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
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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.
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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{ 11 comments… read them below or add one }
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.
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.
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.
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.
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…
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.
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!
I finally found my migraine soulmate in you, James.
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!
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.
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