Given the broad range of symptoms and the significant impact migraine can have across multiple aspects of a person’s life, effective management of the condition requires more than a single clinical intervention writes Deirdre Ní Mhórdha of the Migraine Association of Ireland

For many years, migraine was misunderstood and frequently dismissed as ‘just a headache’. Unfortunately, this misconception still exists among the general public and, at times, even within healthcare settings.

However, advances in scientific understanding have confirmed that migraine is a complex neurological disorder affecting far more than the head. It is a whole-body condition that can significantly affect numerous systems, a person’s quality of life, education, employment, relationships and mental wellbeing.

With more than one billion people affected worldwide, migraine is one of the most common neurological conditions globally. The World Health Organization ranks migraine as one of the most disabling illnesses worldwide, and identifies it as the leading cause of disability among women under the age of 50, due, in part, to hormonal influences. Despite this substantial burden, migraine remains under-recognised, under-diagnosed and under-treated.

With more than one billion people affected worldwide, migraine is one of the most common neurological conditions globally

Given the broad range of symptoms and the significant impact migraine can have across multiple aspects of a person’s life, effective management requires more than a single clinical intervention. Instead, it demands a multidisciplinary team (MDT) approach that places the individual at the centre of care, and draws on the expertise of a range of healthcare professionals.

Migraine: more than a headache
While headache is the symptom most commonly associated with migraine, it is only one aspect of the highly complex neurological condition. Migraine originates in the brain and can affect several neurological pathways, leading to a wide variety of symptoms, both during, and between attacks.

Migraine can involve disturbances in the visual system, speech centres, balance mechanisms, sensory pathways and gastrointestinal function. Some individuals may experience aura symptoms that include visual distortions, blind spots, temporary sight loss, or difficulties with speech and language. Others may experience temporary weakness or paralysis on one side of the body, symptoms that can be frightening, and are sometimes mistaken for stroke.

Common migraine symptoms may include:

Nausea/Vomiting
Dizziness and balance problems
Brain fog and cognitive difficulties
Fatigue
Anxiety/Depression
Sleep disturbances
Restless leg syndrome
Neck and shoulder pain
Facial pain/Eye pain
Visual disturbances/Temporary sight loss
Aphasia (difficulty speaking or understanding language)
Temporary paralysis or weakness

Importantly, many of these symptoms are not confined to acute migraine attacks. For some people, symptoms such as fatigue, cognitive impairment, dizziness, neck pain, anxiety or sleep difficulties may persist between attacks, creating a continuous burden that affects daily functioning.

This broad symptom profile highlights why migraine cannot be effectively managed through a single-treatment pathway. A person living with migraine may require support for pain management, mobility, mental health, occupational functioning, sleep and medication management, simultaneously.

The importance of early recognition
Many people experiencing migraine symptoms will first seek help from their local pharmacist or general practitioner. These healthcare professionals therefore play a critical role in the early recognition, assessment and management of migraine.

Unfortunately, patients often report that their symptoms have been minimised or misunderstood. Because migraine presents in many different ways, individuals may seek help for dizziness, gastrointestinal symptoms, visual disturbances, facial pain or cognitive difficulties without realising these symptoms may be linked to migraine.

Healthcare professionals on the frontline must therefore be aware of the many presentations of migraine, and take patient symptoms seriously. Fast recognition can reduce delays in diagnosis and help ensure that individuals receive appropriate advice, treatment and referral at an earlier stage.

Pharmacists can help identify patterns of symptoms, provide guidance on acute treatments and detect medication overuse headaches. General practitioners are often responsible for initial diagnosis, prescribing preventive therapies, monitoring progress and coordinating referrals to specialist services when required.

By recognising migraine as a complex neurological condition rather than simply a recurrent headache, primary care professionals can play an essential role in improving patient outcomes.

The role of Specialist Neurology Services
While many migraine cases can be managed effectively in primary care, access to specialist neurology services remains vital for individuals with complex, chronic, or treatment-resistant migraine.

Neurologists provide diagnostic confirmation, rule out other neurological conditions, and oversee advanced treatment options. They are particularly important when patients present with unusual neurological symptoms such as temporary paralysis, severe aura, or significant functional impairment.

Specialist headache services can also offer access to newer treatment options, including targeted preventive therapies when standard treatments have failed.

Neurology nurses are increasingly recognised as valuable members of the migraine care team. They often provide ongoing patient education, treatment monitoring, support with medication management, and assistance in helping patients navigate complex treatment plans. Their role can improve continuity of care and enhance patient engagement in self-management strategies.

The contribution of allied health professionals
The diversity of migraine symptoms means that many patients benefit from the expertise of allied health professionals as part of their treatment plan.

Physiotherapy
Neck pain and musculoskeletal dysfunction are common among people living with migraine. Physiotherapists can assess posture, movement patterns, muscular tension, and physical triggers that may contribute to symptom severity.

Physiotherapy interventions may help individuals improve mobility, reduce musculoskeletal pain, and develop strategies to manage physical symptoms associated with migraine.

For patients experiencing dizziness or balance disturbances, vestibular rehabilitation may also be beneficial.

Occupational Therapy
Migraine can profoundly affect a person’s ability to work, study, care for family members, and participate in daily activities.

Occupational therapists help individuals manage these functional challenges by identifying practical adaptations and strategies that support participation in everyday life.

This may include workplace modifications, energy conservation techniques, pacing strategies, sensory management approaches, and assistance with returning to work following periods of significant disability.

Occupational therapists can play a particularly important role for individuals living with chronic migraine, where symptoms may fluctuate unpredictably and impact productivity and independence.

Psychological Support
The relationship between migraine and mental health is well-established. Anxiety and depression frequently co-exist with migraine, while the unpredictability and disabling nature of attacks can contribute to emotional distress, social isolation and a reduced quality-of-life.

Psychologists and mental health professionals can support patients in developing coping strategies, addressing stress, managing anxiety related to attacks and improving resilience.

Psychological interventions do not imply that migraine is ‘all in the mind’, rather, they acknowledge the significant emotional burden associated with living with a chronic neurological condition.

Integrating mental health support into migraine care recognises the interconnected nature of physical and psychological wellbeing.

A whole-person approach to care
The value of a multidisciplinary team lies in its ability to deliver person-centred, holistic care. Rather than focusing solely on headache frequency, an MDT considers the full impact of migraine on an individual’s life.

This approach allows healthcare professionals to address multiple dimensions of health simultaneously, including:

Symptom management
Medication optimisation
Physical function
Mental health
Sleep quality
Workplace participation
Social engagement
Overall quality of life

By bringing together professionals with different expertise, patients receive coordinated care that reflects the complexity of their condition.

This philosophy is reflected in Ireland’s National Clinical Programme for Neurology.

When the Headache Pathway was introduced in 2016, it highlighted the importance of multidisciplinary care for people presenting with headache disorders.

The guidelines recognised that migraine management extends beyond medication alone and benefits from coordinated input across a range of healthcare disciplines.

Looking forward
Migraine is one of the most common and disabling neurological conditions worldwide, yet misconceptions continue to undermine effective care.

Understanding migraine as a complex brain disorder that affects multiple body systems is essential if we are to improve outcomes for those living with the condition.

The wide range of symptoms experienced by people with migraine makes it clear that no single healthcare professional can meet all of their needs. Pharmacists, GPs, neurologists, neurology nurses, physiotherapists, occupational therapists, psychologists, and other allied health professionals each have an important role to play.

A multidisciplinary approach provides more comprehensive assessment, coordinated treatment, and person-centred care.

Most importantly, it acknowledges the reality of living with migraine and recognises that managing the condition requires addressing the whole person, not just the headache.

As healthcare systems continue to evolve, expanding access to multidisciplinary migraine services should be a priority.

For the millions of people whose lives are affected by migraine every day, such an approach has the potential to reduce disability, improve quality of life, and ensure that migraine is finally treated with the seriousness it deserves.

Author
Deirdre Ní Mhórdha is the patient support officer for the Migraine Association of Ireland and lives with episodic migraine. She produces patient and healthcare professional education events and leaflets, including the recently published ‘GP Guide to Migraine Management’ which can be ordered by emailing info@migraine.ie.

This article has been checked for medical accuracy by Dr Alina Buture, consultant neurologist in the Mater Hospital, Dublin.

Information
Migraine Awareness Week recently took place from September 7 to 13, with European Migraine Day of Action on Saturday September 12.

With a theme of ‘The Many Non-Headache Symptoms of Migraine,’ the week highlighted the fact that although headache is the most recognised symptom of migraine, there are several others that can be equally or more debilitating.

The Migraine Association of Ireland will continue sharing this message throughout September via social media, videos on its YouTube channel, and an information event.

For more information see: www.migraine.ie