.
Chronic migraines aren’t necessarily more serious than acute (infrequent) migraines, they just occur more often. They aren’t always a sign of something serious, but do require different treatment to normal headaches.
Hypnic headaches
These are sometimes called alarm clock headaches, as they usually occur first thing or just before waking up. It’s not uncommon to wake up with a headache, but if you're over 50 or you’re getting woken up regularly by head pain, it might be a hypnic headache. They're usually not too serious, but need talking to your doctor about.
Throbbing headaches
Although ‘throbbing’ and ‘pounding’ is a common way to describe headaches, very serious throbbing or pulsing in your head can mean that something more serious is going on.
If you’re a woman, headaches that regularly appear around your period could in fact be menstrual migraines. As with most migraines, we don’t know the exact cause, but it’s likely that menstrual migraines are down to rapid changes in hormone levels during menstruation. Although they can make a bad time worse, menstrual migraines are usually treatable with common migraine medications like triptans and gepants, so speaking to your doctor should be your first step.
Another type of migraine often mistaken for throbbing headaches are hemiplegic migraines. This particularly likely if the throbbing occurs on just one side, as well as one-sided weakness or numbness. Hemiplegic migraines can also be linked to your period, or can be genetic.
Persistent headaches
When your headache just won't go away, it's often called a persistent headache. If you've got a headache that's had you calling into work for three days or more, it's worth getting it checked out, especially if it's different from your normal headaches or it's getting worse. Persistent headaches are different from recurring headaches, as it might feel like you don’t get a ‘break’, however they can be another type of chronic migraine.
You can learn more about the many different types of migraines in our migraine advice article.
Should I worry about migraine with aura?
Migraine with aura is very common, and in most cases isn't harmful in itself. According to the NHS, around 1 in 3 people with migraines experience aura before their migraine.
You can think of aura as a migraine that announces itself, usually in the form of visual disturbances or ‘hallucinations’ like spots and flashing lights. These typically come before the headache hits and last for about 20 to 60 minutes. Many people who experience migraines regularly use them as an alarm to identify when a migraine is coming on.
The symptoms of migraine with aura can be unsettling, but they usually pass quickly. That said, if it's your first time experiencing these symptoms, or if they change in intensity, it's always a good idea to chat with a healthcare professional, whether that’s your doctor or one of our GPs.
Some studies have linked migraines with aura to an increased risk of certain health conditions, although we don’t know anything for sure yet.
Are migraines a sign of something more serious?
Migraines can be very painful and sometimes make it difficult to live your life, but on the whole they’re usually not a sign of anything serious. However, there are instances where symptoms resembling migraines could hint at more serious conditions.
Stroke
A stroke happens when blood flow to a part of the brain is interrupted, usually due to blockage or bleeding, and it's crucial to get immediate medical attention before the cells in this very important area start to die off, causing serious long-term problems.
Migraines are not usually a sign of stroke, but some migraine symptoms do overlap with stroke signs, like visual disturbances or numbness on one side. If these symptoms are sudden, severe, or come with other stroke symptoms like confusion, trouble speaking, or difficulty walking, it could be a sign of a stroke and not just a migraine. In this case, you should seek immediate medical attention just in case.
You can find out more about the connection between migraines and strokes here.
Concussion
A concussion is a type of traumatic brain injury caused by a blow to the head. Even minor blows to the head can cause concussion, leaving you with symptoms like headaches and nausea.
If you've recently had a head injury and are experiencing headache, dizziness, confusion, or nausea, it could be a concussion rather than a migraine. Although concussions are sometimes treated as a harmless condition in films and TV, they can in fact be very serious. It's vital to get medical attention after any head injury, even if you feel okay initially.
Heatstroke
Heatstroke is a severe condition that’s usually caused by exposure to high temperatures and sometimes dehydration. Symptoms of heat stroke can include throbbing headaches, dizziness, and a rapid heartbeat that you can feel in your head, which might be mistaken for a migraine.
If someone is showing signs of heatstroke, they should be moved to a cooler place immediately, and you should call 999.
Most importantly, always trust your instincts. If something doesn't feel right, or if your symptoms are different or more severe than usual, speak to a doctor. It's always better to be safe than sorry.
How to treat a serious migraine
How you treat your migraine will depend on what type of migraine you’re experiencing. For most migraines, over-the-counter painkillers won’t help much. However, migraine-specific medications are available, potentially helping you avoid hours of pain.
Over-the-counter (OTC) and prescription medications
- Rizatriptan: A type of ‘triptan’ medication, this medication reduces swelling of the blood vessels in the brain, thought to be behind many types of migraine, to reduce the severity of the symptoms. You can find out more about Rizatriptan here.
- Sumatriptan: Another type of triptan, Sumatriptan works in the same way as Rizatriptan, although might be more or less effective depending on the type of migraine.
- Vydura (Rimegepant): Vydura is a much newer treatment than the triptan options, and can be more effective at helping with the symptoms of acute migraines, depending on their cause. You can learn more about Vydura here.
Other non-medical treatments for avoiding migraines include:
Rest and environment
Find a dark, quiet room to rest. Reducing sensory input (noises and bright lights) can significantly reduce how bad your migraine is, as well as how long it lasts.
Cold or warm compress
Putting a cold compress, usually a wet towel or washcloth, on your forehead can numb the area, providing relief. A warm compress on the back of your neck can also relax tense muscles, which helps reduce the pain in some people.
Staying hydrated
Dehydration is often reported as a migraine trigger. If you’re prone to migraines, try to make sure you're drinking enough water, this might help you minimise how regularly they happen.
Avoid triggers
Although we don’t know everything about migraines, we do know that there are certain ‘triggers’ which are often associated with them. Being aware of your migraine triggers, like certain foods, fragrances, stress, or lighting, can help you avoid them and potentially reduce how often you get migraines.
Summary
While migraines can occasionally hint at or be confused for more serious conditions like strokes, concussions, or heatstroke, this is relatively rare. Unfortunately, migraines themselves can be very difficult to live with.
While there are a range of treatments available over the counter and through our service, you should always speak to your doctor if you’re experiencing very serious migraines, or you’re getting migraines regularly. Your doctor can work with you to identify your triggers as well as the type of migraine you’re getting, and create a tailored treatment plan. Help is available, so don’t go it alone.
For more information, check out the links below.
References
https://www.nice.org.uk/guidance/ta260/documents/migraine-chronic-botulinum-toxin-type-a-final-scope
https://www.nhs.uk/conditions/headaches/
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/migraine/
