What is Migraine? (the Story of Symptoms)

If a migraine is different from a typical headache, how is it different?  Is it just more painful?  Or is there more to it?

Recently we looked a migraine from the scientific standpoint – what exactly is going on in the body during an attack?  Where does migraine disease actually come from?  You can read that here – What is Migraine? (the scientific story)

But we also need to know what the outward signs of migraine are.  What is it that a migraineur actually has to deal with during an attack?

Before we start

This post is not a diagnostic tool.  Many symptoms of migraine are also symptoms of other diseases.  It’s important to see a qualified specialist who can help you rule out other causes.  Also, this is not intended to be an exhaustive list of exactly what every migraineur goes through – only an explanation of some of the more common symptoms.

Also, and this is especially the case once we start talking about less common symptoms, many symptoms are associated with a specific type of migraine.  We’re not going to talk about all the specific types, but just give you an idea of the big picture.

One more thing about migraine symptoms.  We’re still not sure how much permanent damage migraine attacks do to the body.  However, usually the symptoms are temporary.  If a symptom continues all the time, it’s a sign that there is something else going on, and you need to discuss it with your doctor.

The most Common Migraine Symptoms

Woman with headache
© Ioana Grecu | Dreamstime.com

Headache is a common symptom of migraine.  But it is neither the only symptom nor a necessary symptom.  Many people have migraine attacks and no headache at all (including me).

What is the headache like?  It’s usually (not always) one-sided, it feels worse with routine physical activity, and it’s usually pulsating or throbbing.  The pain is usually between moderate and severe.  The pain can leave a person writhing on the floor, and can drive people to suicide.  Women who know have compared migraine attacks to childbirth, and say that the migraine pain is much worse.

It’s a common misconception that migraine headache pain is always severe ("If you really had a migraine, you wouldn’t be standing there talking to me!").  Actually, the headache pain can be anywhere from slight to severe.  The headache pain also is only one phase of the attack – for most of the attack there may be no headache at all.  (This causes a whole new set of problems – people may go to work with an attack, for example, but may be very much less productive)

Nausea and vomiting, sometimes vomiting over and over (cyclical), are very common symptoms of a migraine attack.  This is why migraine used to be called sick headache.

Photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound).  In a dark room, a slight bit of light under the crack of the door can be agonizing.

Phases of the attack

An attack may actually last several days, even though the headache phase (if there is one) is only a few hours.  First come the premonitory symptoms (formerly called the prodrome), which may come a day or more before the main part of the attack.  Then the aura, which usually happens minutes or hours before.  Then the main phase (pain phase), and the postdrome (migraine hangover), which may last a day or even a few days.

Generally the common symptoms above are a part of the main or pain phase.  Some of the symptoms we’ll talk about now are a part of one or more of the other phases.

Common Premonitory Symptoms

Some of the symptoms that may begin a day or more before the main or pain phase: unusual fatigue, stiff neck, blurred vision, excessive yawning, pale skin (pallor), trouble concentrating and difficulty using language (dyphasic symptoms).  Language difficulties may include trouble thinking of the right word.  (Language difficulties may also be a side effect of medications such as Topamax).

Other Common Symptoms

When people think of migraine aura, they most commonly think of visual disturbances.  This might include seeing zigzags, flickering lights, or other patterns.  There could be blurred vision, even vision loss (blindness).

Pins and needles, tingling and numbness are also very common.  These are often one-sided.

Congestion, runny nose and watery and/or bloodshot eyes are common symptoms, leading many people to be misdiagnosed with sinus headache.

More common symptoms include:  Swelling of fingers, feet and/or face, sensitivity to odors (osmophobia), foggy/fuzzy-headedness, body heaviness, lethargy, depression or sadness (particularly in the postdrome phase), constipation or diarrhoea, food cravings and increased appetite, decreased appetite, fever or a feverish feeling, abdominal pain, dehydration or fluid retention, and allodynia.

Allodynia is a common symptom where the person has tender spots or sensitive skin.  This could actually mean pain.  Some people cannot even comb their hair because of the scalp pain.  Wearing a shirt may be unbearable because the brushing of the shirt against the skin is so painful.

Also common at various stages of the attack may be mood changes, euphoria and extra energy, extra creativity, and of course decreased energy.

Less Common Symptoms

Other symptoms of a migraine attack include:  Motor weakness, loss of coordination (ataxia), seizures, olfactory hallucinations (smelling things that aren’t there), decrease in or loss of consciousness, vertigo and dizziness, Alice in Wonderland Syndrome (changes in perception, such as altered perception of body image – a feeling things are the wrong size), ringing in the ears (tinnitus) or diminished hearing, ear fullness (with popping or clicking), hot flashes and chills, increased urination, chest pressure, and slurred speech.

What is Migraine?  The story of Symptoms

Summary: What is Migraine?

There’s a reason why migraine is now #19 on the World Health Organization’s list of top disabilities.  From the standpoint of the symptoms, migraine is a very disabling disease, and much more than a headache.

Typically, a migraine attack is a chain of events lasting several days.  Any phase of migraine can be disabling.  It could completely disable someone, leaving them unable to do anything.  Or, it could decrease their ability to do common daily tasks, or their job.

Migraine attacks often start with fatigue, food cravings, trouble thinking, speaking and concentrating, stiffness and mood changes.  This may be followed by an aura with visual or other sensory disturbances, including partial blindness.  This is a common phase, though in reality most migraine attacks are not preceded by visual aura.  Usually this is followed by moderate to severe pain in the head and/or other parts of the body, nausea and possibly vomiting, a feverish feeling and sensitivity to light and sound.

The last phase can be the most frustrating of all.  The "migraine hangover" may leave you with less pain, but an inability to think clearly, general heaviness, mood changes and depression.  When you’re supposed to be "over it" and "back to work", you find yourself as disabled as ever.

No, migraine is not just a bad headache.  As we’ve seen, even without considering the head pain, even with a handful of the above symptoms, migraine can be incredibly disabling.

And that’s what migraine is.  And that’s another reason why we’re fighting it.

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25 comments… add one
  • Lisa Vancelette Nov 29, 2008

    James,

    You write that a migraine headache is: “usually pulsating or throbbing.” It saddens me that migraine headaches are often described in this way. My migraines are never pulsating or throbbing, and yet I am very confident that they are migraines because they are one-sided, do respond to triptans, create phonophobia and photophobia, nausea, etc.

    I understand that most people experience throbbing, and that you did use the disclaimer: “usually.” I just wish there was more awareness out there that migraines don’t have to be throbbing. I believe this misunderstanding that people/doctors have was part of the reason that I went ten years with “headaches” before being diagnosed correctly with migraines. I hope my comment can help others get diagnosed correctly.

  • James Nov 30, 2008

    Hi Lisa,

    You’re right – of course. As you noted, I did say “usually”. The problem is, we’re always talking in terms of generalities when we’re talking about migraine.

    If we were talking about a deep cut in your foot, we would have to say “it (almost) always bleeds”. With a neurological disease, things are a lot more complex.

    We can certainly go through ALL the symptoms and emphasize – everyone is different, and this could very well be different with you! That’s why a specialist needs to understand your medical history and look at all your symptoms, ruling out other causes, before she can give you a correct diagnosis.

    Thanks for the reminder, Lisa! I hope you’re getting good treatment now that you have a diagnosis.

  • Kelly, Flywithhope Dec 2, 2008

    James,

    Well done again.

    I think any time we try to summarize this disease, it is going to be a difficult undertaking. Migraine is so different in each person, which is why treatment is not clear cut. I truly appreciate your successful attempt at summarizing Migraine. It is a hard task to do and you did a great job.

  • Carol Dec 8, 2008

    Thank you!
    I try to explain Migraine as not just a ‘head’ problem, but a ‘whole body’ problem. It seems the only way non-migraineurs can understand it is for them to get a migraine.

  • James Dec 8, 2008

    Thanks Carol and Kelly! Yes, sometimes I explain migraine pain and then end up by saying “Sometimes there’s head pain too”. No doubt, often the headache is the worst symptom – but even without a headache, a migraine can be nasty. Take it from one who knows…

  • Catherine Dec 30, 2008

    Thank you for confirming the whole body symptoms. Nice to know it is not just me and that it is just part of the migraine. Until triptans were invented, I did not realize that the back pain I had before and during the head pain was also migraine. Had assumed they were caused by muscle tension. When the triptans removed the back pain at the same time as the head pain, I had an eureka moment.

  • James Dec 31, 2008

    Thanks, Catherine. There’s no doubt it takes time to connect the symptoms with migraine. I get pain in one eye quite often, and it took me months, maybe years, to notice that it was connected to my migraine attacks.

    One reason it’s tricky is because the symptoms don’t necessarily come right at the height of the attack – they may come hours before, or even days after!

  • Aurora Sep 16, 2009

    I finally found my migraine soulmate in you, James.

  • Beth Oct 1, 2009

    I was just re-reading this and I have to say that as many people that read these articles and get SO much help from them, I guarantee that you only hear from a small fraction of them.

    I haven’t told you lately how much I appreciate everything that you do – all the research and work you put into this website for all of us!!

    Thank you, James! God bless you and your family!

  • Melanie Oct 7, 2009

    Hi…well I am in Atlantic Canada. I only started getting migraines this summer. They have sent me to the ER at least 6 times in the past 3 months. I am just learning on how to deal with them. Today we are expecting heavy rain, rain warning. I woke up with migraine and started on my meds right away. Right now I know I am on my way. Scared because I am hoping it isn’t going to go full blown. But I am so sure it will. I am trying to soak in all the information I can. I am on my last two pills of presecription. I know I am going to have to go to the after hours clinic tonight. I have missed so much work over the last few months that I am scared. I am trying to get them under control. Any help would be greatly appreciated, with a young family and trying to make ends meet…this is getting really hard to deal with! Thanks.

  • anne Dec 8, 2009

    Hi, at the moment i am on holiday and feeling very down, have just had my 3rd migraine in 3 weeks and i get most of the effects with it but the hangover after is really awful lasts for nearly a week and have tried every thing. Can you advise anything?

    Anne

  • Lamia May 29, 2011

    Nearly cried when I read this; growing up “migraines” were something posh women with pearl strings suffered from on sweaty afternoons; my headaches were regarded as common old sinus ones. Maybe they were/still are. But as I’ve gotten older and the headaches have become worse, I’ve had more opportunity to recognise the warning signs – and the symptoms just don’t seem to add up to a sinus headache anymore. (I’ve tried talking the doctor about it; I always get the impression he thinks I’m exaggerating or making it all up.)

    Excessive yawning is usually my first sign; often but not always the yawning is accompanied with unbelievable fatigue. I’d underline that if I could. Unbelievable. Often from nowhere. Suddenly I’m yawning, and that’s it – away we go – headache on its way. Often the nausea kicks in soon after, although sometimes the nausea’s the first thing; I’ll wake up feeling sick and I’ll know from that point on my day is going to be a challenge. I seldom get blurred vision, but my speech can get slurred and I’ll have trouble thinking. During the headache phase – if I’m “lucky” – there’s very little pain, just a sense of my brain feeling hollow in places; if I’m “unlucky”, there’s a slight throbbing that can be control by staying very, very still; and when it’s really bad, drugs, a darkened room, and staying very, very, very still until i can sleep are my only saviors. (I’ve never been prescribed migraine-specific pain relief – I rely on over-the-counter stuff; as I’ve aged, it seems to have lost its efficacy – leading one friend to suggest my problem was not headaches but pain relief addiction.) I consider myself lucky. I get these headaches on an almost weekly basis but they are seldom bad enough to keep me from work. The “hangover” is what I hate worst; I literally feel stupid.

    After reading this, I’m more convinced than ever that it’s migraines I suffer from – not sinus headaches. I know the dangers of self-diagnosis – but I also know that I catalogued my symptoms before I even suspected my headaches were migraines. I think it’s time the doctor and I had a little chat.

  • Dan Dec 21, 2011

    My Migranie pain is between 5/7 on a scale of 1/10.
    My wife and I can’t go anywhere were there might be loud music or conversation I just get hit with pain and the trouble starts. We went to a banquet and when they started plaing the music I started to feel funny and when they up the bass, that was it, I was in full migrane. I couldn’t walk to the cab, the movement of the car made me sick but the cold air felt good. i was told that I stop the cab and dove out of it and tried to but my head into the ground, my friends thought of takeing me to the hospital. The piercing, stabbing, pounding pain made me jam my head into the frezzer when I got home. I suffer from Post Concussion since April of 2010 and have had around 10 -15 concussions in my life ( I just turned 50). My last concussion was June 2010 playing baseball. I am being look after at St Michaels hospital by Dr Oucterlonie. My question is am I ever going to be able to go to parties were there might be loud music playing and conversation/ Is this my life from here on? I have gone down from 5 headaches a week to 1 or 2 every two weeks. The pain stays pretty much the same 5/7.
    Thank you for reading this rather long story.

    Dan

  • Debbie Jul 23, 2012

    I am so happy I have discovered your blog. My husband has suffered from severe chronic migraine for 22 years +. We have an excellent doctor but most people who are close to us do not understand migraine! They cannot understand how he can be so disabled from “just a headache”! I no longer feel so alone in our struggle and through your articles I am able to help those around us to better understand what he deals with daily. On a good day his pain level is 7/10.

  • peter rasmussen Oct 19, 2012

    my headaches last four about four days. cant touch my hair. been taking imatracks for almost 30 years. now they taking that away, because im got direaia with blood in it plus alot of other thing it causes. what am i to do now. im a veit namn vet. have agent orange. im 62 male. had headaches almost all my life.

  • Marion Feb 10, 2013

    Thanks to Botox my migraines are pretty much “under control” and not as severe as they used to be. They started when I was 19 and I’ve had them at least 2 or 3 times a month for the last 30 years. Almost all the symptoms described above were the ones I had, except for the stabbing pain. My pain was ALWAYS in the left temporal region including the left eye and it was always a severe BURNING DULL PAIN, not stabbing, and it lasted for up to 2 days occasionally even 3.—- Suicidal?? Yes I was. Nothing ever helped and I tried everything. Seen many doctors, was checked multiple times to find a possible cause but to this day havnt been able to figure it out. Like I said, the Botox has been a lifesaver to me. Finally about 5 years ago I met a German doctor who suggested I get Botox injections into my trigger area. Just a couple of units every 3 months and I’m feeling so much better. It does not always take the pain away completely but it’s nothing compared to what I went through before. I can function, go to work and the pain doesn’t last as long.

  • Bonnie Mar 25, 2013

    The bridge of my nose gets very heavy like I have heavy glasses sitting on it. So I know it’s coming.

  • Mandy Woods Sep 27, 2013

    I too have migraines. I never thought most of those symptoms were linked to migraines. My doctor did tell me that some of them were due to migraine. But wow the ones I saw listed that I have; I never knew they were linked! I have been told they don’t know the cause. Usually. Could be hereditary, could be hormonal, could be…? I also have SVT. So when I do have throbbing pain, it’s at 160-180 bpm.

  • Shelia Nov 12, 2013

    Wow! I am just on the upswing of a migraine right now. Many of these things I have never connected to my actual pain until reading this. As a matter of fact, just today in the midst of the excruciating, pulsing and throbbing pain (as mine almost always are) I said to my son that I smelled something fruity and there wasn’t anything here that would smell like that. It wasn’t until I read about the olfactory hallucinations that I was like “ah ha!!” I have suffered migraines since childhood and they have yet to get better. I’ll tell ya, I’ve missed out on a lot over the years because of this. I was in tears this afternoon. I had taken the maximum dose excedrine migraine and it didn’t help. I don’t have medical insurance at this time but I was to the point I thought I needed to go to the ER but wanted to avoid that. I called our local urgent care center to ask if they treat migraines. I felt like she thought I was just looking for drugs because the first thing she said to me is that they don’t have narcotics here and “I could give you an RX for ibuprofen”. So needless to say I decided not to seek treatment. However after reading this, I am going to have a conversation with my doctor about my symptoms. Thank you!

  • Karen Jan 30, 2015

    Wow! I just read this, and I didn’t know I actually had migraines until Monday. I don’t get the normal ones. I don’t classic migraine, or common. I have abdominal migraines. I was recently diagnosed with asthma, and had allergy testing done. Food makes me sick. Food makes me really sick, so they tested me for food allergies. I only have three true allergies, to apples, pears, and scallops. But, I have dealt with chronic diarrhea, stomach cramps so bad some people have thought I had appendicitis. It sometimes comes with a headache as well, though most of the intense pain is in my abdomen. I feel nauseous. I had no clue though, that the other symptoms I had were from the migraines. The allergist I am seeing told me we ruled out allergies, and it seems to him that my problems are migraine. I was floored. He said you can get them in your colon. I may not get the throbbing headache other people get, but the stomach pain is sometimes a 10. It seems it’s triggered by foods, the weather, and my periods, since I’m a girl. I also have cognitive problems before the pain starts. I’ll say the wrong word, when I meant to say a different word. I’ll get kinda clumsy and have motor problems. I’m a waitress, and I’ll drop cups, or spill things trying to clear tables. I get the skin sensitivity, too, where your skin is really tender even to light touch. And yes, sound and light do bother me. And I feel major major fatigue. I had no clue that my lifelong stomach pain and other issues were from migraines!

  • Rebecca Turner Apr 6, 2015

    I had migraines until I was 12 years old, when I started menstruating. I am 35 now and have never had another one. I had absolute pre-symptoms: 1. I would always first have a tiny “blindspot” in the middle of my view point. i.e. if I was looking at a word I could see the word as a whole but I could not see all of the letters in succession. I would immediately become terrified because I knew that with NO exceptions I would get the headache within 1.5 hours max. After the visual phenomenon (always identical always recognizable though an extremely minor change in viewing) next one of my arms would go numb. (I think usually only one, possible either I can’t remember.) Nausea was during the headache I remember, not sure if it was pre because I would be so afraid and panicky that nausea was secondary to frantically trying to prepare for torture. I would take painkillers, the best treatment being anesthetized to get through the pain while “asleep”. When my vomiting began the worst of it would be over.
    I have since been diagnosed with ADD and bipolar, depression and just got out of another treatment facility. Recently for like the second time in my life that I can remember, my left leg became painful from about the thigh down. But only like the skin. It is very difficult to explain. It was scary. There was no pain except for when there was ANY slight teeny touch on my leg. I took off all clothing on that leg and kept it in open air. My family was perplexed also. Until reading this article I had never heard of this, I also have always believed that my migraines were ended at 12. The doctors said it was relatively (0.1% or greater) common for this to resolve this way in women/girls.
    Im wondering if im experiencing migraines still, but with other symptoms and no headaches…
    Thoughts? Thx, Becca

  • Leah Dec 27, 2015

    I have suffered with migraines for 26 years. I get auras, what I call thunder headaches, they come on very quickly and incapacitate me and now I seem to be getting ocular migraines. My vision in my left eye is impaired and it is red and watery after the latest episode. These damn things are horrible and interfere with my every day life. I take topramate but that that does not stop them completely. My sympathy to all that suffer with migraines it’s not nice

  • Elizabeth Mar 5, 2016

    Does anyone get tiny red dots on the skin around your eyes when you get a migraine? I call it my panda eyes, it usually goes away after a few days. I don’t have it every time I have a migraine , it’s usually when it’s a really bad one. A normal migraine for me has pins. and needles, heightened smell, sencetivety to light , trouble getting the right words out and being sick. Has anyone got any answers to the panda eyes, the red dote on the skin?

  • Valerie Roberts Jul 28, 2017

    My migraine began in the middle of the night , last night. Woke up with the visual ‘lightening’ had I been awake, I would have started with the blind spot which then would have been followed by the aura which last usually half an hour, it works from the right side, across the eye and disappears into the left side. I have had neck pain and tender scalp and facial skin for several days, a clear warning, along with the yawning. Today I am exhausted ! And feeling depressed, fortunately I know this will not last ! Have a low grade headache and neck pain which will continue for 24 hrs.
    I just wish I could find the triggers, is it red wine is it chocolate or caffeine, I have tried giving up these things but migraines still pop up, maybe not as often, but I know something is triggering them. Also I have found that doing close vision work for any length of time definitely does trigger a migraine.
    Good luck to everyone finding their way through their migraines.

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