Migraine pain can be unilateral or bilateral, and is most often pulsating or throbbing in quality. Fifty per cent of migraine sufferers report the onset of migraine pain in the occipital region (back of the head), and up to 80% of migraineurs may experience posterior pain (back of the head, or even neck pain) before or during an attack.  Regardless of where pain begins, it often settles into a one-sided headache. Often, migraine pain is made worse by routine physical activity, such as climbing stairs. The vast majority of migraine attacks are of moderate to severe pain intensity.

If not treated early, up to 80% of migraine sufferers can develop a highly sensitized pain called allodynia, in which a usually normal level of touch is perceived as painful.  While this usually affects the face and head, it can on occasion spread to the upper torso and extremities as well, and migraine sufferers will find it uncomfortable to put up with usual things, like jewelry, eyeglasses, neckties, clothing, hats and similar things.

There is usually associated avoidance of light, sound, or even smell. The technical terms for these are photophobia, phonophobia, and osmophobia. There is often nausea or loss of appetite. Many migraine sufferers have difficulty thinking or concentrating during an attack. Some experience dizziness, lightheadedness or vertigo.

The Warning Phase: Migraine aura and prodrome

About 20% of migraine sufferers report a prodrome preceding their headaches, consisting of vague symptoms like mood changes, yawning, food cravings, thirst, or excessive urination.  This can be brief, lasting a few minutes, or can be prolonged, lasting hours, a day, or longer.

Fifteen to twenty per cent of migraine sufferers sometimes or always have an aura preceding their headaches. Auras are neurologic symptoms, most often affecting vision with spots, colors, sparkles, or vision loss. An aura can also cause stroke-like symptoms like tingling, numbness, or weakness in the face, an arm, or sometimes an entire side.  Most migraine auras last 15-30 minutes; some will last up to an hour.  If an aura lasts longer than an hour, and this is not your characteristic aura pattern, it would be prudent to seek medical evaluation.

It is also possible to experience the aura phase of the migraine without any headache pain. When this happens, it is still considered a migraine, and is sometimes called acephalgic migraine, which just means migraine without pain.