If your headache throbs or pulses, gets worse when you move, and comes with nausea or sensitivity to light, there’s a good chance it’s a migraine. Migraines affect roughly 12% of the population, hitting women about three times more often than men. But the distinction between a migraine and other headache types isn’t always obvious, especially if you’ve never been diagnosed. Here’s how to sort it out.
The Key Features That Separate Migraines
A migraine isn’t just a bad headache. The International Headache Society uses specific criteria to define one, and you can apply the same checklist to your own experience. A migraine headache lasts between 4 and 72 hours if untreated, and it has at least two of these four characteristics: pain on one side of your head, a pulsating or throbbing quality, moderate to severe intensity, and pain that gets worse with routine physical activity like walking or climbing stairs.
On top of the pain itself, a migraine also involves at least one of these: nausea or vomiting, or sensitivity to both light and sound. That combination is what sets migraines apart. A tension headache, by comparison, typically produces a dull, pressing sensation on both sides of your head without throbbing, and it doesn’t get worse when you move around. You can usually push through a tension headache. Migraines tend to push back.
A Quick Self-Screen
Clinicians sometimes use a validated three-question screening tool called the ID-Migraine to quickly identify likely migraine cases. You can ask yourself the same questions about your headaches:
- Do you feel nauseated or sick to your stomach?
- Does light bother you more than usual?
- Do your headaches limit your ability to work, study, or enjoy life?
If you answer yes to two or three of these, migraine is a strong possibility. This isn’t a diagnosis, but it’s a reliable starting point that performs well even outside clinical settings.
Migraines Have Four Phases
One reason migraines can be confusing is that the headache itself is only one part of a larger event. A full migraine attack can unfold in up to four stages, and recognizing the earlier ones helps you identify what’s coming.
Prodrome
Hours or even days before the pain starts, you may notice mood changes like irritability or depression, unusual fatigue, food cravings, frequent yawning, neck stiffness, or trouble concentrating. Some people experience frequent urination or digestive changes. These warning signs are easy to miss if you don’t know to look for them, but they’re remarkably consistent from one attack to the next.
Aura
About 25 to 30% of people with migraines experience aura, which typically develops over at least 5 minutes and lasts up to an hour. Visual aura is the most common: you might see geometric patterns, flashing lights, shimmering lines, or blind spots that start in the center of your vision and spread outward. Some people get tingling that travels from one hand up the arm to the face, or temporary difficulty speaking. In about 20% of cases, aura can last longer than 60 minutes.
Headache
This is the phase most people recognize. It typically lasts several hours to three days and brings throbbing pain on one or both sides of the head, along with nausea, sensitivity to light, sound, and sometimes smell, anxiety, and difficulty sleeping. The pain often worsens with any physical effort.
Postdrome
After the pain resolves, many people experience what’s sometimes called a “migraine hangover.” Fatigue, body aches, trouble concentrating, dizziness, and lingering light sensitivity can persist for hours. This phase is real and common, not just residual tiredness.
Migraines Without Head Pain
Here’s something that surprises many people: you can have a migraine without a headache at all. Called silent migraines or acephalgic migraines, these produce aura symptoms (visual disturbances, numbness, tingling, difficulty speaking, tinnitus) without the pain phase that follows. Vision changes are the most common presentation. If you periodically experience flashing lights, blind spots, or spreading visual distortions that resolve within an hour, a silent migraine is a possibility worth discussing with your doctor, especially since these symptoms can mimic more serious conditions like stroke.
Common Triggers
Migraines tend to be triggered by specific patterns, and identifying yours is one of the most useful things you can do. Stress is the biggest one, acting as a trigger for nearly 70% of people with migraine. Changes in sleep schedule rank close behind. Nearly half of all migraine attacks happen between 4:00 a.m. and 9:00 a.m., which may explain why sleeping in or losing sleep can set one off.
Hormonal shifts play a major role for women. Up to 75% of women with migraines find attacks cluster around their menstrual period. Weather changes, particularly shifts in barometric pressure, storms, and high humidity, are common environmental triggers. Dehydration triggers attacks in about a third of people with migraine, and for some, even mild dehydration is enough.
Dietary triggers include alcohol (red wine gets the most blame, but other types are equally likely), aged cheese, cured meats, chocolate, artificial sweeteners, and foods high in histamine or MSG. Strong smells can activate nerve receptors in the nasal passages and either trigger an attack or worsen one in progress. Bright or flickering light is both a trigger and a symptom, which creates a frustrating feedback loop during an attack.
One trigger that catches people off guard: overusing pain medication. Taking acute headache medication more than 10 days a month can itself cause more frequent headaches, a pattern known as medication overuse headache.
How Migraines Are Treated
For mild to moderate migraine attacks, over-the-counter pain relievers like ibuprofen, naproxen, or aspirin are considered first-line treatment by major headache societies worldwide. Acetaminophen is an option for those who can’t take anti-inflammatory drugs. These work best when taken early in the attack, ideally during the prodrome or at the very first sign of pain.
For moderate to severe attacks that don’t respond to over-the-counter options, prescription medications called triptans have been the standard for decades. They work by narrowing blood vessels and blocking pain pathways, but they aren’t suitable for people with cardiovascular disease. A newer class of medications, the gepants, treats migraine pain without affecting blood vessels, making them safer for people with heart conditions. They’ve been shown to reduce pain and associated symptoms within two hours.
If you’re having migraines frequently (more than four days a month), preventive treatment may be worth exploring. This shifts the strategy from treating each attack to reducing how often they happen in the first place.
Headaches That Need Immediate 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, can indicate a vascular emergency like an aneurysm and needs immediate evaluation. Other red flags include headache with fever or night sweats, new neurological symptoms like weakness on one side of the body or unusual numbness, headache that clearly worsens when you change position or cough, and a brand-new headache pattern starting after age 50.
A headache that is steadily getting worse over days or weeks, rather than coming and going in distinct episodes, also warrants attention. Migraine is an episodic condition. It comes, it peaks, and it resolves. A headache that only escalates is following a different pattern.