Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
The single most useful thing to know about treating a migraine is timing: painkillers taken in the first half hour work; the same painkillers taken two hours later often don't. Here's what a migraine feels like, what sets one off, how long it lasts, and what actually helps, from the pharmacy shelf and the dark bedroom.
What does a migraine feel like?
A migraine is not just a bad headache. The pain is typically one-sided, throbbing and moderate to severe, made worse by movement, and comes with company: nausea or vomiting, and an intolerance of light, sound and sometimes smell. Around a third of people get an aura first, most often zig-zag lines, blind spots or flashing lights that spread over 20 to 60 minutes before the pain starts. Many describe a warning phase the day before (yawning, cravings, a stiff neck, unusual tiredness) and a washed-out "hangover" for a day after.
What causes migraines?
Migraine is a brain sensitivity you're born with, not something you catch, and it runs in families. Attacks are set off by triggers that tip a sensitive brain over its threshold: missed meals, dehydration, too little or too much sleep, stress and the let-down after stress, hormonal shifts (which is why migraines cluster around periods), alcohol, and bright or flickering light. Foods get blamed more than they deserve; a craving for chocolate is often part of the warning phase rather than the cause. A diary over two or three months usually finds the pattern.
How long do migraines last?
An untreated attack lasts 4 to 72 hours; most settle within a day. If the pain runs beyond three days it needs a GP, both to rule out other causes and because a long attack sometimes needs a different treatment.
How to get rid of a migraine quickly
Act at the first sign, ideally during the aura or warning phase, before the pain peaks. Take a full dose of a simple painkiller straight away: 900mg of aspirin (three 300mg tablets), 400mg of ibuprofen, or 1,000mg of paracetamol. Soluble or fast-acting versions get in before the stomach slows down, which it does during a migraine. Then remove the fuel: a dark, quiet room, something cold on the forehead or the back of the neck, a glass of water, and sleep if you can. Caffeine helps some people if taken with the painkiller, and is a trigger for others.
What helps migraines when the sickness is the problem?
Nausea does two things: it's miserable in itself, and it stops tablets being absorbed. Migraine-specific products combine a painkiller with an anti-sickness medicine: Migraleve pairs paracetamol and codeine with buclizine, an antihistamine that settles nausea, in a pink tablet for the start of the attack and a yellow one for later. If you're too sick to keep a tablet down, a prochlorperazine buccal tablet dissolves between the lip and gum, bypassing the stomach altogether, and is available from the pharmacy for adults with migraine a doctor has already diagnosed. Both are pharmacy medicines, supplied after a short questionnaire.
Migraine tablets from the pharmacy: which is which
Simple painkillers (aspirin, ibuprofen, paracetamol) are first-line and safest for regular use. Codeine combinations such as Migraleve or Nurofen Plus add strength but are for three days at a time only, and codeine is a leading cause of medication-overuse headache. Triptans (sumatriptan 50mg) are the migraine-specific option, available from pharmacies after a consultation; they work best taken as the pain begins, not during the aura. Whatever you use, the rule is the same: painkillers on no more than ten days a month, or the medicine itself starts causing daily headaches. Our full pain relief range is here.
Is a migraine dangerous?
Migraine itself is not dangerous, however brutal it feels. What matters is recognising the headache that isn't a migraine. Call 999 or go to A&E for a headache that hits its worst within seconds (a "thunderclap"), a headache with fever, stiff neck or a rash, weakness or numbness on one side, slurred speech or confusion, an aura that lasts more than an hour, or a headache after a head injury. See a GP if migraines start for the first time over 50, are getting steadily more frequent or severe, wake you from sleep, or you're getting more than four a month, because that's the point at which daily preventive treatment starts to make sense. If you're unsure, ask our pharmacist.
Frequently asked questions
Can I take paracetamol and ibuprofen together for a migraine?
Yes, if each is suitable for you; they work differently and can be combined. Don't add aspirin to ibuprofen, and never stack two products that both contain paracetamol.
Why do I get migraines around my period?
The drop in oestrogen just before a period lowers the migraine threshold. Taking a regular painkiller from the day before it's due, for a few days, prevents attacks for many women; a GP can offer more if that isn't enough.
How can I stop migraines coming back?
Regular meals, regular sleep, water, and a diary to find your own triggers. If attacks still come more than four times a month, ask a GP about preventive treatment; it's under-used and often works.