A migraine is more than a bad headache. It produces moderate to severe pain that typically pulses or throbs, lasts anywhere from 4 to 72 hours, and comes with at least one additional symptom like nausea, vomiting, or strong sensitivity to light and sound. If your headache gets worse when you walk up stairs, bend over, or do other routine physical activity, that’s another hallmark sign. The combination of these features is what separates a migraine from other headache types.
The Core Features of a Migraine
Doctors look for a specific pattern when diagnosing migraines. The pain needs at least two of these four 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 ordinary movement like walking. On top of the pain, you also experience nausea, vomiting, or both light and sound sensitivity during the attack.
Not every migraine checks every box. You might have one that hits both sides of your head, or one without nausea. What matters is the overall pattern across multiple episodes. A clinical diagnosis typically requires at least five attacks that follow this general profile, so if you’ve only had one or two headaches like this, tracking your symptoms over time will help clarify things.
In children and teenagers, attacks can be shorter, lasting as little as two hours.
Warning Signs That Start Before the Pain
Many people notice subtle changes hours or even days before the headache arrives. This early phase, called the prodrome, can include mood shifts (irritability, depression, difficulty focusing), fatigue, insomnia, muscle stiffness in the neck and shoulders, and digestive changes like constipation or diarrhea. A few prodrome symptoms are particularly distinctive: unexplained yawning, cravings for specific foods, and frequent urination. If you notice these showing up repeatedly before your headaches, it’s a strong signal you’re dealing with migraines.
About one in four people with migraines also experience an aura, which usually starts 5 to 60 minutes before the pain. Visual aura is the most common type: you might see zigzag lines drifting across your vision, shimmering spots, flashes of light, or blind spots outlined by geometric shapes. Some people get tingling that starts in one hand and slowly creeps up the arm, or numbness in the face, tongue, or mouth. Speech can become temporarily difficult. These symptoms are reversible, typically resolving before or shortly after the headache begins.
How Migraines Differ From Other Headaches
Tension headaches are the most common type and feel different from migraines in several ways. The pain is usually on both sides of the head (often across the forehead or the back of the skull), feels like pressure or tightness rather than throbbing, and stays at a mild to moderate level. Tension headaches don’t typically cause nausea or get worse when you move around. They can last from 30 minutes to a few hours, occasionally stretching to days, but they lack the additional sensory symptoms that define migraines.
Cluster headaches are rarer and harder to confuse with migraines once you know the pattern. They produce intense, stabbing pain focused around one eye or temple, last 15 minutes to 3 hours, and often come with tearing, nasal congestion, or a drooping eyelid on the affected side. They tend to strike in clusters over weeks or months, sometimes at the same time each day.
The quick way to screen yourself: ask three questions. Does nausea accompany your headaches? Does light bother you during them? Do they limit your ability to work or function normally? Answering yes to two or three of these correctly identifies migraine about 70% of the time.
Sensory Sensitivity During an Attack
Light and sound sensitivity are so central to migraines that most people with the condition instinctively retreat to a dark, quiet room. Research on migraine patients found that roughly 69% met clinical thresholds for photosensitivity, meaning light doesn’t just bother them during attacks but can actively trigger or intensify pain. People who get auras tend to have even more pronounced light sensitivity than those who don’t.
About 25% of migraine patients also experience a phenomenon where normally painless touch becomes uncomfortable. Your scalp might hurt when you brush your hair, or wearing a hat or glasses feels painful. This skin sensitivity tends to develop as an attack progresses, which is one reason treating early in an episode often works better than waiting.
The Migraine “Hangover”
Once the headache fades, you’re not necessarily done. Most people go through a recovery phase that can last a few hours to two full days. You might feel exhausted, foggy, or have trouble concentrating. Neck stiffness, lingering nausea, residual light and sound sensitivity, and dizziness are all common. Some people experience mood swings during this phase, ranging from mild depression to an unexpected sense of euphoria. If you regularly feel wiped out the day after a bad headache, that post-attack fatigue is itself a clue that you’re having migraines.
Episodic vs. Chronic Migraine
Most people with migraines have episodic attacks, meaning they get them periodically but have plenty of headache-free days. Chronic migraine is a separate classification: headaches on 15 or more days per month for at least three months, with migraine features on at least 8 of those days. The distinction matters because chronic migraine responds to different treatment strategies and qualifies for preventive therapies that episodic migraine may not.
If your migraines are becoming more frequent or more severe over time, that progression itself is worth paying attention to and discussing with a doctor.
Headache Signs That Need Immediate Attention
Most migraines, while miserable, are not dangerous. But certain headache features suggest something more serious is going on. Seek emergency evaluation if you experience any of the following:
- Sudden, explosive onset: A headache that hits maximum intensity within seconds, sometimes called a thunderclap headache, can signal a blood vessel problem like an aneurysm.
- New neurological symptoms: Weakness in an arm or leg, new numbness that doesn’t match your typical aura pattern, or vision changes that don’t resolve.
- Fever, night sweats, or other systemic symptoms accompanying the headache.
- First severe headache after age 50: New-onset headaches later in life are more likely to have an underlying cause.
- Headaches that change with position: Pain that dramatically shifts when you stand up or lie down can indicate a pressure problem.
- Headaches triggered by coughing or straining.
- New headaches during or after pregnancy, which need evaluation for vascular or hormonal conditions.
The overall pattern to watch for is anything new, sudden, or clearly getting worse over time. Migraines tend to follow a recognizable, repeating pattern for each person. When a headache breaks that pattern, it deserves a closer look.