Pain management

A migraine is a headache that can cause severe throbbing pain, usually on one side of the head. Many people also experience nausea, vomiting and extreme sensitivity to light and sound. Migraine attacks can last from hours to days and the pain can interfere with daily activities.

For some people, a warning sign, known as an aura, happens before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face, an arm or a leg and difficulty speaking.

Though migraines aren’t fully understood, experts think migraines are the result of abnormal brain activity affecting nerve signals, chemicals and blood vessels in the brain. It’s not known what causes this brain activity, but for many people there is a link to their genes. Migraines can be triggered by a stressful event, skipping meals, low blood sugar, alcohol intake, hormonal changes (such as periods or menopause), lack of sleep and the environment (lighting, temperature).

Many people who have migraines find that over-the-counter pain relief, such as paracetamol, aspirin, ibuprofen or sumatriptan, can help ease their pain symptoms.

If an over-the-counter pain relief medicine is not helping to relieve your migraine symptoms, your GP may recommend taking a type of medicine called a triptan and possibly anti-sickness medicine. Triptan medicines, including Sumatriptan, are a specific medicine for migraine symptoms. They're thought to work by reversing the changes in the brain that may cause migraine. You can also access prescription-only migraine treatments without the need to see your GP from Boots Online Doctor Migraine Treatment Service**. Anti-sickness medicines, known as anti-emetics, can successfully treat migraines in some people, even if you do not experience feeling or being sick. These are prescribed by a GP and can often be taken alongside pain relief medication and triptans.

If these medicines are unsuitable, or do not help with your migraine symptoms, you may want to consider acupuncture. Most GP surgeries do not offer this, so you may have to pay for it privately. If these other treatments are not effectively controlling your migraines, you may want to refer to a specialist pain clinic such as Leva*, which is available online via Boots Health Hub, for further investigation and treatment.

If you have frequent or severe migraine symptoms, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. Keeping a diary is useful and can help to identify the type of headache you’re having. It’s important to get a diagnosis so you can get the right treatment and, if appropriate, make lifestyle changes.

Sometimes, migraines may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible. You should call 999 immediately if you experience:

• Paralysis or weakness in one or both arms, or one side of the face.
• Slurred speech.
• A sudden, agonising headache, unlike anything experienced before.
• A headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash.

Many people get period pain during their menstrual cycle, the medical term for this pain is called dysmenorrhea. It's usually felt as painful muscle cramps in the stomach, which can spread to the back and thighs. It can be anything from dull achy cramps to intense spasms. Each period can vary, with some periods being more painful than others. Some women also get pelvic pain even when they do not have their period. 

Period pain happens because chemicals called prostaglandins trigger muscle contractions in the uterus. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.

During a period, the wall of the womb starts to contract more vigorously to help the womb lining shed as part of her period.

It's not known why some women have more period pain than others. It may be that some women have a build-up of prostaglandins, which means they experience stronger contractions.Painful menstrual periods can also be the result of an underlying medical condition, such as:

- Endometriosis - This is a painful medical condition in which cells similar to ones that line the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis.

- Fibroids - Fibroids are noncancerous growths that can put pressure on the uterus and can make periods heavy and painful.

- Pelvic inflammatory disease (PID) - PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that cause inflammation and pain.

- Adenomyosis - This is a rare condition in which the tissue that lines the womb grows into the muscular womb wall, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.

A type of contraception, called an intrauterine device (IUD) made from copper and plastic that fits inside the womb can also cause period pain. This most commonly happens during the first few months after it's inserted.

See a GP if you have severe period pain or your normal pattern of periods changes; for example, if your periods become heavier than usual or irregular. There is a range of over-the-counter pain relief products available to treat period pain, speak to your pharmacist if you need advice.

Sports injuries can be caused by accident, not warming up before exercising or even using equipment inappropriately and applying poor technique to your workout. Some sports injuries can also be linked to pushing yourself too hard. Exercise and sports injuries can affect any part of your body including bones, muscles joints and connective tissues, with ankles and knees being the areas most prone to injury.

When you injure yourself, you may experience pain, tenderness, swelling, bruising, and will also notice that the affected areas become stiff, and you are restricted with movement. These symptoms aren’t always noticeable as soon as you injure yourself, as sometimes they may take several hours to be felt after exercising.

If you feel pain whilst exercising, you should stop exercising immediately, whether it's a sudden injury or if it's pain that you have experienced before. If it's a sprain or strain, you should rest the affected part of the body for the first 48 to 72 hours to prevent further damage. An ice pack applied to the affected area regularly can help to reduce any swelling.

If your symptoms are not improving, you should speak to your GP who may be able to refer you to specialist pain treatment or support such as physiotherapy. If your symptoms are severe, you should phone NHS 111 or go to A&E. You can get help from NHS 111 online or call 111. It's available 24 hours a day, seven days a week. Online physiotherapy via PhysioFast Online* is available via Boots Health Hub.

There can be several causes of joint pain. Damage to the joints from injury or disease impacts the way in which we move and, depending on the cause, may cause significant pain. Joint pain is very common, particularly as we age and although it can occur in any joint, common joints affected are knees, hips, shoulders and hands. There are a number of medical conditions that can lead to joint pain including:

Osteoarthritis - the most common form of arthritis, which is caused when the protective cartilage on the ends of your bones breaks down. You may experience pain and stiffness in your joints, loss of flexibility and swelling around the joints. Osteoarthritis usually affects the knees, hips and small joints of the hands. Treatment can help manage the symptoms of osteoarthritis.

Rheumatoid arthritis - an autoimmune disease that causes pain, swelling and stiffness in the joints. It is caused when the immune system, which usually fights infection, mistakenly attacks the cells that line the joints. Unlike the gradual wear down caused by osteoarthritis, rheumatoid arthritis affects the cells that line the joints, causing pain, stiffness and swollen joints which, over time, may lead to joint, cartilage and bone damage. Symptoms can include pain in one or more joints, often on both sides of the body, sometimes accompanied by fatigue or a low-grade fever.

Bursitis - a painful condition that affects the small, fluid-filled sacs that cushion the bones, muscles and tendons. When these sacs become inflamed, it is called bursitis.

Gout - a type of arthritis that often causes sudden severe pain in a joint, typically the big toe but may affect other joints too. Gout can affect anyone but is more likely to affect men. It is caused by the build-up of uric acid in the blood, which can cause sharp crystals to form around your joints. Risk factors for gout include obesity, diabetes, untreated hypertension and kidney disease.

In addition, viral infections, tendonitis and sports injuries can cause joint pain. If you have new or unexplained pain in your joints, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It is important to find out what is causing joint pain to understand the treatment options available and whether lifestyle changes are recommended.

To find out more about arthritis click here

Pain that affects the muscles, ligaments, tendons, nerves and bones is known as musculoskeletal (MSK) pain. Muscle tissue can become damaged with the wear and tear of daily activities. Trauma to an area, such as from an accident, fall or fracture, can cause musculoskeletal pain. Other causes of pain including consistently poor posture, repetitive movements and overuse injuries. Changes in posture may result in spinal alignment problems and muscle shortening, which can cause other muscles to be misused and become painful.

People with musculoskeletal pain sometimes complain that their entire bodies ache. Their muscles may feel like they have been pulled or overworked. Sometimes, the muscles twitch or burn. Symptoms vary from person to person, but the common symptoms are pain, fatigue and sleep disturbances. People with persistent pain often report a negative effect on their mental health, with feelings of anxiety and depression being common. This is because of the way the nervous system responds to pain.

The most common types of musculoskeletal pain include:

• Bone pain - injuries, such as bone fractures, cause bone pain. Rarely, a tumour may cause bone pain.
• Joint pain - stiffness and inflammation often accompany joint pain. For many people, joint pain gets better with rest and worsens with activity.
• Muscle pain - muscle spasms, cramps and injuries can all cause muscle pain. Some infections or tumours may also lead to muscle pain.
• Tendon and ligament pain - sprains, strains and overuse injuries can lead to tendon or ligament pain.

Maintaining strong bones and joints is important for preventing musculoskeletal pain. You can work to avoid musculoskeletal pain if you:

• Limit repetitive movements.
• Use good posture.
• Practise correct lifting techniques.
• Stretch regularly.

If pain interferes with your daily activities, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It’s important to get a diagnosis so you can get the right treatments and make any required lifestyle changes.

Nerve pain, or neuropathic pain, happens when there is a problem with the nerves themselves. This means that the normal process of detecting and sending messages about pain, as well as other types of sensation, is disrupted. As a result, you might feel pain even when there’s been no new injury to the body. Nerve pain is often described as a shooting or burning pain. It can go away on its own, but is often chronic. Sometimes it is constant and severe, sometimes it comes and goes.

Common causes of neuropathic pain include:

• Nerve pressure or damage after surgery or trauma.
• Certain infections, such as shingles, Lyme disease, diptheria, botulism and HIV.
• Certain types of cancer.
• Vascular malformations.
• Alcoholism.
• Neurological conditions, such as multiple sclerosis (MS).
• Metabolic conditions, such as diabetes.
• Side effect of certain medications.

If you have symptoms of nerve pain, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It’s important to get a diagnosis so you can get the right treatments and make any required lifestyle changes.