What is a migraine?

  • A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head.

How common are migraines?

  • Headaches affect almost everyone at some time.
  • It is more common in women than in men (1).
  • Over a 1-year period, approximately 12% of the general population will suffer from a migraine (4).

Should I worry?

  • No.
  • Headaches are generally a normal part of life and will commonly pass on their own.
  • Approximately 2% of people seen in UK general practice with headaches are referred to a neurologist to rule out more dangerous causes (4).

Who is most likely to suffer from a migraine?

  • Females are more likely to suffer from primary headaches (a type of disease-free headache) than males (1, 2).
  • Those with an unhealthy lifestyle.
  • Those under excessive stress.

What are the common symptoms?

  • Migraines tend to be unilateral, throbbing and disproportionately disabling.
  • Nausea is common.
  • Migraines can occur with or without aura.
  • Visual symptoms are the most common manifestation of an aura and consist of flickering lights, spots or zig-zag lines, fortification spectra or blind spots (1).

What can I do?

  • Consider using a headache diary to aid the diagnosis of primary headaches.
  • Consider causes/what you are doing during onset, intensity, area of pain, any other symptoms you experience whilst having a headache. Finding any patterns may help your healthcare professional better manage your headache (6).

How long will it take to recover?

  • This is dependent on the cause and subtype of the headache itself. Many headaches will settle without concern however, some will require further investigation.
  • Some headaches may be linked to neck problems and in these cases, treatment and rehabilitation will be helpful.
  • We recommend an assessment from a musculoskeletal physiotherapist to determine if this is the case.

1. Introduction

Headaches in general are not cause for concern. On average 37,000 people visit their general practice in the UK every day (1). On rare occasions, however, certain types of headaches accompanied by other symptoms may suggest a more dangerous condition. See the assessment and diagnosis section for symptoms that may require onward referral or investigation.

The International Headache Society classifies headaches into primary and secondary headache disorders (1, 2). The majority of headaches are primary (approximately 90%). This means that the headache is not caused by a disease. The three most common types of primary headaches are tension-type headache (40%), migraine (10%) and cluster headache (1%-3%) (3, 4). Migraine is a chronic neurological disorder characterised by attacks of moderate or severe headache, and reversible neurological and systemic symptoms (5). At times, migraine sufferers will experience neck pain and/or visual symptoms such as flickering lights, spots or lines and/or partial loss of vision, sensory symptoms such as numbness and/or pins and needles, and/or speech disturbance called aura (1).


2. Signs & Symptoms

Aura symptoms:

3. Causes

The earliest stage of a migraine attack starts in the central nervous system (5). A study has shown activation in parts of the brain that connect to the limbic system (the system that controls emotion, memories and arousal) which could explain why migraine is commonly triggered by alterations in homoeostasis (e.g. changes in sleep-wake cycles, missed meals) and also some of the symptoms during the premonitory phase, e.g. yawning, polyuria, food cravings, and mood changes (5). There is also evidence that migraines can be linked to menstruation in girls and women (1).


4. Risk Factors

This is not an exhaustive list. These factors could increase the likelihood of someone developing migraines. It does not mean everyone with these risk factors will develop symptoms.


5. Prevalence

Migraine is one of the most prevalent and disabling medical illnesses in the world. The World Health Organisation ranks migraine as the third most prevalent medical condition and the second most disabling neurological disorder in the world (7, 8).

6. Assessment & Diagnosis

Your GP will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Diagnosis into subtypes of headaches like cluster, tension and migraine comes from the symptoms, frequency and triggers you may experience. For those who present with headache and any of the following features, further investigations and/or referrals may be considered to rule out secondary and dangerous headaches (6):

  • Worsening headache with fever.
  • Sudden onset headache reaching maximum intensity within 5 minutes (thunderclap headache).
  • New onset neurological deficit.
  • New onset cognitive dysfunction.
  • Change in personality.
  • Impaired level of consciousness.
  • Recent (typically within the past 3 months) head trauma.
  • Headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze.
  • Headache triggered by exercise.
  • Orthostatic headache (headache that changes with posture).
  • Symptoms are suggestive of giant cell arteritis.
  • Symptoms and signs of acute narrow-angle glaucoma.
  • A substantial change in the characteristics of their headache.

Further investigations should be considered and/or referral for people who present with or without migraine headache, and with any of the following atypical aura symptoms that meet the criteria in recommendation (1):

  • Motor weakness.
  • Double vision.
  • Visual symptoms affecting only one eye.
  • Poor balance.
  • Decreased level of consciousness.

7. Self-Management

A diary may help you to find what triggers your headache and also help indicate when your GP needs to refer you. Keep a headache diary for a minimum of 8 weeks (1) including:

  • Frequency, duration and severity of headaches.
  • Any associated symptoms.
  • All prescribed and over-the-counter medications taken to relieve headaches.
  • Possible precipitants.
  • Relationship of headaches to menstruation.

8. Rehabilitation

Rehabilitation will be determined by your symptoms and triggers. Recovery can take some time and should be managed by your GP.

9. Migraine Headaches Rehabilitation Plans

Early Plan

Pain should not exceed 2/10 on your perceived pain scale whilst completing this exercise programme.

Early Plan  - Rating

Advanced Plan

These exercises provide a progression from the previous exercises aiming to progress strength and flexibility around the neck and upper back. Pain should not exceed 2/10 on your perceived pain scale whilst completing this exercise programme.

Advanced Plan - Rating

10. Return to Sport/Normal Life

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment.  Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

11. Other Treatment Options

As always, speak to your GP about possible medical management. A course of up to 10 sessions of acupuncture over 5-8 weeks may be effective depending on any other medical conditions you may have and the risk of adverse events (6).


Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.


  1. NICE. (2012). Headaches: diagnosis and management of headaches in young people and adults. NICE Clinical Guideline.
  2. International Headache Society Classification of Headaches ICHD II; Updated Web-based Version.
  3. Hale, N. and Paauw, D,S. (2014). Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. The Medical Clinics of North America 98(3), 505-527.
  4. Latinovic, R., Gulliford, M., Ridsdale, L. (2006). Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurology Neurosurg Psychiatry 77(3), 385-387.
  5. Dodick, David, W. (2018). Migraine. The Lancet. 391 (10127), 1315-1330.
  6. NICE. (2015). Suspected cancer: recognition and referral NICE guideline. NICE Guideline.
  7. Disease and Injury Incidence and Prevalence Collaborators. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study. Lancet. https://doi.org/10.1016/S0140-6736(16)31678-6.
  8. Neurological Disorders Collaborator Group. (2015). Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurology. 2017 (16), 877–97.
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