Migraine isn’t a single condition. It comes in several distinct types, each with different symptoms, timelines, and triggers. The type you have depends on what happens before, during, and alongside your head pain, whether you experience visual disturbances, dizziness, weakness, or stomach symptoms, and how often attacks occur. Here’s how to tell them apart.
The Four Phases of Any Migraine Attack
Before identifying your type, it helps to understand the anatomy of an attack. Most migraines move through up to four phases, though not everyone experiences all of them.
The prodrome phase can start hours or even days before pain hits. Symptoms include mood changes, food cravings, frequent yawning, neck stiffness, fatigue, and trouble concentrating. Many people don’t recognize these as migraine-related until they start tracking them.
The aura phase, when it occurs, typically builds over at least 5 minutes and lasts up to 60 minutes. It involves visual, sensory, or speech disturbances. About 20% of people who get aura find it lasts longer than an hour, and sometimes it starts after the headache has already begun rather than before.
The headache phase brings pain on one or both sides of the head, lasting anywhere from several hours to three days. Nausea, anxiety, and sensitivity to light, sound, and smell often come along with it.
The postdrome, sometimes called the “migraine hangover,” follows the pain. Fatigue, body aches, dizziness, trouble concentrating, and lingering light sensitivity can persist even after the headache itself resolves.
Migraine Without Aura
This is the most common type. Attacks last 4 to 72 hours if untreated. The pain typically has at least two of these features: it affects one side of the head, has a pulsating or throbbing quality, is moderate to severe in intensity, or gets worse with routine physical activity like walking or climbing stairs. Most attacks also include nausea, light sensitivity, or sound sensitivity.
If your migraines are painful and disabling but you’ve never experienced visual disturbances, tingling, or other neurological symptoms beforehand, this is likely your type.
Migraine With Aura
About a quarter to a third of people with migraine experience aura at least some of the time. The most recognizable form is visual aura: zigzag lines, shimmering lights, geometric patterns, or blind spots that appear in both eyes. These often start near the center of your vision and spread outward, sometimes leaving a temporary blank spot behind.
Aura can also be sensory. Pins and needles that slowly spread from one point across part of your body, face, or tongue are typical. Numbness may follow the tingling, or numbness alone may be the only symptom. Less commonly, aura affects speech, causing difficulty finding words or forming sentences. Each individual aura symptom lasts between 5 and 60 minutes, and if you experience multiple types in sequence, each one adds to the total duration.
You can have migraine with aura sometimes and migraine without aura other times. Having one doesn’t exclude the other.
Vestibular Migraine
If your primary symptom is dizziness or vertigo rather than head pain, you may have vestibular migraine. This type causes episodes of moderate to severe balance-related symptoms lasting anywhere from 5 minutes to 72 hours.
The dizziness takes several forms: a false sense that you’re moving when you’re still, a sensation that the room is spinning, vertigo triggered by changing head position, or dizziness brought on by complex visual environments like scrolling on a phone or watching traffic. Some people feel disoriented and nauseated with head movement. The vertigo is considered moderate if it interferes with daily activities and severe if it stops them entirely.
What makes vestibular migraine tricky is that headache pain may be mild or even absent during episodes. Many people see multiple specialists before getting this diagnosis because the symptoms point toward inner ear problems rather than migraine.
Hemiplegic Migraine
This rare type causes temporary motor weakness on one side of the body as part of the aura phase. You might notice your arm or leg feeling heavy or difficult to move, alongside typical visual, sensory, or speech aura symptoms. Despite the name (which translates to “paralysis”), most episodes involve weakness rather than complete loss of movement.
Motor symptoms generally resolve within 72 hours, though some people experience weakness lasting weeks. It can run in families. Because one-sided weakness also mimics stroke, this type requires careful medical evaluation to distinguish from more dangerous conditions.
Retinal Migraine
This is a rare and frequently misunderstood type. A standard migraine aura affects vision in both eyes. A retinal migraine affects only one eye, causing repeated episodes of partial vision loss or blind spots in that eye. These episodes are short-lived and may happen before or during the headache.
The one-eye distinction matters. If you cover one eye and the visual disturbance disappears, it was likely affecting both eyes (a typical aura). If you cover one eye and still see the disturbance in the other, that suggests it’s isolated to a single eye and warrants prompt evaluation. Visual changes in only one eye, visual changes lasting less than 5 minutes or more than 60 minutes, and any new visual symptoms that haven’t been assessed before all deserve urgent attention.
Menstrual Migraine
If your migraines reliably cluster around your period, you may have menstrual migraine. The strict definition requires attacks to occur exclusively within a window from two days before to three days after the start of menstruation, in at least two out of three cycles, with no attacks at other times in the cycle.
In practice, many people experience migraines both around their period and at other times. That pattern is called menstrually related migraine rather than pure menstrual migraine, and it’s far more common. Tracking your attacks alongside your cycle for at least three months is the clearest way to identify this pattern. Hormone fluctuations, specifically the drop in estrogen just before bleeding begins, drive the timing.
Abdominal Migraine
This type primarily affects children, though it occasionally persists into adulthood. Instead of head pain, it causes recurrent episodes of moderate to severe abdominal pain centered in the middle of the belly. Attacks last 2 to 72 hours and come with nausea, vomiting, and vasomotor symptoms like pallor or dark circles under the eyes. Between episodes, people feel completely normal.
Headache is notably absent during these episodes, which is why abdominal migraine often goes unrecognized. The diagnosis requires ruling out gastrointestinal and kidney conditions first, and at least five attacks must have occurred. Many children with abdominal migraine go on to develop more typical migraine with head pain later in life.
Episodic vs. Chronic Migraine
Any of the types above can be either episodic or chronic. The dividing line is specific: chronic migraine means headache on 15 or more days per month for more than three months, with at least 8 of those days having migraine features. Episodic migraine is anything below that threshold.
This distinction matters because it affects treatment strategy. Chronic migraine often develops gradually from episodic migraine, a process called transformation. Overuse of acute pain medication is one of the most common drivers of this progression. If your headache days have been steadily increasing over months, that pattern itself is worth discussing with a specialist.
Warning Signs That It’s Not Migraine
Not all severe headaches are migraine, and some red flags suggest something more serious is happening. A headache that reaches maximum intensity within seconds (a “thunderclap” headache) can signal a vascular emergency and needs immediate evaluation. Other concerning signs include fever or night sweats alongside headache, new neurological symptoms like weakness or numbness that aren’t part of your established pattern, and headache that clearly changes with body position or straining.
New-onset headaches after age 50 are more likely to have a secondary cause. So are headaches that steadily worsen over weeks, becoming more severe or more frequent without plateauing. New headache during or after pregnancy also warrants evaluation for vascular or hormonal conditions. If your headaches have changed in character, frequency, or severity from your usual pattern, treat that change as meaningful information worth investigating.