A migraine is more than a bad headache. It’s a neurological event with a specific pattern: moderate to severe throbbing pain, usually on one side of the head, that lasts between 4 and 72 hours and comes with at least one additional symptom like nausea, vomiting, or sensitivity to light and sound. If your headache gets worse when you walk upstairs, makes you want to lie down in a dark room, and comes with a queasy stomach, there’s a good chance it’s a migraine.
The Core Symptoms That Define a Migraine
Doctors use a specific checklist to diagnose migraine. Your headache needs at least two of these four pain characteristics: it’s on one side of your head, it pulses or throbs, it’s moderate to severe in intensity, and it gets worse with routine physical activity like walking or climbing stairs. On top of the pain, you also need at least one of these: nausea or vomiting, or both sensitivity to light and sensitivity to sound.
Not every migraine checks every box. Some people get bilateral pain (both sides), and some never vomit. But the combination of throbbing, one-sided pain that worsens with movement and comes packaged with nausea or light sensitivity is what separates a migraine from other headache types. A formal diagnosis typically requires at least five attacks that follow this pattern.
What a Migraine Feels Like Before the Pain Starts
Many people with migraines notice warning signs hours or even days before the headache arrives. This early phase, called the prodrome, can include mood changes (irritability, depression, or difficulty focusing), fatigue, neck stiffness, food cravings, frequent urination, and excessive yawning. Some people experience insomnia, nausea, or changes in bowel habits. These symptoms are easy to dismiss on their own, but once you recognize the pattern, they become a reliable early signal that a migraine is on its way.
Aura: Visual and Sensory Disturbances
About a quarter to a third of people with migraines experience aura, which typically begins before the headache and lasts between 5 and 60 minutes. The most common type is visual aura: flashing lights, zigzag lines, blind spots, or shimmering patches in your field of vision. These symptoms build gradually rather than appearing all at once.
Some people get sensory aura instead, feeling tingling or numbness that spreads slowly through one hand and up the arm, sometimes reaching the face. A less common form affects speech, causing slurred or jumbled words. You can experience aura without a headache following it, which can be confusing and even frightening if you don’t know what’s happening. If you’ve never had aura before and suddenly develop visual disturbances or numbness, it’s worth getting evaluated to rule out other causes.
How Migraines Differ From Other Headaches
Tension headaches are the most common headache type, and they feel distinctly different. Tension headaches produce a dull, pressing sensation on both sides of the head, like a band squeezing around your skull. They don’t throb, they don’t get worse when you move, and they rarely cause nausea or light sensitivity. You can typically push through daily tasks with a tension headache. With a migraine, most people can’t.
Cluster headaches are rarer but often more intense. They cause severe burning pain around or above one eye, usually with visible signs on the affected side: a red, watering eye, a drooping eyelid, or nasal congestion. Cluster attacks are shorter (15 minutes to 3 hours) and tend to strike repeatedly over weeks or months, often at the same time of day. Unlike migraine, where you want to lie still, cluster headaches often make people restless and unable to sit down.
Cervicogenic headaches originate from problems in the neck and are limited to head and neck pain, sometimes with restricted neck mobility. They lack the nausea, light sensitivity, and throbbing quality of migraines.
Migraines That Don’t Look Like Migraines
Not all migraines center on head pain. Vestibular migraine primarily causes dizziness, vertigo, and balance problems that can last minutes to days, sometimes with no headache at all. People with this type almost always have a history of motion sensitivity going back to childhood and have had more typical migraines at some point in their lives, even if it was years ago. Because the dizziness can appear without a headache, vestibular migraine is frequently misdiagnosed.
Abdominal migraine is most common in children. Instead of head pain, it causes pain in the middle of the belly, around the navel, along with nausea, vomiting, loss of appetite, and a pale complexion. Retinal migraine causes temporary vision loss in one eye only, distinguishing it from the visual aura that affects both eyes. Hemiplegic migraine causes temporary weakness on one side of the body, sometimes mimicking stroke symptoms.
Common Triggers to Track
Identifying what sets off your migraines is one of the most useful things you can do. The most frequently reported triggers are sleep disturbance (affecting roughly 70% of people with migraines), stress (about 67%), and fatigue (about 64%). Excess screen time, loud noise, and skipping meals are also common culprits. For women, menstruation triggers attacks in about a third of cases.
Keeping a headache diary for a few weeks can help you spot your personal triggers. Track when attacks start, what you ate, how much you slept, your stress level, where you are in your menstrual cycle if applicable, and any environmental factors like weather changes or strong smells. Patterns often emerge quickly.
The “Hangover” After a Migraine
Once the headache fades, many people enter a postdrome phase that can feel like a hangover. Symptoms include fatigue, body aches, trouble concentrating, dizziness, and lingering sensitivity to light. This phase varies in length but can last a day or more. It’s a real part of the attack, not just residual tiredness, and it helps explain why migraines can knock you out for longer than the headache itself lasts.
Episodic vs. Chronic Migraine
Most people with migraines have episodic attacks, meaning fewer than 15 headache days per month. 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. Chronic migraine often develops gradually from episodic migraine, sometimes driven by overuse of pain medication, worsening triggers, or other factors. If your headaches are becoming more frequent over time, that progression itself is worth paying attention to.
Warning Signs That Need Urgent Attention
Most headaches, including migraines, aren’t dangerous. But certain features signal something more serious. A headache that reaches maximum intensity within seconds (sometimes called a thunderclap headache) needs emergency evaluation, as it can indicate a blood vessel problem like an aneurysm. Other red flags include headache accompanied by fever or night sweats, new neurological symptoms you haven’t experienced before (such as weakness in a limb, unusual numbness, or vision changes that don’t fit your typical aura pattern), and a new type of headache starting after age 50.
A headache that is clearly getting worse over weeks or months, becoming more severe or more frequent in a pattern you haven’t seen before, also warrants medical attention. If your headaches have been consistent for years and fit the migraine pattern described above, that’s reassuring. If something about them has changed, that change is what matters.