What Causes Migraines and How Can I Prevent Them?

A migraine isn’t “a bad headache” — it’s a neurological event that can floor you for hours or days, often with nausea, light sensitivity, and visual disturbances. I get them, and the aura phase (zigzag lights, blind spots) still unnerves me every time despite years of practice. If you suffer too, you know the particular dread of feeling one coming on at work. “what causes migraines and how can I prevent them” — let’s get into it properly, with the detail and straight talking the question deserves.

The good news: migraines are among the most manageable neurological conditions once you understand your personal triggers and have a treatment plan. This guide covers what causes them, how to prevent attacks, what to do when one hits, and when to involve your GP.

What actually causes a migraine

The old “blood vessels constricting” explanation is outdated. Current understanding: migraine is a disorder of brain excitability — the migraine brain overreacts to triggers, setting off a cascade involving the trigeminal nerve system and inflammatory chemicals. Genetics play a huge role: if one parent has migraines, you have roughly a 50 percent chance; with two affected parents, it’s around 75 percent.

Triggers don’t cause migraine in non-sufferers, but they tip the susceptible brain over the edge. The classic ones: stress (and notably the let-down after stress — weekend migraines are textbook), hormonal fluctuations (many women get menstrual migraines), missed meals or dehydration, too much or too little sleep, bright or flickering lights, strong smells, alcohol (red wine is the notorious one, though any alcohol can do it), aged cheeses and processed meats (tyramine), caffeine withdrawal, and weather pressure changes.

The tricky part: triggers are cumulative. One coffee skipped might be fine; skipped coffee plus poor sleep plus a stressful day equals migraine. This is why trigger diaries work — patterns emerge over weeks that single incidents hide. Note sleep, meals, hydration, stress, hormones, and weather alongside each attack.

Recognising the phases (and acting early)

Migraines often announce themselves hours ahead. The prodrome phase — up to 24 hours before — can include yawning, food cravings, mood changes, neck stiffness, and frequent urination. I now recognise my prodrome (irritability plus neck ache) as reliably as a weather forecast. Then comes aura for about a quarter of sufferers: visual disturbances, tingling, or speech difficulty lasting 5 to 60 minutes.

The headache phase brings the main event: typically one-sided, throbbing, moderate-to-severe pain worsened by movement, plus nausea and sensitivity to light and sound. It lasts 4 to 72 hours untreated. Then the postdrome — the infamous “migraine hangover” of exhaustion and brain fog that can linger a day.

Acting early is everything: treatment works best taken at the first sign, not once you’re hiding in a dark room. Keep medication with you always — the attack that starts at the office is the one you’re unprepared for. Learn your prodrome; it’s your early-warning system.

Prevention: the lifestyle foundations

Before medication, the foundations: keep sleep consistent (same wake time daily, including weekends — lie-ins are a classic trigger), eat regular meals (blood sugar dips trigger attacks), hydrate properly, manage stress with actual techniques rather than white-knuckling, and limit alcohol and caffeine to consistent moderate amounts (erratic caffeine is worse than steady caffeine).

Supplements with decent evidence: magnesium (400mg daily) helps some people, riboflavin (vitamin B2, 400mg daily) has good trial data, and CoQ10 shows promise. They’re not miracle cures but they’re low-risk additions worth trying for frequent sufferers. Regular moderate exercise reduces migraine frequency for many — though intense exercise can trigger attacks in some, so build up gradually.

Keep a trigger diary for 8 weeks (sleep, food, stress, hormones, weather)
Consistent sleep schedule — weekends included
Regular meals and good hydration
Stress management: exercise, CBT, relaxation techniques
Consider magnesium, riboflavin (B2) after discussing with pharmacist/GP

Treatment options and when to see your GP

For acute attacks: simple painkillers (ibuprofen, paracetamol, aspirin) work if taken early; many sufferers do better with combination products. Triptans (sumatriptan and others) are migraine-specific prescription drugs that work for most people — if over-the-counter options fail, ask your GP. Anti-nausea medication (domperidone, prochlorperazine) helps when vomiting prevents tablets working. Avoid overusing painkillers (more than 10–15 days a month) — it causes medication-overuse headaches, a cruel trap.

See your GP if: migraines are new or changed pattern, you’re getting them weekly, over-the-counter treatment isn’t working, or they’re affecting your work and life. Preventive daily medication (beta-blockers, amitriptyline, topiramate, or newer CGRP treatments for chronic migraine) can halve attack frequency for suitable patients. The NHS migraine guide is a solid reference.

Seek urgent care for: sudden “worst headache of my life,” headache with fever and stiff neck, new neurological symptoms, or migraine with aura that’s dramatically different from your usual — these can signal conditions needing emergency assessment.

Migraines at work: practical tips and your rights

Migraines and employment are a difficult combination — unpredictable, invisible, and easy for unsympathetic managers to dismiss. Know your position: under the Equality Act 2010, chronic migraines can count as a disability if they substantially affect daily life over the long term, which triggers your employer’s duty to make reasonable adjustments. You don’t need the legal label to ask for help, but it’s useful context.

Reasonable adjustments worth requesting: control over lighting (no flickering fluorescents at your desk), screen filters or dark mode, permission to work from home during prodrome, a quiet dark room to retreat to, flexible hours around attacks, and exemption from strong fragrances if they’re a trigger. Access to Work grants can fund adjustments including specialist equipment. Keep a brief paper trail of requests and responses.

Practically: tell your manager and one trusted colleague the basics — what a migraine looks like for you, what you need (usually: let me go somewhere dark, don’t call an ambulance unless I ask), and that you’ll make up the time. Keep rescue medication at work, not just at home. If you’re self-employed, build buffer into deadlines during known high-risk periods (for menstrual migraine, for example). And track work-loss days — if you’re losing several days a month, that’s the threshold where preventive treatment becomes clearly worthwhile; take that data to your GP.