What Does a Migraine Feel Like? Symptoms and What to Do

Symptoms of severe headaches called migraines often occur quickly and cause pulsating and steady pain in various parts of the head. People who suffer from migraine headaches experience recurring events.

Triggers for these headaches differ, but experts advise people who experience them to track their diet, surrounding environment and other external factors in a search for triggers to avoid in the future.

Dark rooms, cold compresses and minimal sounds are among the best self-treatments.

How Does a Migraine Feel?

A migraine without aura or common migraine causes intense, pulsating, or throbbing headaches, usually on one side of your head, that can last anywhere from a few hours to three days. There are no symptoms before the migraine attack. 

A migraine with aura is characterized by sensory disturbances (vision, speech, movement, and sensation) which occur before or during the migraine attack. Many people describe migraine pain as steady, throbbing, pulsating, pounding and debilitating.

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Symptoms of a Migraine

If you have a migraine, you may experience recurring symptoms referred to as episodes or attacks. Headaches are the primary symptoms of migraines and can range in severity from mild to intense. 

A migraine headache often affects one side of your head, but it can also affect both sides or shift sides. A migraine attack may occur in four distinct phases. Not everyone who gets migraines experiences all four phases. The phases are:

• Premonitory
• Aura
• Headache
• Postdrome

Premonitory Phase

The premonitory phase is also referred to as the prodrome or pre-headache phase. This phase is characterized by non-painful symptoms that can occur days before the migraine headache starts. Symptoms during this phase include:

• Mood changes
• Irritability
• Sensory sensitivity (light, smells, and sound)
• Stiffness of the neck
• Food cravings 
• Frequent yawning
• Fatigue

Aura Phase

Auras are sensory disturbances that may occur before or during a migraine episode. Auras can be visual, auditory, motor or somatosensory. Visual auras may cause blurred vision, flashing lights, expanding blind spots, and zigzagging lines in one or both eyes. 

Motor auras may cause slurred speech, difficulty in thinking clearly, difficulty in understanding what other people say, and difficulty in writing sentences. Sensory auras cause tingling or numbness originating in your arm and radiating to your face.

Headache Phase

The headache phase is the most acute phase of a migraine attack where the actual headaches occur. This phase can last anywhere between four and 72 hours in adults. Severity of the headache ranges from mild to severe.

In some cases, the headache phase overlaps the aura phase. The headache usually comes on gradually and is unilateral and throbbing, often affecting your forehead area. In some cases, pain can be bilateral, and neck pain may be present.

Bilateral pain is more common in individuals who have migraine without aura. Physical activity can aggravate the migraine headache. The following associated symptoms can accompany a migraine headache:

• Nausea and vomiting
• Sensitivity to light, sound, and smells
• Irritability and fatigue

Postdrome Phase

The postdrome phase occurs when the headache subsides. There may be transient headaches upon sudden head movements. During this phase, you may feel confused, exhausted or generally unwell.

Causes

Medical researchers have never discovered one underlying cause of migraines. A mix of genetic and environmental factors are associated with the development of migraines. Migraines run in families in about two-thirds of the cases. 

Several psychological conditions, including anxiety, depression, and panic disorder, are associated with migraines. A number of biological events or triggers have also been identified.

The significance and strength of the relationships between migraines and the triggers are uncertain.

Migraine vs. Headache

A headache refers to pain in your head, face, or upper neck area that can vary in intensity and frequency. Headaches can be classified into two main categories: primary and secondary.

• Primary headaches are independent conditions that cause pain in your head or face, like a tension headache.
• Secondary headaches result from another medical condition such as stress, medication abuse, or infection. 

A migraine is a primary headache disorder that can cause severe recurring headaches and other symptoms such as nausea, sensory sensitivity, visual problem and vomiting.

A headache is one of the main symptoms of a migraine and maybe felt on one side of the head. 

What to Do If You Have a Migraine

If a migraine is left untreated, it can go from mild to severe and last up to three days. As such, it is advisable to seek medical attention upon the onset of a migraine. 

It may also be beneficial to keep a migraine journal. Documenting your activities before and during migraine episodes may help doctors identify your migraine triggers.

Treatment

Migraine treatment has three primary aspects to it:

• Identifying and avoiding triggers
• Treating symptoms
• Medication for prevention

Lifestyle adjustments such as adequate sleep, stress management, dietary changes, and exercise can help mitigate most of the migraine triggers. The goal of medication is to reduce the frequency, duration, and painfulness of migraine episodes and symptoms. 

Acute treatment focuses on the pain and symptoms during the migraine episode. Drugs for acute treatment include:

• Painkillers: Over-the-counter (OTC) painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Ergotamine’s 
• Triptans: Increase brain serotonin levels to constrict blood vessels and reduce inflammation, thus alleviating migraines.
• Antinausea drugs: Reduce nausea and vomiting associated with migraines.
• Opioids: Prescribed sparingly for migraines that don’t respond to other painkillers

Preventive treatment is recommended if your migraine episodes are frequent and debilitating or if you cannot tolerate the drugs for acute treatment. Pharmacologic options for preventive treatment include:

• CGRP antagonists
• Beta-blockers
• Calcium channel blockers
• Antidepressants
• Anticonvulsants

Migraine Trigger List

Many people suffering from migraines report experiencing triggers. Symptoms can occur up to 24 hours after a trigger. The most-reported triggers are:

• Hormonal changes: Estrogen fluctuations, such as before and during menstruation, pregnancy, or menopause, may trigger migraines in women.
• Psychological stress: Stress has been identified as a trigger by a large majority of people affected by migraines. Migraines are associated with post-traumatic stress disorder and abuse.
• Foods and beverages: Foods including processed foods, salty foods, and aged cheeses have been reported to trigger migraines. This is also the case for beverages with alcohol and caffeine (wine and coffee). Many reports indicate that tyramine, which is present in chocolate, most cheeses, alcoholic beverages, processed meats, triggers migraine symptoms. Monosodium glutamate, a common food additive, can also trigger migraine symptoms. 
• Sensory stimuli: Bright flashing lights, loud sounds, and strong smells (paint thinner, perfume, and secondhand smoke) can induce migraines in some people.
• Sleep changes: Sleep deprivation or excess sleep may trigger migraines in some individuals.
• Medication: Certain medications such as vasodilators, oral contraceptives can aggravate migraines.
• Weather: Some weather conditions, including severe heat, changes in barometric pressure, can prompt migraines.
• Hunger
• Intense physical exertion

References

1. Headache Disorders. (April 2016). World Health Organization.

2. Migraine with Aura. (November 2021). StatPearls Publishing.

3. Genetics of migraine and pharmacogenomics: some considerations. (December 2007). The Journal of Headache and Pain.

4. ICHD-II Classification: Parts 1 -3: Primary, Secondary and Other. (May 2004). SAGE Journals.

5. A Phase-by-Phase Review of Migraine Pathophysiology. (May 2018). National Center for Biotechnology Information.

6. The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. (January 2015). The Journal of Head and Face Pain.

7. Migraine and the Environment. (May 2009). The Journal of Head and Face Pain.

8. Understanding the nature of psychiatric comorbidity in migraine:  a systematic review focused on interactions and treatment implications. (May 2019). The Journal of Headache and Pain.

9. Headache disorders: differentiating and managing the common subtypes. (August 2016). British Journal of Pain.

10. Preventive Migraine Treatment. (August 2015). American Academy of Neurology.

11. Migraine Triggers: An Overview of the Pharmacology, Biochemistry, Atmospherics, and Their Effects on Neural Networks. (April 2021). The Cureus Journal of Medical Science.

12. Triggers, Protectors, and Predictors in Episodic Migraine. (October 2018). National Center for Biotechnology Information.