Symptoms of Migraine
Core Diagnostic Features
Migraine is characterized by recurrent episodes of moderate to severe headache lasting 4 to 72 hours, typically with a pulsating quality, often accompanied by nausea, vomiting, photophobia, and phonophobia. 1
Primary Headache Characteristics
Migraine headache requires at least two of the following features 1:
- Unilateral location (though bilateral pain occurs in ~40% of patients) 1
- Throbbing or pulsating character 1
- Moderate to severe intensity that interferes with daily activities 1
- Worsening with routine physical activity 1
Associated Symptoms
At least one of the following must be present 1:
Prodromal Symptoms (Before Headache Onset)
These symptoms can occur hours to days before the headache phase 1:
- Depressed mood 1
- Yawning 1
- Fatigue 1
- Food cravings (particularly for specific foods) 1
- Heightened sensory perceptions 1
- Alterations in mood or behavior 1
Postdromal Symptoms (After Headache Resolution)
These symptoms can persist up to 48 hours after headache resolution 1:
Migraine with Aura
Approximately one-third of individuals with migraine experience aura, defined as transient focal neurological symptoms that usually precede but sometimes accompany the headache phase. 1
Visual Aura (Most Common)
- Occurs in >90% of patients with aura 1
- Fortification spectra (classic zigzag patterns) 1
- Scotomas (blind spots) 1
- Visual distortions 1
Sensory Aura
- Occurs in ~31% of patients with aura 1
- Predominantly unilateral paresthesia (pins and needles and/or numbness) 1
- Spreads gradually in the face or arm 1
Less Common Aura Types
- Aphasic speech disturbance 1
- Brainstem symptoms (dysarthria, vertigo) 1
- Motor weakness (in hemiplegic migraine) 1
- Retinal symptoms 1
Clinical Presentation Patterns
Attack Duration and Frequency
- Episodic migraine: 1 to 14 headache days per month 1
- Chronic migraine: Headaches on at least 15 days per month for at least 3 months, with migraine features on at least 8 days per month 1, 2
- Individual attack duration: 4 to 72 hours if untreated 1
Common Triggers
- Hormonal changes 1
- Certain foods 1
- Sensory stimuli (light, smells) 1
- Missed meals 1
- Relief of tension after stressful events 1
Disability and Impact
Migraine is the second leading cause of global disability in all adults and the top cause in females aged 15 to 49 years. 1 The attacks can be completely immobilizing, requiring bed rest and resulting in significant interference with daily living and quality of life 1, 3.
When to Suspect Migraine
Suspect migraine when patients present with 1:
- Recurrent headache of moderate to severe intensity 1
- Visual aura 1
- Family history of migraine 1
- Onset of symptoms at or around puberty 1
Critical Pitfall to Avoid
Do not dismiss bilateral headaches as "not migraine"—approximately 40% of migraine patients experience bilateral pain during attacks. 1 Many patients incorrectly label milder migraine episodes as "sinus headaches" or "tension headaches," which can delay proper diagnosis and treatment 4.