What Are Signs and Symptoms of Migraine?

Migraine is associated with a surprising array of symptoms that can vary from person to person or attack to attack. In fact, while some refer to migraine as a migraine headache, a headache is only one of several symptoms people experience. Symptoms of an attack may also change over a person’s lifetime in someone who experiences both chronic and episodic migraine.

Common Signs and Symptoms of Migraine

Below are commonly reported symptoms of migraine.

Sensory Sensitivities

If you are living with migraine, you may experience sensitivity to light, sound, smell, and touch. This means that normal levels of these stimuli are uncomfortable. This sensitivity is why people with migraine typically prefer to be alone in a dark, quiet room during an attack.

When normal touch becomes uncomfortable (a phenomenon called allodynia), you may experience discomfort, typically in the head and neck. Daily activities such as combing your hair, showering, or wearing a necklace become painful.

Nausea and Vomiting

You may experience a change in appetite during attacks and have nausea and vomiting. Severe nausea and vomiting in younger people tend to improve with age. Some people find other attack symptoms, particularly headaches, improve after vomiting.

Migraine Pain

Then, of course, there is the pain. People often report feeling one-sided, severe, and throbbing pain. Sometimes, a migraine attack causes dull pain. Pain is generally made worse by movement.

These features of migraine are highly variable, however. Migraine may be constant and may range in severity from crushing to moderate to mild. Headache pain (often a severe headache) is a common type of pain caused by a migraine attack. That's why people often refer to migraine as "migraine headaches."

Migraine pain may be on both sides of your head or just one side of your head. The most common areas affected by head pain are around the eye, forehead, temple, or back of the head. Migraine may begin in one location and spread to others as the attack progresses. And while a headache is the most common pain people experience during a migraine attack, you may also feel pain in other locations.

Some people also experience neck pain during an attack. Neck pain is common before, during, or after migraine. Neck pain can start hours before migraine pain and last long after migraine resolves. Jaw or shoulder pain is also associated with migraine attacks.

Aura Symptoms

The migraine aura typically refers to symptoms that occur before the migraine but may also occur during the migraine phase. The aura phase affects approximately one-quarter of people with migraine.

Aura symptoms generally last for several minutes up to an hour and then resolve completely. Occasionally, they may last for more than an hour and sometimes even last for days, although that’s rare.

An aura may affect the visual, sensory, language, and/or motor systems. The migraine visual aura has been recorded and documented with paintings and drawings over centuries.

Common migraine aura symptoms include:

• Scintillating scotoma — This symptom refers to a hole in the vision that spreads with a leading edge that is flickering. Sometimes the leading edge is a series of intersecting jagged lines that are either black and white or in color. This is referred to as a fortification spectra, because the intersecting jagged lines may resemble those of a fortress.
• Visual disturbances — This may include flashing lights, tunnel vision, holes in the vision (scotoma), blurred vision, or difficulty focusing.
• Tingling sensation — A sensory migraine aura typically causes a tingling or pins-and-needles sensation. It may also have an electrical quality. The most common locations for these sensory symptoms are the face and arm, although it may occasionally involve the leg and trunk.
• Numbness — In some cases, numbness or the absence of sensation may occur.
• Garbled speech — Language symptoms are described as difficulty finding words or an increased effort required to produce speech.
• Clumsiness or weakness — Motor symptoms include clumsiness or weakness in parts of the body, mostly in the arm and hand. This may manifest as difficulty performing fine-motor tasks, but in severe cases, it may result in significant weakness or even paralysis known as hemiplegic migraine.

There is also a classification of symptoms that may originate in the base of the brain. They are thought to be produced by dysfunction in a part of the brain called the brainstem.

A brainstem aura can result in:

• Dizziness (and vertigo)
• Ringing in the ears (tinnitus)
• Back and forth movements of the eyes (nystagmus)
• Significant incoordination that is not associated with weakness (ataxia)

As with other migraine aura, symptoms are highly variable from person to person and from attack to attack for one person.

Other Symptoms and Signs of Migraine

Other common symptoms reflect changes in different parts of the nervous system:

• Fatigue or an intense need for sleep
• Mental dysfunction such as difficulty concentrating or performing complex cognitive tasks
• Lightheadedness, dizziness, and vertigo
• Mood changes
• Depression and anxiety before or after migraine that may be persistent between attacks
• Ringing in the ears (tinnitus)
• Tearing of the eyes
• Sinus pain
• Diarrhea
• Aversion to odors

While these are the most common migraine symptoms, a migraine attack affects each person differently, with varying degrees of pain and other symptoms. 

How to Watch for Signs of a Migraine Attack

Because migraine attacks cause a wide range of symptoms, it can be hard to know what to look for. Here are some ways you can watch for signs of an impending migraine attack.

Keep a Migraine Journal

It may be helpful to identify and recognize all of your symptoms of migraine, not just headache. By tracking your symptoms, you may be able to predict when a migraine attack is coming on or about to end. You may also be able to detect migraine triggers or other risk factors, such as food cravings that trigger migraine.

Your migraine journal should include the frequency and severity of your symptoms. This information will help guide the most effective treatment plan and help prevent or relieve migraine pain. There are a number of apps that can help track your migraine signs and symptoms, which can easily be shared with your doctor without having to lug a paper journal around.

The various symptoms of an attack may call for different therapies. Recognition of all of the symptoms of migraine helps you better understand the total impact of them on your life so you can better manage this disease.

Recognize Pre-Migraine Symptoms

The prodrome and aura phases of a migraine attack tend to come before the headache phase. The prodrome phase consists of all symptoms that precede headache, except for those defined as aura symptoms (see above). The prodrome phase can begin up to three days before the start of headache pain.

Recognizing these prodrome symptoms gives you the chance to stop an attack before it escalates. Treating the attack early is usually more effective than waiting to treat it.

Prodrome or premonitory symptoms include:

• Excessive yawning when otherwise not feeling tired
• General irritability
• Sensitivity to light, smell, and sound
• Neck soreness

Often, people don’t recognize these as symptoms of migraine. However, studies in which patients were given electronic diaries to record prodrome symptoms indicate that the prodromal symptoms may occur hours before the migraine begins. In some cases, prodromal symptoms can occur even a day or more before the onset of migraine and are often misinterpreted as triggers for migraine attacks.

For example, prodromal symptoms of sensitivity to light, sound, or smell may lead patients to believe that bright lights, loud sounds, or strong smells are triggers for their attacks when, in fact, they’re actually part of an attack that has already started. Recognizing prodromal symptoms may help people better understand whether their migraine triggers include environmental risk factors.

Symptoms to share with your healthcare provider:

• Mental/emotional health issues
• Medication side effects
• Sleep problems
• Nausea
• Vision problems
• Brain fog/cognitive difficulties
• Fatigue
• Dizziness/vertigo

Watch for Different Types of Migraine

The widely variable symptoms of migraine help healthcare professionals accurately diagnose the type of migraine you are experiencing. For example:

• Those with significant weakness associated with migraine attacks are classified as having hemiplegic migraine.
• Those with dizziness and/or vertigo may be classified as having vestibular migraine.
• Those with primarily gastrointestinal symptoms may be classified as having abdominal migraine.
• Those with visual, sensory, language, or motor symptoms before or with a severe headache may be classified as having migraine with aura.

These categorizations based on individual symptoms may be helpful for research purposes. In some cases, specific therapies may be indicated for each symptom group.

It’s important to understand, however, that all of these subclassifications of migraine are still migraine, and most of these different types of migraine include other common migraine symptoms.

Remember That Migraine Doesn’t Always Cause Headaches

Migraine isn’t always associated with headache symptoms. The most obvious example of a migraine attack without headache is migraine aura without an associated headache. You may experience other migraine symptoms, like light sensitivity, cognitive function, and fatigue, but the headache doesn’t occur.

It’s more challenging to understand that symptoms are caused by migraine without headache when the symptoms are less dramatic or definitive than a visual aura.

One example is when individuals have episodic abdominal pain, nausea, and sometimes vomiting but no significant headache. These symptoms respond nicely to migraine-specific therapies, which is a clue that the symptoms are caused by migraine, even in the absence of headache.

An interesting question that is somewhat controversial is whether symptoms like intermittent unexplained fatigue or brain fog could be common symptoms of migraine without headache.

Final Thoughts

Once you learn how to deal with your migraine symptoms more effectively, you’ll discover all the ways migraine impacts the body and mind from classic manifestations to some truly surprising symptoms.

For a complete list of symptoms, see Evil Headache + 39 Other Migraine Symptoms You Need to Know. And for even more facts about migraine, see 35 Eye-Opening Migraine Facts You Need to Know.