Migraine
Also called: migraine headache, migraine with aura, migraine without aura, sick headache, adhay sar ka dard (half-head headache)
Migraine is a common brain condition that causes repeated attacks of moderate to severe headache, often on one side, with sickness and sensitivity to light and sound. Attacks last hours to days. Painkillers, triptans and preventive medicines can control it.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Migraine is one of the most common headache disorders in the world. It is not just a bad headache. It is a condition of the brain in which attacks of pain come back again and again, usually with other symptoms such as feeling sick (nausea), vomiting, and not being able to bear light or noise. Some people get warning signs called an aura (short-lived changes in vision, feeling or speech) before the pain starts. An attack usually lasts between 4 hours and 3 days.
Migraine affects people of all ages, incomes and regions. It most often starts around puberty and is most troublesome between the ages of 35 and 45. Women get it more often than men. The World Health Organization lists migraine among the leading causes of disability worldwide, because attacks stop people from working, studying and caring for their families.
The exact cause is still not fully understood. Doctors believe that nerve pathways and chemicals in the brain become over-active, releasing pain-producing substances around the nerves and blood vessels of the head. Migraine often runs in families. It cannot be cured, but most people can control it well. Treatment has two parts: medicines to stop an attack when it starts, and, for people with frequent attacks, daily preventive medicines and lifestyle changes to make attacks fewer and milder.
In Pakistan: what studies show
A nationwide household survey found that 22.5% of adults in Pakistan had migraine in the past year, and women were affected more often (26.9%) than men (18.0%).
- In a nationwide household survey of 4,223 adults in Pakistan, 76.6% said they had had a headache in the past year.[1] (national survey, data not stated)
- The same nationwide survey found that 22.5% of adults had migraine in the past year (after adjusting for age and sex).[1] (national survey, data not stated)
- In that survey, migraine was more common in women (26.9%) than in men (18.0%).[1] (national survey, data not stated)
- Headache caused by taking painkillers too often (probable medication-overuse headache) was found in 0.7% of adults in the nationwide survey.[1] (national survey, data not stated)
- Global Burden of Disease 2021 modelling estimated that 33,211.06 thousand people in Pakistan were living with migraine in 2021, up from 14,026.04 thousand in 1990.[3] (modelled estimate, data 1990-2021)
- One study of 413 students at two medical colleges in Karachi in 2013 found that 21% had migraine.[4] (cross-sectional, data September-December 2013)
- In the same Karachi student study, 96.9% treated their headaches themselves with medicines (self-medication).[4] (cross-sectional, data September-December 2013)
- In one hospital study of 50 migraine patients at Jinnah Postgraduate Medical Centre in 2018, 40% had severe disability from their migraine.[5] (cross-sectional, data April-May 2018)
What we do not know yet: The only nationwide survey does not state on its pages when the fieldwork was done, and one university repository marks its copy as withdrawn although the publisher and Altmetric pages show no retraction notice, so this should be rechecked. No Pakistan study found gave percentages for common migraine triggers, student and hospital studies are small and from Karachi, GBD figures are modelled with wide uncertainty, and no Pakistan migraine guideline was found.
Pakistan studies cited
- Herekar AA, Ahmad A, Uqaili UL, et al. Primary headache disorders in the adult general population of Pakistan - a cross sectional nationwide prevalence survey. The Journal of Headache and Pain 2017;18(1):28. doi:10.1186/s10194-017-0734-1. Open source
- Herekar AD, Herekar AA, Ahmad A, et al. The burden of headache disorders in Pakistan: methodology of a population-based nationwide study, and questionnaire validation. The Journal of Headache and Pain 2013;14:73. doi:10.1186/1129-2377-14-73. Open source
- Satapathy P, Chauhan S, Gaidhane S, et al. Trends in migraine and tension-type headaches in South Asia: findings from the Global Burden of Disease Study 2021 (1990-2021). Frontiers in Neurology 2025;16:1514712. doi:10.3389/fneur.2025.1514712. Open source
- Noor T, Sajjad A, Asma A. Frequency, character and predisposing factor of headache among students of medical college of Karachi. Journal of the Pakistan Medical Association 2016;66(2):159. Open source
- Jawed S, Ali W, Yaqoob U, et al. Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study. Pain and Therapy 2019;8(2):233-238. doi:10.1007/s40122-019-0130-4. Open source
Symptoms
- Throbbing or pulsating headache, usually moderate or severe, often on one side of the head or behind one eye (it can be on both sides)
- Pain that gets worse with normal activity such as walking or climbing stairs, so the person wants to lie still
- Feeling sick (nausea) or vomiting
- Unusual sensitivity to light and sound; some people are also bothered by smells
- Aura before or during the headache in about one in four people: flickering lights, zigzag lines, spots, patches of lost vision, pins and needles or numbness spreading up an arm or the face, or trouble finding words; aura builds up over a few minutes and usually lasts under an hour
- Warning signs up to a day or two before the pain (prodrome): yawning, tiredness, irritability, a stiff neck or food cravings
- An attack usually lasts 4 to 72 hours; in teenagers attacks can be shorter
- After the attack (postdrome or 'migraine hangover'): feeling drained, mentally dull, needing extra sleep, and neck pain
- In children, attacks tend to be shorter and stomach symptoms are more prominent than headache
Causes and risk factors
Causes
- Over-activity of nerve pathways and chemical messengers in the brain, which releases pain-producing inflammatory substances around the nerves and blood vessels of the head
- A wave of changed electrical activity spreading across the surface of the brain is thought to cause the aura
- A chemical called CGRP (calcitonin gene-related peptide) widens blood vessels and carries pain signals; newer medicines block it
- Genetics: migraine often runs in families, although the exact genes are not fully known
- Hormone changes in women, for example around periods, which is why attacks often improve after the menopause
What makes it more likely
- Being female; women have attacks far more often than men
- Age between puberty and about 45; attacks usually become less frequent with age
- A family history of migraine
- Stress, anxiety and depression, which are more common in people with migraine
- Poor or irregular sleep, skipping meals, fasting or dehydration
- Too much caffeine or caffeine withdrawal, alcohol, and smoking
- Hormone changes: menstrual periods and birth control pills containing oestrogen
- Being overweight and lack of regular exercise
Complications
Most people with migraine stay otherwise healthy, but there are some important problems to know about. Taking painkillers or triptans too often can itself cause daily headaches, called medication overuse headache; this is the most common 'secondary' headache in the world and is often worst on waking. Migraine can become chronic, meaning headache on 15 or more days a month for over 3 months. An attack lasting more than 3 days (status migrainosus) may need hospital treatment. People with migraine with aura have a somewhat higher risk of stroke, and the risk is higher again with smoking or oestrogen-containing contraceptive pills. Depression and anxiety are more common in people with migraine, and the condition often causes missed work and school.
When to see a doctor
- A very sudden, severe 'thunderclap' headache that reaches its worst within 5 minutes, or the worst headache of your life: call for emergency help
- Headache with new weakness, numbness, trouble speaking, double vision, loss of balance, confusion or drowsiness, especially if different from your usual migraine: this could be a stroke
- Headache with fever, stiff neck or a rash that does not fade under pressure (possible meningitis)
- Headache that gets steadily worse over days or weeks, or a big change in your usual headache pattern
- Headache after a head injury in the last 3 months, or headache brought on by coughing, straining, sneezing or exercise
- Aura that is unusual: weakness of one side, vision lost in one eye only, or aura lasting more than an hour
- A new headache starting after age 50, in pregnancy, in someone with cancer or a weak immune system, or with vomiting that has no other cause
Diagnosis
Migraine is diagnosed from the story you tell your doctor and a physical and nerve (neurological) examination. There is no blood test or scan that proves migraine. Doctors look for repeated attacks of moderate to severe headache lasting 4 to 72 hours that are usually throbbing, often one-sided and made worse by normal activity, together with nausea or vomiting, or sensitivity to light and sound. Headaches on fewer than 15 days a month are called episodic migraine; 15 or more days a month for over 3 months is chronic migraine.
Keeping a headache diary for at least 8 weeks is very helpful. Note the date, how long the attack lasted, how bad it was, other symptoms, every medicine you took (including over-the-counter painkillers) and possible triggers such as periods or missed sleep. Brain scans (CT or MRI) are not needed just for reassurance when the pattern is typical. A scan or referral to a specialist is arranged when there are warning features such as a sudden severe headache, new nerve symptoms, unusual aura, fever, or a headache that keeps changing.
Treatment
- At the first sign of an attack, take your attack medicine straight away; waiting makes it work less well. Rest in a quiet, dark room and drink fluids.
- For milder attacks, a simple painkiller such as paracetamol or an anti-inflammatory (NSAID) is often enough. Your doctor decides the dose and which one suits you.
- For moderate or severe attacks, guidelines recommend a triptan (a migraine-specific medicine), usually combined with an NSAID or paracetamol. If one triptan does not work after a fair trial, another may be tried.
- An anti-sickness medicine can be added to help nausea and to help other medicines be absorbed, even if you are not vomiting. If tablets cannot be kept down, injections, nasal sprays or suppositories are options.
- Do not use opioid painkillers or ergot medicines for migraine; they work poorly and increase the risk of daily headache. Limit attack medicines to 2 days a week or fewer to avoid medication overuse headache.
- If attacks are frequent or disabling, your doctor may suggest a daily preventive medicine such as a beta blocker, amitriptyline or topiramate, reviewed after 3 to 6 months. Riboflavin (vitamin B2) and acupuncture are other options in guidelines.
- If several preventives have failed, a specialist may consider newer CGRP-blocking medicines, or botulinum toxin injections for chronic migraine.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Triptans (migraine-specific medicines) | first choice for moderate or severe attacks, usually combined with an NSAID or paracetamol; not suitable for people with heart disease, previous stroke or uncontrolled blood pressure | Sumatriptan (23 brands), Sumatriptan + Naproxen (1 brand) |
| Simple painkillers and NSAIDs | for mild to moderate attacks on their own, or together with a triptan; aspirin should not be given to children under 16 | Paracetamol (350 brands), Ibuprofen (378 brands), Naproxen (5 brands), Diclofenac (26 brands), Acetylsalicylic acid (Aspirin) (59 brands) |
| Anti-sickness medicines (antiemetics) | added to attack treatment to control nausea and vomiting; given by injection if tablets are not kept down | Metoclopramide (51 brands) |
| Blood pressure medicines used for prevention | daily preventive treatment to reduce the number of attacks; beta blockers are a first-line choice, candesartan has more limited evidence | Propranolol (17 brands), Metoprolol Tartrate (7 brands), Candesartan Cilexetil (4 brands) |
| Antidepressants used for prevention | daily preventive treatment, useful when there is also poor sleep, depression or tension-type headache | Amitriptyline (6 brands) |
| Antiepileptic medicines used for prevention | daily preventive treatment when other options fail; valproate must be avoided in women who could become pregnant | Sodium valproate (42 brands), Magnesium Valproate (3 brands) |
Also used (not yet in our price list): topiramate (preventive; must not be used in pregnancy or in women who could become pregnant without reliable contraception), prochlorperazine (anti-sickness medicine), other triptans such as zolmitriptan and frovatriptan, rimegepant and other CGRP-blocking medicines (atogepant, erenumab, fremanezumab, galcanezumab, eptinezumab) for people in whom several standard treatments have failed, botulinum toxin type A injections for chronic migraine, riboflavin (vitamin B2) supplement
Self-care and prevention
Self-care
- Keep a headache diary for at least 8 weeks to find your personal triggers and to show your doctor how well treatment is working
- Eat meals at regular times and do not skip meals or fast for long periods without planning for it
- Go to bed and wake up at regular times; both too little and too much sleep can set off an attack
- Drink enough water, limit caffeine, and avoid alcohol if it triggers you
- Take regular exercise and keep to a healthy weight
- Learn ways to manage stress, such as relaxation exercises; cognitive behavioural therapy can also help
- During an attack, lie down in a dark, quiet room and take your attack medicine early
- Do not take painkillers or triptans on more than 2 days a week; if you need them more often, see your doctor about prevention
Prevention
- Avoid the triggers you have identified in your diary, for example missed meals, poor sleep, dehydration or certain foods
- Keep a regular daily routine for sleep, meals and exercise
- If attacks are frequent, ask your doctor about a daily preventive medicine; it may take 3 to 6 months to judge the benefit
- Riboflavin (vitamin B2) and acupuncture are listed in guidelines as options that help some people
- Women with migraine with aura should not usually take combined hormonal contraceptive pills because of stroke risk; discuss other methods with your doctor
- Do not smoke
Common questions
Is migraine dangerous?
For most people migraine is painful and disabling but not life-threatening. People who have migraine with aura have a slightly higher risk of stroke, and this risk rises with smoking and oestrogen-containing contraceptive pills. Any sudden severe headache or headache with new weakness, confusion or speech problems needs emergency care, because it may not be migraine.
How is migraine different from an ordinary headache?
A tension-type headache is usually a dull, tight pressure on both sides and does not stop you doing things. Migraine is usually throbbing, moderate to severe, often one-sided, lasts hours to days, and comes with nausea or sensitivity to light and sound. Normal activity makes migraine worse.
Can I just take painkillers every time?
Painkillers and triptans work well when taken early, but using them on more than about 2 days a week can cause medication overuse headache, where the headache comes almost every day. If you need attack medicines this often, ask your doctor about preventive treatment. The treatment for medication overuse headache is to stop the overused medicine, which may make headaches worse for a short time.
Will migraine go away on its own?
Migraine is usually lifelong but attacks often become fewer and milder with age. Many women find attacks improve after the menopause and sometimes during pregnancy. Good control of triggers and the right medicines can greatly reduce attacks at any age.
Can I take migraine medicine during pregnancy?
Paracetamol is the usual first choice in pregnancy. Triptans or anti-inflammatory painkillers may be considered after discussing the risks with your doctor. Topiramate must not be used for migraine prevention in pregnancy, and any preventive treatment in pregnancy needs specialist advice.
Sources
- NICE. Headaches in over 12s: diagnosis and management (NICE clinical guideline CG150) (2025).
- WHO. Migraine and other headache disorders (2025).
- StatPearls (NCBI Bookshelf). Migraine With Aura - StatPearls - NCBI Bookshelf (2024).
- MedlinePlus. Migraine: MedlinePlus Medical Encyclopedia (2025).
- NHS. Migraine - NHS (2026).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.