How to identify, treat and prevent migraines

Written by: Dr Hadi Manji
Edited by: Emma McLeod

The severity of migraines can range from mild to debilitating. In any case, the identification of symptoms, prevention and treatment of migraines are valuable for improving migraine sufferers’ quality of life.


Dr Hadi Manji is a leading consultant neurologist in London who has helped countless patients with the management of their migraines. He shares his professional expertise so that you can understand migraine symptoms, prevention and treatment.

A person covering their face with their hands in despair as they suffer with a migraine

What are migraine symptoms?

Migraine sufferers typically experience a gradually increasing, one-sided, throbbing headache. This can be associated with:


Also, migraines can cause significant disability and productivity at work. They occur in 8 per cent of men and 18 per cent of women.


Are there migraine warning signs?

Some people might get warning (premonitory) symptoms 24 to 48 hours before the migraine starts e.g.

  • Fatigue
  • Excessive yawning
  • Urinating more frequently


Auras, which are neurological symptoms that happen immediately before an attack, occur in 30 per cent of patients. These auras include flashing lights, zigzag lines or a disturbance in speech.


How can I prevent migraines?

To prevent migraines, patients can identify triggers:

  • Dehydration (the strongest reversible trigger)
  • A lack of sleep
  • Too much sleep
  • Stress
  • Red wine
  • Menstrual cycle


What triggers a migraine will vary from individual to individual. In any case, a healthy and regular diet, adequate hydration, exercise and sleep are vital for preventing migraines.


What should I do during a migraine attack?

For a migraine attack, take medication early (paracetamol, aspirin or ibuprofen). If these fail, consider the triptan group of drugs. In patients with frequent attacks, a preventative medication may be prescribed (e.g. beta-blockers, topiramate, calcium channel blockers or tricyclic antidepressants).


In patients with chronic migraine and who are unresponsive to the usual medication, there is a role for Botox injections and greater occipital nerve (GON) blocks. Calcitonin gene-related peptide (CRGP) inhibitors are a new class of drugs that have recently been introduced but not yet approved by NICE (The National Institute for Health and Care Excellence) for treating migraines.


Do you have concerns about your neurological health? Visit Dr Hadi Manji’s profile to learn how he can help you.

By Dr Hadi Manji

Dr Hadi Manji is a Senior Consultant Neurologist, Associate Professor of Neurology at University College London and Lecturer at the world famous National Hospital for Neurology, Queen Square, London. Dr Manji's areas of expertise include headache disorders such as migraine, peripheral nerve disorders, tremor and movement disorders, and infectious neurological disorders including HIV. 

Dr Manji initially trained as a GP in Edinburgh, before training in neurology at The Royal Free, and National Hospitals as well as L'Hopital Kremlin-Bicetre in Paris. In 1997, he was appointed Consultant NHS Neurologist to The National Hospital and also Ipswich Hospital, where he holds clinics in peripheral nerve disorders, general neurology and Parkinson's disease, and has been elected President of the Neurosciences Section of the Royal Society of Medicine.

Dr Manji is actively involved in teaching and currently is appointed as Senior Lecturer at the National Hospital. He has been involved in the development of a new medical school in Beira, Mozambique, and  is also involved in the training of neurologists from Kenya and most recently Malaysia. 

Dr Manji is widely published and is the Chief Author and Editor of the Oxford Handbook of Neurology. The first edition of the book sold 11,000 copies and is used during training for junior doctors and neurologists around the world. His latest book is entitled: Neuromuscular Disease - case studies from Queen Square (written and edited with Dr Matt Evans and Dr Chris Turner). Dr Manji has also published numerous papers on the subject of peripheral nerve disorders, general neurology, and HIV neurology. 

Dr Manji was awarded the Association of British Neurologists (ABN) Medal for services to National and International Neurology. The award ceremony took place at the annual ABN meeting in Harrogate in May 2022. The citation by Professor Tom Warner (President of the ABN) and Dr Manji's lecture entitled 'From Eldoret to Harrogate...the story so far' is available on the ABN website for those interested. 


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