A migraine is more than a bad headache. You can identify one by its distinct combination of symptoms: throbbing or pulsating pain (often on one side of the head), lasting 4 to 72 hours, and accompanied by nausea, sensitivity to light, or sensitivity to sound. If routine activities like walking or climbing stairs make the pain worse, that’s another hallmark sign. A regular headache rarely checks all of those boxes.
What a Migraine Feels Like vs. a Regular Headache
The most common type of everyday headache, a tension headache, produces mild to moderate steady pressure felt across the forehead or the back of the head. It’s uncomfortable, but it doesn’t usually come with nausea or make you want to hide in a dark room. A migraine feels different in almost every way. The pain is moderate to severe, often described as throbbing or pulsating, and it tends to concentrate around the temple, behind one eye, or at the back of the head, frequently on one side only.
The real giveaway is what comes along with the pain. Migraines are often accompanied by nausea (sometimes vomiting), sensitivity to light, sensitivity to sound, and sometimes sensitivity to smell. If turning on a lamp or hearing normal conversation makes everything worse, that pattern points strongly toward migraine rather than a tension headache.
The Four Phases of a Migraine Attack
Not everyone experiences all four phases, but knowing them can help you recognize a migraine before the pain even starts.
Prodrome
Hours or even days before the headache hits, you may notice subtle warning signs: mood changes like irritability or difficulty focusing, unusual fatigue, neck stiffness, food cravings, frequent urination, or excessive yawning. Many people don’t connect these symptoms to migraine until they start tracking them over time. Recognizing your prodrome pattern gives you a window to take action early.
Aura
About one in four people with migraines experience aura, which typically develops over at least five minutes and lasts up to 60 minutes (though in roughly 20% of cases it can stretch longer). Visual aura is the most common type: zigzag lines drifting across your field of vision, shimmering spots, flashes of light, or blind spots sometimes outlined by a circle or geometric shape. These disturbances usually start in the center of your vision and spread outward.
Aura isn’t always visual. Some people feel tingling or numbness that starts in one hand and slowly creeps up the arm, or tingling of the tongue and mouth. Others have temporary difficulty finding words or speaking clearly. These symptoms can be alarming the first time they happen, but they’re typically temporary and resolve before or during the headache phase.
Headache
This is the phase most people think of. It lasts anywhere from several hours to three days and involves the throbbing, one-sided pain described above. Nausea, anxiety, inability to sleep, and heightened sensitivity to light, sound, and smell are all common during this phase. Most people find it impossible to continue normal activities.
Postdrome
After the pain fades, many people feel drained for hours or longer. Fatigue, body aches, trouble concentrating, dizziness, and lingering light sensitivity are typical. Some people describe feeling “hungover.” This phase varies in length but is a real part of the attack, not just tiredness.
Why Migraines Hurt the Way They Do
Migraine pain follows nerve pathways in the face and head. The trigeminal nerve, the largest nerve running through your face, has three branches that cover different areas: the forehead and eye area, the cheek, and the jaw. During a migraine, this nerve system becomes activated and releases a signaling molecule that drives inflammation and pain around the blood vessels covering the brain. That’s why the pain often feels localized to specific regions of the face or head, and why it can shift or radiate. The pattern of migraine pain closely mirrors the referred pain seen when blood vessels around the brain are directly stimulated during certain surgeries.
Common Triggers to Watch For
Migraines often have identifiable triggers, though they vary from person to person. Hormonal fluctuations are one of the most common, particularly drops in estrogen around menstrual periods, during pregnancy, or in perimenopause. Stress is another major trigger, along with sleep changes (both too little and too much), skipping meals, weather shifts, and sensory overload from bright lights or strong smells.
Dietary triggers include alcohol (especially red wine), too much caffeine, aged cheeses, and processed foods. Not every person with migraines has dietary triggers, but keeping a headache diary that logs what you ate, how you slept, and what was happening in your life can reveal patterns over weeks.
Migraine Without the Headache
Some people experience migraine symptoms, particularly aura or dizziness, without ever developing significant head pain. Vestibular migraine is one example: the primary symptom is moderate to severe vertigo or dizziness rather than head pain. This can include a false sensation of spinning, dizziness triggered by head movement, or vertigo set off by busy visual environments like scrolling on a phone or watching traffic. Episodes last anywhere from five minutes to 72 hours. Because there’s no classic headache, many people don’t realize these episodes are migraine-related, which can delay recognition for years.
When a Headache Is Episodic vs. Chronic
Most people with migraines have episodic attacks, meaning they occur periodically but not constantly. Chronic migraine is defined as having headaches on 15 or more days per month for more than three months, with at least 8 of those days meeting the criteria for migraine. If your headaches are clearly becoming more frequent or more severe over time, that progression is worth paying attention to. Tracking your headache days on a calendar gives you concrete data to bring to a medical appointment.
Red Flags That Need Immediate Attention
Most headaches, even painful ones, are not dangerous. But certain patterns signal something more serious than migraine. The most urgent is a thunderclap headache: sudden onset at maximum intensity, like a switch being flipped. This can point to a vascular emergency like a brain aneurysm and needs evaluation immediately.
Other warning signs include headache accompanied by fever, night sweats, or signs of illness; new neurological symptoms like sudden weakness in an arm or leg, new numbness, or vision changes that don’t fit your usual migraine pattern; headache that changes intensity when you shift positions (standing to lying down) or is triggered by coughing or straining; and a first-time headache starting after age 50. New headaches during or just after pregnancy also warrant prompt evaluation, as they can be related to vascular or hormonal conditions that need treatment.
If your headaches are steadily worsening in severity or frequency over weeks, that progression pattern is itself a red flag, even if each individual headache seems manageable. Primary headaches like migraine tend to follow a relatively stable pattern over time. A clear upward trend is different.
How Migraine Is Formally Diagnosed
There is no blood test or brain scan that confirms migraine. Diagnosis is based on your symptom history. The international criteria used by clinicians require at least five attacks that each lasted 4 to 72 hours (untreated), with at least two of these four pain features: one-sided location, pulsating quality, moderate to severe intensity, or worsening with routine physical activity. On top of that, each attack must include at least one of the following: nausea or vomiting, or both light and sound sensitivity.
If you’ve had fewer than five attacks but the pattern fits, you may still be experiencing migraines. Keeping a detailed record of your symptoms, including timing, pain location, and accompanying symptoms like nausea or light sensitivity, gives a much clearer picture than trying to describe attacks from memory.