What Are Symptoms of a Migraine Headache?

The pain of a migraine can be unilateral or bilateral, and is most often pulsating, pounding, or throbbing in quality. Fifty per cent of migraine sufferers report the onset of migraine pain in the occipital region (back of the head), or even neck pain. 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 have moderate to severe pain intensity.

How long do migraines last?

The vast majority of migraines last between 4 hours and 72 hours. Rarely, a migraine attack will last longer than three days. This can be an indicator of a more serious problem, and should lead you to seek medical attention. 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.

What are other symptoms of a migraine attack?

There is usually associated avoidance of light (photophobia), sound, or even smell. 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. Recent information regarding migraine sufferers indicate that neck pain is present in many migraine attacks, and may be even more common than nausea.

The Warning Phase: Migraine aura and prodrome

About 20% of migraine sufferers report a prodrome, or warning phase, 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.

Other Phases of Migraine

The prodrome phase and the aura phase of migraine are the first two of four possible phases of migraine. In some migraines, the prodrome phase may be brief or subtle, and not everyone realizes they are experiencing a prodrome. Symptoms you’ve always just thought were “part of the migraine” may be prodromal symptoms. The headache phase of the migraine is the obvious phase in which the headache pain and associated symptoms develop. This typically lasts from 4 to 72 hours. Finally, there is the postdrome phase. In the postdrome, you may feel drained, empty, or tired. Some people refer to this as a “migraine hangover.”

Migraine Treatment

You should treat your migraine headache as soon as you begin to feel headache pain. While early treatment of acute migraine attacks is important, trying to treat in the prodrome phase is too early, and there is not yet sufficient study data to recommend treating during the aura phase, although it may help in some people. Treatment of migraine can be abortive, which means taking medication intended to stop the migraine attack, or preventive, in which medication intended to prevent migraine attacks is taken on a daily basis. If abortive treatment has not worked, or not worked well enough, rescue medication can also be used later in the attack.

Learn more about treatment here.