Knowing the typical migraine symptoms is important. First, it will help you determine your course of treatment—both to relieve your pain and help prevent future attacks. Second, a severe headache may also indicate another, more severe and even life-threatening condition that requires immediate medical attention.
Migraines are primary headaches. They are not symptomatic of injury, illness or an underlying medical problem. Migraine symptoms typically progress through four phases—although not every migraine sufferer experiences all of them: prodrome, aura, attack and postdrome. Further, many of the symptoms associated with one phase also may occur during other stages.
Phase 1: Prodrome
The warning signs that a migraine is coming on may begin minutes, hours or even a day before an attack starts. Many migraine sufferers will experience some combination of prodrome symptoms, but the exact symptoms will vary by individual. Here is a list of some of the more common symptoms:
- Mood changes—you might experience depression or irritability.
- Energy level changes—some people have greater energy (hyperactivity) before a migraine attack; others become very sleepy.
- Restlessness—you may feel unable to settle down, accompanied by a heightened sense of nervousness.
- Food cravings—not only might you feel unusually hungry, but you may also find you crave certain foods, especially chocolate and carbohydrates.
- Lost appetite—some people report they have little to no desire to eat before a migraine attack.
- Excessive thirst—since dehydration is a possible migraine trigger, being thirsty may be your body telling you to drink water.
- Frequent urination—while frequent urination may be a migraine symptom, it also can be an indicator of other medical disorders, including diabetes.
- Neck pain—the pain is typically in the base of the neck and radiates up into the head.
- Speech difficulties—Called aphasia or transient aphasia, this is a temporary loss of your ability to speak in clear, intelligible sentences. It may also include a sense of confusion. In migraine patients, aphasia often accompanies an aura. If speech difficulties accompany the sudden onset of a severe headache, this may be an indicator of something more serious, such as a stroke.
Phase 2: Aura
As with many aspects of a migraine, the cause of aura is not entirely understood. The exact percentage of migraine patients that experience a migraine aura is not defined, but the International Headache Society’s classification puts it at 25-30%.1 If you are among them, you may see spots, streaks or flashes of bright light and blind spots in vision. The aura phase may occur anywhere from minutes to an hour before a migraine attack begins. Other possible symptoms during this stage include:
- Tingling sensation in hands, arms or face
- Possible numbness in one hand
- Muscle weakness
Phase 3: Attack
The symptoms directly associated with a migraine attack are the most debilitating and may last up to 72 hours. While your symptoms may vary, here’s a list of common symptoms associated with a migraine attack:
- Moderate-to-severe throbbing or pulsating headache pain
- Pain on one (unilateral) or both (bilateral) sides of head
- Pain behind the eye
- Sensitivity to bright lights, loud noise and some odors
- Nausea and vomiting
- Temporary weakness in the arm or leg on one side of the body
- Tingling in face, arms and shoulders
- Blurred vision
- Difficulty concentrating
- Sinus symptoms (stuffy nose, clear nasal drainage), droopy eyelids and watery eyes
- Vertigo, dizziness or double vision (symptoms of a basilar-type migraine)
Phase 4: Postdrome
After a headache subsides, you may feel relieved. But often your relief is accompanied by a loss of energy, trouble concentrating and fatigue. You may describe your condition as being “wiped out” or depressed. Postdrome symptoms can feel similar to a hangover. However, some sufferers have the opposite response and may feel an emotional high or euphoria.
Your migraine symptoms may vary. Keep a journal of your experiences during each of the four phases of your migraines and discuss them with your physician to determine your best course of treatment.