Symptoms and signs of migraine headache

Doctors have identified two types of migraine:

  • migraine without aura, and
  • migraine with aura.

Both types of migraine:

  • are associated with a severe throbbing or ‘pounding’ pain, usually only on one side of the head, although the affected side may change between, or even during, attacks
  • usually last from four hours up to three days
  • are often accompanied by other symptoms such as nausea and vomiting, and a sensitivity to bright lights or noise. Many people feel the need retreat to a quiet, dark room when they have a migraine
  • are often so painful and distressing that normal everyday activities become impossible during an attack
  • can leave a person feeling drained and exhausted afterward
  • can be aggravated by physical activity such as walking or climbing stairs.

Some people may experience a range of characteristic symptoms — such as fatigue, difficulty concentrating, neck stiffness, food cravings and a sensitivity to light or sound — up to a day or so before a migraine attack.

Migraines with aura are preceded by aura, which present as altered vision, speech, sensation or more rarely, altered movement.

The visual symptoms of aura usually develop five minutes to an hour in advance of pain and may include flashes of light and colour (as though looking through a prism), blurred vision or blind spots, zigzag or jagged lines (doctors describe the latter as fortification spectra as it resembles a fortified town).

Disturbances of speech, usually problems in finding the right word, can be part of the aura. These symptoms occur because of changes in brain activity before a migraine.Some people also develop ‘pins and needles’ in a hand or arm, or on one side of their face. Symptoms can mimic stroke and understandably be quite frightening the first few times they occur. Although symptoms vary from person to person, the symptoms in an individual tend to be much the same.

Overall, migraine with aura affects about one-third of migraine sufferers. It’s possible, however, for the same person to have attacks of migraine with aura and without aura at different times.

Migraine affects everyone differently. Some people have migraines very occasionally, perhaps only one a year. Others have frequent attacks, up to several times a week or even daily. Overall, the average is about one to two attacks per month.

Chronic migraine is classified as migraine occurring on 15 days per month or more. Chronic migraine is difficult to diagnose and treat and usually needs to be managed by a specialist (neurologist).

Who is at risk of migraine?

Migraine strongly runs in families, which suggests an inherited tendency.

Menstruation and menopause may trigger migraine in some women, possibly due to the drop in oestrogen hormone levels that occurs at these times. Read more about hormone-related migraine.

Head and neck problems can predispose some people to migraine and may respond to non-medicine treatment e.g. physiotherapy or chiropractic. However, not all migraines improve with physical treatments, so if you decide to seek treatment, monitor your response and carefully assess whether it is helping you.

People who have been diagnosed with depression and anxiety appear more prone to migraine. Treating the underlying depression and anxiety may help migraine symptoms as well.

Stress can sometimes aggravate migraine but attacks tend to occur when the stress is easing rather than when it comes on. Sufferers may benefit from lifestyle changes and stress management strategies.