Migraine is not just a bad headache. It’s a disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders. The American Migraine Foundation estimates that at least 39 million Americans live with migraine, but because many people do not get a diagnosis or the treatment they need the actual number is probably higher.

What Are the Common Symptoms of Migraine?

How can you tell if your head pain is actually migraine? The symptoms vary from person to person. But if you agree with some or many of the statements below, your head pain may be migraine and you should think about seeing a doctor.

• Your head pain is moderate or severe and often intense. The pain may be hard to endure and may be unbearable.
• The pain may be on one side or the head or both. It could be in the front or in the back. Some patients experience migraine in or around their eyes and behind their cheeks.
• Your head pain causes a throbbing, pounding, or pulsating sensation.
• Your head pain gets worse with physical activity or any movement.
• You experience nausea and/or vomiting
• You are sensitive to light, noise and/or smells.
• Your head pain is severe enough to make you miss school, work or other activities (or it keeps you from being at your best when you do those activities).
• A migraine attack lasts anywhere from four hours to several days.

Some people have migraine with aura. The most common type of aura is visual (flashes of light, blind spots, shapes or bright spots). Aura can also cause blurred vision or loss of vision. Typically, aura occurs before the head pain of the attack begins, and fully resolves in an hour or less.

Migraine can be classified as episodic or chronic. People with episodic migraine have 14 or fewer headache days per month. People with chronic migraine experience more than 15 headache days per month (for three or more months) with at least eight that include migraine features (see above). In some people, episodic migraine can become chronic, which may happen if it’s not recognized and treated correctly.

What Does An Attack Look Like?

There are four distinct phases of a migraine attack: prodrome, aura, headache, postdrome. You don’t have to experience all the phases. In fact, only about 20% of people with migraine have an aura. Understanding the phases can help you manage the disease better.

The prodrome and aura phases usually occur before the headache develops. Prodrome may precede the migraine attack by several hours or even days. Typical prodrome symptoms include extreme tiredness and yawning, irritability or moodiness, difficulty concentrating, and food cravings. About 75% of people with migraine experience a prodrome—but often they don’t recognize it as the beginning of an attack. Aura is rarer and usually begins just before the headache starts. Most people experience changes in their vision, while others notice tingling, numbness or trouble speaking.

These symptoms can serve as a warning sign and allow you to take acute medication before the headache begins. Identifying and treating a migraine early can even help prevent further symptoms in some people.

The headache phase of an attack typically involves pain on one or both sides of the head and lasts from several hours to three days but can also include nausea, vomiting or sensitivity to lights and noises. The final phase of an attack, called postdrome, is also sometimes called the “migraine hangover” and 80% of people with migraine experience it. Symptoms of postdrome include fatigue, body aches, trouble concentrating, dizziness and sensitivity to light.

What Causes Migraine?

The causes of migraine aren’t really clear, but genetics and environment do play a role. Migraine often runs in families, so there’s likely a hereditary link.

Most people with migraine will have spontaneous attacks, meaning there is nothing they did or didn’t do to trigger the attack. This is just how the disease behaves. Some people will have attacks that have an identifiable cause. Everyone has different triggers. But there are a few common culprits that affect a large number of people. Common triggers include stress (good or bad), certain foods, skipping meals, alcohol, sleeping too much or too little, changes in weather or barometric pressure, hormonal changes in women, concussions and traumatic brain injuries.

While migraine can affect people of any gender, sex, age, race, ethnicity, or background, it’s especially common in women. Three times more women live with this disease than men, and research shows that hormones play a role. Girls are more likely to start experiencing attacks when they get their first period, and migraine in women is most common during their childbearing years.

How Is Migraine Diagnosed?

There’s no blood test or scan (ultrasound, CT scan, or MRI) that will tell your doctor if your head pain is migraine. The only real way for your doctor to know is to talk to you. They need to get information about the specifics of your head pain, your response to current and previous treatments, your family history, and how your head pain affects your daily functioning and quality of life.