Migraines look different depending on whether you mean the visual disturbances a person sees during an attack, the physical signs visible to others, or the full experience across all four phases of a migraine episode. Over 1.16 billion people worldwide experience migraines, and no two attacks are exactly alike. Here’s what they actually look like, from the inside and the outside.
What You See During a Visual Aura
About one in four people with migraines experience a visual aura, a set of temporary visual disturbances that typically appear before the headache begins. The most recognizable pattern is called a fortification spectrum, named because it resembles the walls of a medieval fort. It often starts as a small hole of light or a cluster of bright geometric lines in your visual field, then expands into a C-shaped or sickle-shaped object with zigzag lines along the leading edge.
Other people see bright spots, flashes of light, or shimmering waves. Some experience a scotoma, a partial loss of vision that creates a blind spot or dark patch. These visual disturbances typically last between 5 and 60 minutes, with most resolving within 30 minutes. They spread gradually, often starting small in the center of your vision and expanding outward. In rare cases, continuous aura symptoms can persist for more than a week.
What a Migraine Looks Like to Others
Someone in the middle of a migraine attack can show visible physical changes that go well beyond “having a headache.” Common signs include facial pallor (looking washed out or pale), red or watery eyes from conjunctival injection and tearing, swollen eyelids, drooping of one eyelid, nasal congestion or a runny nose, and facial flushing or sweating. Many people with migraines retreat to dark, quiet rooms, cover their eyes, or hold their head still, avoiding any movement that could worsen the pain.
These visible signs vary from person to person and attack to attack. Some people look essentially normal despite severe internal symptoms, which is one reason migraines are so often dismissed by others.
The Four Phases of an Attack
A migraine isn’t just a headache. It unfolds in up to four distinct phases, each with its own set of symptoms.
Prodrome
Hours to days before the headache, roughly 39% of migraine patients notice warning symptoms: neck stiffness, fatigue, difficulty concentrating, yawning, irritability, anxiety, and food cravings. Sensitivity to light and sound can start here too, well before any pain. Research suggests that many supposed migraine “triggers” like bright lights or certain foods are actually early symptoms of an attack already underway. Your brain’s threshold for sensory input drops during this phase, making normal stimuli feel unpleasant or overwhelming.
Aura
When aura occurs, it typically lasts 5 to 60 minutes and can include visual changes, tingling or numbness (often starting in the hand and spreading to the arm and face), difficulty speaking, or dizziness. Aura symptoms spread gradually over at least five minutes and are fully reversible.
Headache
The headache phase brings throbbing or pulsating pain, usually on one side of the head, that worsens with physical activity. Nausea, vomiting, and extreme sensitivity to light, sound, and smell are common companions. During this phase, people tend to focus entirely on the pain and become less aware of other symptoms.
Postdrome
After the headache resolves, the postdrome can last up to 48 hours. People describe feeling drained, having trouble concentrating, and experiencing lingering neck stiffness. Some people, interestingly, report feelings of relief or even mild euphoria once the pain lifts.
Sensory Overload During an Attack
One of the defining features of migraine is how your senses become amplified. Light that’s normally comfortable becomes painful. Ordinary conversation volume feels piercing. Everyday smells like cooking food or perfume can trigger nausea. This isn’t psychological sensitivity. It reflects real changes in how your brain processes sensory signals during an attack.
What makes this especially tricky is that these sensitivities often begin during the prodrome phase, before you realize a migraine is coming. You might notice that sunlight suddenly feels too bright or a coworker’s perfume is intolerable, and assume the light or the smell caused your migraine, when in reality your brain was already shifting into a migraine state and lowering its tolerance for incoming signals.
Migraines That Don’t Look Like Headaches
Some migraine subtypes produce symptoms you’d never associate with a headache, which makes them harder to recognize.
Vestibular Migraine
Vestibular migraine affects about 3% of the population and is probably the second most common cause of dizziness overall. It produces episodes of vertigo, imbalance, and disorientation that can last anywhere from 5 minutes to 72 hours, intense enough to interfere with daily activities. Patients often struggle to describe the sensation, using phrases like “stepping into a hole” or “being inside a barrel” rather than the classic “room spinning.” About 20% of migraine patients report vestibular symptoms during headache attacks, and a third describe isolated vertigo episodes with no headache at all.
Hemiplegic Migraine
Hemiplegic migraine is a rare subtype that causes temporary weakness or paralysis on one side of the body, closely mimicking a stroke. Motor symptoms usually start in the hand and spread to the arm and face over 20 to 30 minutes. The weakness can range from mild to severe and typically affects the upper body more than the lower. In rare cases, it can develop suddenly enough to be indistinguishable from a stroke without medical evaluation. Symptoms usually resolve within hours to days, though in exceptional cases the weakness can persist for up to four weeks. About one-third of people with hemiplegic migraine experience weakness on both sides of the body during an attack.
Abdominal Migraine in Children
In children, migraines frequently show up as intense abdominal pain rather than headache. Abdominal migraine causes episodes of acute pain around the belly button or across the midsection lasting at least an hour, severe enough to stop normal activities. Up to 93% to 100% of affected children turn noticeably pale during episodes, 91% lose their appetite, 73% to 91% feel nauseated, and 35% to 50% vomit. These episodes are paroxysmal, meaning they come on suddenly and recur over time. A related condition, cyclic vomiting syndrome, produces bouts of rapid, persistent vomiting that in young children must occur at least twice over six months to meet diagnostic criteria.
Who Gets Migraines
Migraine prevalence peaks in the 30 to 44 age range, with the highest number of cases in the 30 to 34 age group (roughly 128 million people globally). Women are affected nearly twice as often as men: about 725 million women compared to 433 million men had migraines in 2021. The rate per 100,000 people is approximately 17,903 for women versus 10,624 for men. Between 1990 and 2021, global migraine prevalence increased by over 58%, growing from about 733 million to 1.16 billion cases.