A migraine is more than a bad headache. If your head pain is moderate to severe, feels like throbbing or pulsing, shows up mostly on one side, and comes with nausea or sensitivity to light and sound, you’re likely dealing with a migraine. The pain typically lasts between 4 and 72 hours, and routine activity like walking or climbing stairs makes it noticeably worse. Here’s how to recognize the full picture.
The Core Signs of a Migraine
Clinically, a migraine is identified by a specific combination of features. You don’t need all of them, but your headache should have at least two of these four pain characteristics: it hits one side of your head, it pulses or throbs, the intensity is moderate to severe, and physical activity makes it worse or forces you to stop what you’re doing. On top of the pain itself, you’ll also experience at least one of the following: nausea or vomiting, or both sensitivity to light and sensitivity to sound.
That light and sound sensitivity is one of the strongest clues. Over 80% of people with migraine experience both, and for many, these sensitivities persist even between attacks. You might notice that bright screens, sunny days, or noisy social settings bother you more than they seem to bother other people, even on days when you don’t have a headache.
If you’ve had five or more episodes matching this pattern, that’s generally enough for a migraine diagnosis. In children and teenagers, attacks can be shorter, lasting as little as two hours.
A Migraine Has Four Phases
One reason migraines are confusing is that the headache itself is only one part of the experience. A full migraine attack can move through up to four distinct phases, and recognizing the early ones can help you catch an episode before the pain peaks.
Prodrome (Hours to Days Before)
The prodrome is a set of subtle warning signs that show up hours or even a day or two before the headache. Common symptoms include mood changes (irritability, depression, difficulty focusing), fatigue, neck and shoulder stiffness, insomnia, nausea, and constipation or diarrhea. Some prodrome symptoms are surprisingly specific to migraine: excessive yawning, unusual food cravings, and frequent urination. If you notice the same cluster of these symptoms repeatedly before your headaches, it’s a strong signal you’re dealing with migraines.
Aura (5 to 60 Minutes Before)
About one in four people with migraine experience aura, which is a short-lived sensory disturbance that usually appears just before or at the start of the pain. The most common type is visual: flashing lights, zigzag lines, blind spots, or shimmering dots in your field of vision. Some people get sensory aura instead, feeling tingling or numbness that spreads through a hand or up an arm. Less commonly, aura affects speech, causing slurred words or difficulty finding the right word. Aura typically builds over several minutes and resolves within an hour.
The Headache Phase
This is the part most people recognize. Pain can last anywhere from 4 to 72 hours if untreated. It often starts on one side and may spread. Nausea, vomiting, and extreme sensitivity to light, sound, and sometimes smell are common companions.
Postdrome (The Migraine Hangover)
After the pain fades, many people feel drained, foggy, or sore for up to 48 hours. Common postdrome symptoms include fatigue, stiff neck, difficulty concentrating, lingering nausea, and mood shifts that can range from feeling low to a brief sense of euphoria. If you’ve ever felt “off” for a day or two after a bad headache, this phase may explain why.
How Migraines Differ From Other Headaches
A tension headache feels like a tight band squeezing both sides of your head. The pain is usually mild to moderate, steady rather than pulsing, and it doesn’t get worse when you move around. There’s no aura, no prodrome, and nausea or light sensitivity are rare. If your headache fits this description, it’s probably not a migraine.
Cluster headaches are a different beast entirely. They cause excruciating, piercing pain focused around one eye, and they come with visible signs on the affected side: a red or watering eye, drooping eyelid, nasal congestion, or facial sweating. People with cluster headaches tend to pace or rock during attacks because the pain is too intense to lie still. Migraines, by contrast, usually make you want to lie down in a dark, quiet room. Cluster attacks are also shorter, typically lasting 15 minutes to three hours, and they occur in daily “clusters” over weeks.
Common Triggers to Watch For
Identifying what sets off your attacks is one of the most useful things you can do. Stress is the single most common trigger. Hormonal shifts tied to the menstrual cycle or pregnancy are another major one. Beyond those, the list is varied and personal:
- Food and drink: Aged cheeses, fermented or pickled foods, processed meats, alcohol (especially wine), and excessive caffeine or caffeine withdrawal.
- Meal timing: Skipping meals or eating at irregular times.
- Sleep: Too little sleep, too much sleep, or conditions like sleep apnea.
- Environment: Bright lights, loud noises, strong smells, and sudden weather changes like drops in barometric pressure.
- Medication overuse: Taking pain relievers too frequently, including ones meant for migraine, can paradoxically increase the number of headache days you have.
- Smoking: Nicotine constricts blood vessels in the brain, which can trigger attacks.
Keeping a headache diary for a month or two, noting what you ate, how you slept, your stress level, and where you were in your menstrual cycle, can reveal patterns that are hard to spot otherwise. Not everyone has obvious triggers, but many people find that a combination of two or three factors at once is what tips them over the threshold.
Episodic vs. Chronic Migraine
If you have headaches on fewer than 15 days per month, that’s considered episodic migraine. Once you cross 15 headache days per month, with at least 8 of those days meeting the criteria for migraine, the condition is classified as chronic migraine. This distinction matters because chronic migraine often requires different treatment strategies, and it tends to have a bigger impact on daily life. Many people with episodic migraine gradually shift toward chronic migraine over time, particularly if attacks aren’t well managed or if medication overuse becomes a factor.
Headache Signs That Need Urgent Attention
Most migraines, while painful, aren’t dangerous. But certain headache features point to something more serious. A sudden, explosive headache that reaches maximum intensity within seconds, sometimes called a thunderclap headache, can signal a vascular emergency like a brain aneurysm and needs immediate evaluation. Other warning signs include headaches accompanied by fever or night sweats, new neurological symptoms like weakness on one side of the body or vision changes that don’t resolve, a new headache pattern starting after age 50, and headaches that are clearly getting worse over weeks or months in either severity or frequency. Any of these patterns warrant prompt medical attention rather than a wait-and-see approach.