Migraine is a complex neurological condition that extends far beyond a typical headache. It involves episodes of moderate to severe head pain, often with other symptoms that significantly impact daily life. Recognizing these distinct characteristics is crucial for identifying and managing a migraine attack.
Recognizing Core Migraine Symptoms
A migraine attack typically involves throbbing or pulsating head pain, ranging from moderate to severe. This pain often starts as a dull ache and intensifies, making routine activities difficult. While commonly felt on one side, the pain can affect both sides or shift. Physical activity frequently aggravates this head pain, making simple movements more difficult.
Beyond head pain, migraines are commonly accompanied by heightened sensitivities and other disruptive symptoms. Over 85% of individuals experience extreme sensitivity to light (photophobia) and sound (phonophobia) during an attack. Normal light and sound levels can feel uncomfortable, prompting many to seek dark, quiet environments. Some also report increased sensitivity to smells.
Nausea is a common symptom, affecting nearly 90% of migraine sufferers. About one-third also experience vomiting. These gastrointestinal disturbances, combined with head pain and sensory sensitivities, contribute to the debilitating nature of a migraine attack.
Understanding Migraine Phases
A migraine attack often progresses through distinct stages, beginning hours or days before the main headache. The initial stage, known as the prodrome, involves subtle changes signaling an impending migraine. Pre-headache symptoms might include mood shifts such as irritability or depression, unusual fatigue, neck stiffness, food cravings, or increased yawning. Recognizing these early indicators can allow for timely intervention.
Following the prodrome, some individuals experience an aura, temporary neurological symptoms. Aura commonly manifests as visual disturbances like flashing lights, zigzag lines, or blind spots. Other forms can involve sensory changes such as tingling or numbness, or even speech difficulties. Not everyone with migraines experiences aura; only about 15-30% report them.
The attack phase is when the headache typically occurs, accompanied by nausea, vomiting, and heightened sensitivities to light and sound, known as photophobia and phonophobia. This phase can last from four to 72 hours if untreated. After the main headache subsides, many enter the postdrome phase, often called a “migraine hangover.” During this time, individuals may feel drained, fatigued, confused, or have residual head pain.
Distinguishing Migraine from Other Headaches
Migraines are often confused with other headaches, but have unique characteristics. Tension headaches, for example, are typically mild to moderate, feeling like a dull ache or pressure band around the head. Unlike migraines, they usually lack nausea, vomiting, or increased sensitivity to light or sound, and generally do not worsen with physical activity.
Cluster headaches involve severe, sharp, or stabbing pain, usually concentrated around one eye or temple. They often include distinct autonomic symptoms on the affected side, such as eye tearing, nasal congestion, or eyelid drooping. Cluster headaches occur in patterns or “clusters,” distinguishing them from episodic migraines. They are also shorter, typically lasting 15 minutes to three hours.
Sinus headaches typically cause pain and pressure in the face, forehead, and around the eyes, often with nasal congestion and facial tenderness. They are generally associated with sinus infections, which may include fever and discolored nasal discharge. While some migraine symptoms can overlap, the characteristic throbbing pain and specific sensitivities of migraines are usually absent in true sinus headaches. Migraine-related nasal discharge is typically clear.
Knowing When to Consult a Doctor
Consulting a doctor is important for proper diagnosis and management of headaches, especially if severe or unusual. Seek medical attention for a first-time severe headache or a sudden, explosive “thunderclap” headache that reaches maximum intensity within 60 seconds. These may indicate a more serious underlying condition.
Medical attention is also warranted if a headache accompanies concerning symptoms like fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, or speech difficulty. Headaches developing after a head injury, worsening over time, or unresponsive to typical pain relief also require professional evaluation. If headache patterns change, new symptoms emerge, or headaches frequently disrupt daily life, a doctor can help establish an accurate diagnosis and effective treatment plan.