What is Migraine?
Migraine is a common, often inherited brain disorder in which the pain-processing systems of the brain — especially the trigeminal nerve and the blood vessels of the membranes around the brain — become over-sensitive. During an attack, nerve endings release substances such as CGRP (calcitonin gene-related peptide), which trigger inflammation around blood vessels and spread the pain. That is why migraine affects so much more than the head: light, sound, smell, digestion, mood and concentration are all involved.
Around one in seven adults has migraine, and women are affected about three times as often as men. It usually starts in adolescence or early adulthood and is most troublesome between the ages of 25 and 50. Having a parent or sibling with migraine makes it more likely.
Doctors distinguish episodic migraine (fewer than 15 headache days a month) from chronic migraine (15 or more headache days a month for more than three months, at least 8 of them with migraine features). Taking painkillers on more than 10–15 days a month can itself make headaches more frequent — this is called medication-overuse headache and is one of the most common reasons migraine becomes chronic.
Why see a neurologist for migraine?
Many people manage migraine for years with over-the-counter painkillers and never receive a proper diagnosis or preventive plan. A neurologist confirms that the headache really is migraine, rules out other causes, identifies medication overuse and builds a treatment plan that fits your life — including newer options such as CGRP-targeted medicines and Botox for chronic migraine.
Symptoms of Migraine
A migraine attack usually lasts from 4 to 72 hours and typically includes several of the following:
- Pain on one side of the head (it can switch sides or affect both)
- Throbbing or pulsating pain
- Moderate or severe intensity that disrupts daily activities
- Pain that gets worse with routine activity such as climbing stairs
- Nausea and sometimes vomiting
- Sensitivity to light, sound and smells — wanting to lie down in a dark, quiet room
- Warning signs hours before the pain: yawning, tiredness, food cravings, a stiff neck
- A “hangover” feeling of fatigue and poor concentration for a day afterwards
Migraine with aura
About one in three people with migraine experiences an aura before the headache: usually visual disturbances lasting 5–60 minutes such as zigzag lines, flashing lights or blind spots, and sometimes tingling in the hand and face or difficulty finding words. A first-ever aura, or one that is different from usual, should always be assessed by a doctor.
When should you see a neurologist?
We recommend seeing a neurologist if:
- Headaches make you miss work, study or family life on four or more days a month
- You take painkillers on more than 10 days a month
- Your usual headache has changed in character or frequency
- Your medicines no longer work or cause side effects
- A new type of headache starts after the age of 50
- You are planning a pregnancy and want to know which treatments are safe
Seek emergency care immediately (call 112 in Turkey and Europe, or your local emergency number) for the worst headache of your life coming on suddenly, headache with fever and a stiff neck, weakness, speech problems, loss of vision or confusion.
How is Migraine diagnosed?
Migraine is diagnosed mainly from a detailed history and a neurological examination. We ask when the headaches started, how often they occur, what they feel like, what comes with them, what triggers them, which medicines you take and whether anyone in your family has migraine.
When the examination is normal and the headaches have typical migraine features, further tests are often unnecessary. An MRI scan or other tests are requested when:
- The headache is new or has clearly changed
- The neurological examination is abnormal
- The aura is prolonged or unusual
- Fainting or seizures are suspected (an EEG may be requested)
- Other contributing problems — blood pressure, thyroid, anaemia — need checking
You will usually be asked to keep a headache diary: the days with headache, how severe it was, which medicine you took and any possible triggers. This simple record clarifies the diagnosis and later shows objectively whether treatment is working. If you are travelling to Istanbul, bring the diary from the last one to three months.
How is Migraine treated?
Migraine treatment has two parts: acute treatment to stop an attack and preventive treatment to reduce how often attacks happen.
Acute (attack) treatment
Mild attacks may respond to simple painkillers or anti-inflammatory medicines. Moderate to severe attacks are usually treated with migraine-specific medicines called triptans; newer acute options are available for people who cannot take triptans. Taking the medicine early in the attack makes it far more effective. Anti-sickness medicine can be added if nausea is a problem. Acute medicines should not be used on more than 10 days a month.
Preventive treatment
Prevention is recommended if you have four or more attacks a month, if attacks are long and disabling, or if acute medicines do not work. Depending on your age, other health conditions and pregnancy plans, options include certain blood-pressure medicines, low-dose antidepressants, anti-seizure medicines and calcium-channel blockers. For suitable patients, CGRP-targeted treatments (monthly injections or tablets) are also available. Preventive medicines usually take 6–8 weeks to show their full effect and are often continued for 6–12 months.
Botox and nerve blocks for chronic migraine
If you have chronic migraine and preventive medicines have not helped enough, Botox for migraine — injections at standard points on the head and neck, repeated every 12 weeks — may be offered. Occipital nerve blocks can provide relatively quick relief during difficult periods.
Lifestyle measures that genuinely help
- Regular sleep, going to bed and getting up at similar times — including at weekends
- Not skipping meals and drinking enough water
- Aerobic exercise at least three times a week
- Keeping caffeine moderate and consistent
- Stress management and relaxation techniques
- Identifying personal triggers with a diary (alcohol, certain foods, screen time, hormonal changes)
Treatment timeline and your stay in Istanbul
The first consultation takes 30–45 minutes. If preventive treatment is started, the first review is after 6–8 weeks, when your headache diary is compared with the starting point. Prevention is usually continued for 6–12 months and then gradually reduced if attacks are well controlled.
For patients travelling from abroad, the consultation and any tests can usually be completed in 1–2 days in Istanbul. If Botox is indicated it can often be given on the same day. Most follow-up can then continue by video call.
Follow-up after treatment
Migraine is a long-term condition, so treatment works best as a partnership. Keep your headache diary, take medicines as advised and attend follow-up appointments, even when you feel better.
- Do not increase painkillers on your own; tell your doctor if you are using them more often
- Do not stop a preventive medicine after two or three weeks — it takes time to work
- Review all medicines with your doctor if you are planning a pregnancy
- Bring your appointment forward if your aura changes or new symptoms appear
Risks and what to watch for
Every migraine medicine has possible side effects, which is why treatment is chosen individually. Triptans are generally avoided in people with uncontrolled high blood pressure, coronary heart disease or a history of stroke. Some preventive medicines can cause drowsiness, weight change, dry mouth or tiredness.
Women with migraine with aura should know that oestrogen-containing contraceptive pills — particularly combined with smoking — can increase the risk of stroke; the choice of contraception should be discussed with your doctor. One of the biggest risks is medication overuse, which makes migraine chronic; fortunately this can be reversed with the right plan.
Frequently asked questions about Migraine
Can migraine be cured?
Migraine is a long-term condition with a genetic background, so a permanent cure cannot be promised. However, with an accurate diagnosis, effective acute and preventive treatment and lifestyle changes, most people have far fewer and milder attacks. In many women migraine improves after the menopause.
How do I know whether my headache is migraine?
Migraine is typically one-sided, throbbing, moderate to severe and made worse by activity, with nausea and sensitivity to light and sound. Tension-type headache is usually on both sides, pressing and milder, without nausea. A neurological consultation confirms the diagnosis.
Do I need an MRI for migraine?
Not usually. If your headaches have typical migraine features and the examination is normal, an MRI is rarely necessary. It is requested when the headache is new, has changed, the examination is abnormal or the aura is unusual.
Which foods trigger migraine?
Triggers vary from person to person. Some people react to alcohol (especially red wine), aged cheese, processed meat, chocolate, artificial sweeteners or too much caffeine. Skipping meals and dehydration are very common triggers. A headache diary helps you find your own.
Are migraine medicines addictive?
They are not addictive in the usual sense, but using painkillers or triptans on more than 10–15 days a month can cause medication-overuse headache. That is why frequent migraine should be treated with preventive therapy.
Can migraine be treated during pregnancy?
In many women migraine improves during pregnancy. If attacks continue, medicines and non-drug approaches that are safe in pregnancy are chosen with your doctor. If you are planning a pregnancy, review your preventive medicines in advance.
Is Botox suitable for everyone with migraine?
No. Botox is recommended for chronic migraine (15 or more headache days a month) when preventive medicines have not helped enough. It is generally not recommended for episodic migraine. Suitability is decided after a consultation.
I live abroad — can I start treatment in Istanbul and continue at home?
Yes. After the in-person consultation in Istanbul, most follow-up can be done online, and we can liaise with your doctor at home. If you receive Botox, the injections need to be repeated every 12 weeks, either in Istanbul or by a trained doctor in your country.
This page is for general information only and does not replace a medical consultation. Please consult a physician for diagnosis and treatment. Results vary from person to person.
