Can vibration in the head followed by headache be a sign of a migraine?

Can Vibration in the Head Followed by Headache Be a Sign of Migraine?

Yes, a vibration sensation in the head followed by headache can represent a migraine, particularly as a sensory aura symptom that precedes or accompanies the headache phase. This presentation is consistent with migraine with aura, where sensory symptoms develop gradually before the headache begins.

Understanding Sensory Aura in Migraine

Sensory aura symptoms occur in approximately 31% of individuals who experience migraine with aura, making them the second most common aura type after visual symptoms 1. The "vibration" sensation you describe likely represents a form of paresthesia or altered sensory perception that characterizes sensory aura.

Key Diagnostic Features Supporting Migraine

The International Headache Society diagnostic criteria for migraine with sensory aura require 2, 1:

• At least 2 attacks with fully reversible sensory symptoms
• Gradual spread over ≥5 minutes (not sudden onset)
• Duration of 5-60 minutes per symptom
• Followed within 60 minutes by headache meeting migraine criteria
• Complete reversibility of the sensory symptoms

The gradual development and spreading quality of the sensation is particularly important—this "marching" characteristic distinguishes migraine aura from more concerning conditions like transient ischemic attack (TIA), where symptoms appear suddenly and simultaneously at maximal intensity 1.

Migraine Without Aura Considerations

If the vibration sensation occurs during rather than before the headache, this could still represent migraine without aura with accompanying sensory symptoms 2. For this diagnosis, you would need:

• At least 5 attacks lasting 4-72 hours (untreated)
• At least 2 of these headache characteristics: unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by routine physical activity 2
• At least 1 of these associated symptoms: nausea/vomiting OR both photophobia and phonophobia 2

Vestibular Migraine as an Alternative

If the "vibration" sensation has a vestibular quality (feeling of movement, spinning, or imbalance), vestibular migraine should be strongly considered 2. Vestibular migraine was officially recognized by the International Headache Society in 2018 and requires 2:

• At least 5 episodes with vestibular symptoms of moderate-to-severe intensity
• Duration of 5 minutes to 72 hours
• Migraine features present in at least 50% of episodes
• Current or past history of migraine

Vestibular symptoms can include internal sensations of movement or vibration that patients may struggle to describe precisely 3, 4.

Critical Red Flags to Exclude

You must immediately evaluate for alternative diagnoses if any of these features are present 5, 1:

• Sudden onset (maximal at onset rather than gradual spread)
• Loss of consciousness (never a migraine symptom) 5
• Persistent neurological deficits that don't completely resolve 5
• First occurrence after age 50
• Symptoms lasting >60 minutes without progression to headache

The distinction between migraine sensory aura and TIA is critical: migraine aura spreads gradually with a "marching" quality, while TIA symptoms appear suddenly and simultaneously 1.

Recommended Clinical Approach

Document the specific pattern using ICHD-3 criteria 6, 5:

• Onset pattern: Does the vibration develop gradually over at least 5 minutes, or appear suddenly?
• Duration: How long does the vibration last before the headache begins?
• Quality: Does it spread or "march" from one area to another?
• Associated symptoms: Are there visual changes, nausea, light/sound sensitivity?
• Complete reversibility: Does the sensation completely resolve?

Implement a prospective headache diary to track attack frequency, duration, characteristics, and medication use 5. This documentation is essential because retrospective recall consistently underestimates attack frequency and misses diagnostic patterns 5.

Physical examination should be performed to exclude secondary causes, though it is typically normal in migraine and serves primarily to rule out other conditions 5, 1.

When Neuroimaging Is Needed

Neuroimaging should only be pursued when red flags suggest a secondary headache disorder 5. The presence of typical migraine features with gradual onset, complete reversibility, and recurrent pattern does not require imaging 5.

Common Diagnostic Pitfalls

• Failing to count attacks systematically: Migraine without aura requires at least 5 qualifying attacks before definitive diagnosis 6, 1
• Missing the gradual onset: The spreading quality over ≥5 minutes is what distinguishes migraine aura from vascular events 1
• Not recognizing aura without headache: Some patients experience aura symptoms that don't progress to headache, and these still count as migraine 5
• Overlooking vestibular features: If the vibration has any quality of movement or imbalance, vestibular migraine criteria should be systematically applied 2, 4