Migraine Symptoms

It is important to note that migraine symptoms vary widely from patient to patient. One person may have the onset of a migraine and be able to take an over the counter medication and get back to work. Another may be so incapacitated that they need to be hospitalized undergoing powerful IV medications to get relief.

Migraine symptoms often evolve over the course of hours or days. Scientists have divided the phases of migraine into the prodrome (symptoms occuring before the actual head pain), the attack itself, and the resolution (symptoms that occur as the headache is winding down).

The Prodrome

The prodromal phase can occur hours to days prior to the onset of head pain. Not everyone has these symptoms, but many complain about vague symptoms such as feeling depressed, hyperactive, elated, irritable, or drowsy. Patients may have difficulty concentrating, or begin to experience some migraine symptoms such as sensitivity to light or sound. Many more sympoms have been described. For each patient they are consistent (but may differ between patients). The fact that many patients identify prodromal symptoms demonstrates that the process of getting a migraine probably starts long before the head pain occurs.

The Migraine Attack

Migraine attacks vary in intensity and quality among patients. Often headaches are on only one side of the head, but occasionally head pain will be all over and on both sides. Many of my patients report onset of neck pain that slowly moves up to the head culminating in a severe headache. If severe, the pain is often throbbing or pulsating.

Not all patients have all symptoms, but possible associated symptoms include: nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), or sensitivity to smells (osmophobia). Many patients feel that the head pain is worsened by even minor physical activity. Bending forward while standing may also exacerbate the symptoms. Many patients report that complex visual scenes (such as looking at a crowd of people or looking at rapidly changing scenes on the television) causes visual irritation and they must avert their eyes.

Patients may feel very confused during their migraine (confusional migraine), be unable to concentrate, and simply want to retire to a dark, quite room and try to sleep. Many patients also feel irritable, anxious, fatigued, and a sometimes dizzy. Areas of the scalp may feel tender to the touch and can actually be swollen.

The Resolution

As the headache is winding down (sometimes hour to days after onset) patients often feel fatigued, irritable, or even depressed. They often lack the energy to complete activities. They may continue to have poor concentration and scalp tenderness. Occassionally a patient (the lucky ones) may feel refreshed and euphoric at this stage.

Migraine Auras

In about 10% of patients, a migraine aura occurs just before or during the head pain (rarely after the pain). They typically last between 15 minutes to an hour. The most common migraine auras are visual. Classically, patients experience an area of complex visual changes (colors, flashing lights, geometric forms) that may increase in size over minutes. Often in the center of these expanding regions there is a ‘black’ area where vision is absent (amblyopia). While this is a classic aura, there is a tremendous variety of visual auras.

Other types of auras also occur. The next most common aura involves numbness and tingling. This typically first involves the hand and then spreads over minutes to involve the arm, neck, face, lips, and tongue. Again this may last 15-60 minutes.

Many other types of auras can occur but are far more rare. This includes speech disruption or slurred speech, extra movements, or difficulty walking with poor balance.

To review migraines that are associated with weakness on one side of the body, see Hemiplegic Migraine.

To review migraines that are associated with aura that involves dizziness, slurred speech, numbness and tingling on both sides of the body, confusion, and sleepiness, see Basilar Artery Migraine.
To review migraines or headaches that are associated with double vision, see Ophthalmoplegic Migraine.

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