Migraine

What it is

Migraine is a disorder of the brain, involving the trigeminal nerve system, cortical spreading depression and changes in brain excitability. It is not caused by tight muscles, and treating it as a tension headache with a stronger painkiller is a common and unhelpful error.

That said, the upper cervical nerves and the trigeminal nerve share a nucleus in the brainstem, which is why neck input can genuinely trigger and amplify migraine. In people whose attacks reliably begin with neck symptoms, treating the neck is a legitimate part of migraine management - just not a cure for the underlying condition.

What it feels like

• Throbbing or pulsating pain, often but not always one-sided
• Moderate to severe, and made worse by ordinary movement
• Nausea, sometimes vomiting, and a strong aversion to light and sound
• Sometimes preceded by an aura - visual zigzags, blind spots, tingling or speech difficulty
• Lasting hours to days, and leaving a washed-out hangover afterwards

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

An inherently more excitable brain

Migraine brains respond differently to sensory input, with a lower threshold for the cascade that produces an attack. This is largely genetic and it is the underlying condition rather than a trigger.

Trigeminovascular activation

Activation of the trigeminal nerve system releases peptides that dilate blood vessels and sensitise pain pathways around the brain's coverings. This is the mechanism the newer migraine drugs target.

Neck input converging on the same nucleus

The upper cervical nerve roots and the trigeminal nerve share the trigeminocervical nucleus. Input from an irritated neck can therefore trigger or amplify migraine, which is why neck treatment helps a subset of people genuinely.

Sleep disruption

Both too little and too much sleep trigger attacks, and irregular timing is worse than either. It is one of the most consistently reported triggers.

Missed meals and dehydration

Skipping meals is a well-established trigger, probably through blood glucose fluctuation. Dehydration is another common and easily corrected one.

Hormonal fluctuation

Menstrual migraine is triggered by the fall in oestrogen before a period. It is often more severe and less responsive to usual treatment, and it explains why migraine is around three times more common in women.

Stress, and the let-down after it

Attacks frequently arrive at the start of a weekend or a holiday rather than during the stressful period itself. The drop in stress hormones appears to be the trigger.

Sensory triggers

Bright or flickering light, strong smells and loud noise trigger attacks in sensitive people. The threshold is lower in the day or two before an attack, which is part of why triggers seem inconsistent.

Medication overuse

Taking acute painkillers or triptans on more than about ten to fifteen days a month converts episodic migraine into chronic daily headache. This is extremely common and reversible, but only by breaking the cycle.

Weather and barometric change

Frequently reported and modestly supported. It is not modifiable, which makes it useful mainly for knowing an attack is not your fault.

Who tends to get it

• Anyone with a family history - migraine is strongly heritable
• Women, particularly around menstruation and perimenopause
• People with irregular sleep or shift work
• Anyone taking acute headache medication on most days
• People with neck pain that reliably precedes their attacks

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineTension Headache Relief

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Sudden worst-ever headache; new aura after 50; focal deficit that does not resolve; fever with neck stiffness

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Regular exercise reduces attack frequency over eight to twelve weeks and the effect size in trials is comparable to some preventive drugs, which makes it worth doing properly. Migraine is a long-term condition that is managed rather than cured, and effective preventive treatments exist that many people never get offered. A sudden severe headache unlike any before, a headache with fever and neck stiffness, with new neurological signs, or after a head injury needs urgent assessment rather than a migraine plan.

Prevalence basis: Global headache epidemiology

Others the same routine covers

These share the Tension Headache Relief routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.