Get control of migraine – symptoms, causes and what helps

What’s the difference between a headache and a migraine?

 Causes of migraines

 What can trigger a migraine?

 What are the symptoms of a migraine attack?

 What do women say migraine feels like?

 Different types of migraines explained

 Working with your doctor to diagnose migraines

 Treatments from your doctor

Did you know that migraine is the leading cause of disability worldwide in women aged under 50? And in a study of 1161 people with migraine across 7 countries – almost 79% of whom were female – 28% were aware they get migraines and 64% called their migraine ‘headache’.  


With other figures showing that 3 times more women live with migraine than men, clearly it’s time to take control of migraine. In this article, we’ll uncover the difference between a headache and a migraine, the causes of migraines, and the answer to the important question of how long do migraines last?

## What’s the difference between a headache and a migraine?

“A key difference is that headache is just 1 symptom of migraine – it’s not the whole story,” says Dr. Ann Nainan, family doctor and Healthily expert. “Migraine is a neurological condition that’s more complicated.”


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###  How long do migraines last?

There are 4 phases of a migraine. You might not go through every phase and every migraine attack can be different.  

An entire migraine attack can last from a bit more than a day to slightly more than a week – but they’re not typically that long. Generally, a migraine attack lasts 1–2 days. 

The 4 phases of a migraine are:

1. __Prodrome migraine – the ‘pre headache’__ 

__How long it lasts:__ Several hours to several days

__What to expect:__ Symptoms can appear up to 72 hours before the actual migraine kicks in. These symptoms can include:

- fatigue and yawning
- irritability or changes in mood
- difficulty concentrating
- food cravings
- stiff neck

If you tend to get prodrome with your migraines, you may be able to prevent a headache developing by taking medication and avoiding triggers during this phase. Read more in our [migraine prevention article](/self-care/how-to-prevent-migraines). 

2. __Aura – symptoms before an attack__

__How long it lasts:__ 5–60 minutes. But for about 20% of people, aura can last longer than 60 minutes.

__What to expect:__ Around 25% of people with migraines experience aura – symptoms that happen before an attack. Aura symptoms may include:

- flashes of light, dark or colored spots, sparkles or zigzag lines in your vision
- blind spots in 1 or both of your eyes – this is where a small spot in your vision blanks out and the blind spot can get larger
- tingling in your hands or face
- temporary blurred vision or loss of vision in both eyes

“A migraine aura without headache is possible – but auras do typically happen before the headache phase so the aura can be a warning sign to you that a headache is coming,” says Dr. Ann. 

Migraine with aura sometimes gets mistaken for an ocular migraine – find out about the difference here.  

3. __Headache – the migraine attack itself__

__How long it lasts:__ 4–72 hours

__What to expect:__ It’s most common to get pain on 1 side of your head, but it can shift to the other side, or happen on both sides. Find out more about the symptoms of this phase in ‘what are the symptoms of a migraine attack?’

4. __Migraine postdrome – ‘the hangover’__

__How long it lasts:__ 24–48 hours 

__What to expect:__ Sometimes called the ‘migraine hangover’, you might get fatigue, body aches, dizziness, trouble concentrating and sensitivity to light. 

Even though the headache is over, some people find that postdrome can be just as debilitating. You may benefit from avoiding triggers during this time and you may get relief from relaxation techniques such as yoga. Find out more about treating a migraine as it’s happening in our article, [How to get rid of a migraine](/health-library/treatments/how-to-get-rid-of-a-migraine).


#### What does it feel like to go through migraine phases?

This quote from the [National Migraine Centre’s](https://www.nationalmigrainecentre.org.uk/understanding-migraine/what-is-migraine/) website sums up a migraine attack, day by day:

“When I get a migraine, it makes me very ill and really puts me out of action. I can feel it coming on and then the full-blown migraine emerges and I feel terrible. As the second day progresses, the pain finally begins to lessen. The third day leaves me with a vague pain and feeling absolutely shattered.”

#### Status migrainosus

Status migrainosus is a particularly severe and long-lasting migraine headache. Although you can prevent them with the right treatment, attacks can last longer than 72 hours. If you have one you might sometimes need hospital treatment because symptoms can be severe. 

##  Causes of migraines

“We don’t yet know the actual cause of migraines,” says Dr. Ann. 

But there are theories about how and why migraine pain happens: 

- it’s understood that chemicals and hormones, such as serotonin and estrogen, can play a part in pain sensitivity if you experience migraines 
- migraine pain may happen because of waves of activity by groups of brain cells. These trigger chemicals such as serotonin to narrow your blood vessels
- when serotonin or estrogen levels in your body change, the result for some people can be migraine

What we do know for sure is that there are risk factors that might make you more likely to get migraines.

###  Who is most likely to get migraines?
Migraines are the third most common illness in the world. They affect around 39 million Americans and a massive 1 billion people across the globe. Here’s who is most at risk of getting them:

- __females__ – 3 times more women live with migraine than men. Scientists are investigating the link with hormonal changes each month and through life stages like puberty and menopause 
- __middle-aged adults__ – They’re most likely to happen between the ages of 25 and 55 years
- __people with certain health issues__ including obesity, diabetes, cholesterol levels that are out of balance (known as dyslipidemia), and high blood pressure, as well as stress, anxiety and phobias, may be more likely to have migraines
- __people with certain genes__ – Some genes are linked to an increased risk of migraines

###  Why do more women get migraines than men?

“We don’t know exactly why this is but most theories put it down to hormonal differences and changes that women experience,” says Dr. Ann.

Research suggests the link between female hormones and migraines is based on:

- the way the hormone serotonin, which is thought to be a trigger for migraines, interacts with female hormones
- changing levels of estrogen which has 3 effects:
1.  60% of women who get migraines have menstrual migraines that happen before, during or just after your period or while you’re ovulating
2.  migraines can get worse in the lead-up to the menopause when estrogen levels go up and down
3.  women who take oral contraceptives containing estrogen may also be vulnerable to hormonal migraines. Headaches are common in the first few months of starting estrogen-containing contraceptives and migraine attacks tend to be more likely in the hormone-free week

Jelena Pavlovic, a neurologist at the Montefiore Medical Center in New York City, thinks gender bias is to blame for the knowledge gap on why women are more likely to get migraines.

“If migraine affected men at the same rate, we would have much better studies,” says Pavlovic. “A lot of the biases and stigma associated with migraine have to do with it being a disorder of women.” 

##  What can trigger a migraine?

“People with migraines usually have their own particular triggers,” says Dr. Ann. “These could even be shaped by your genes making you more likely to react to a specific trigger.”  

The triggers you react to can change as you get older.  

Keeping a diary to track symptoms and triggers can help you work out what your triggers are, so you can avoid them and help cut your risk of having an attack. 

You can also use the Healthily app tracker tools to help you do this.

Common triggers include:

- stress (good or bad)
- foods such as chocolate and cheese
- skipping meals
- alcohol
- sleeping too much or too little
- changes in weather or barometric pressure
- hormonal changes in women (such as menstrual cycle, menopause or taking oral contraceptives)
- concussion or traumatic brain injuries

###  Can stress cause migraines?

“Patients often ask me about stress and migraines,” says Dr. Ann. “Stress is a common trigger of migraines, but like all triggers, it’s not the cause – in other words not everyone who has migraines has them due to stress.”

- around 70% of people with migraine say stress is a trigger, and worrying about that can also create more stress
- some research has found that stressful life events – such as moving home or bereavement – can be a risk factor for developing chronic migraine (this is where you have headache on 15 or more days a month, and at least 8 of those headache days have migraine features)
- did you know that release from stress can also trigger a migraine? It’s known as a ‘let-down migraine.’ This is when your migraine kicks in once you’ve stopped feeling stressed
- so why would stress release trigger migraine? Researchers think it may be down to the stress hormone cortisol which rises when you feel frazzled and falls when you’re relaxed. Constant fluctuations in your cortisol levels can trigger a migraine attack

To find out about managing stress, read our article on migraine prevention.


##  What are the symptoms of a migraine attack?

Symptoms of migraines can vary from person to person. The most common symptoms of migraine attacks are:

- intense headache on one side of your head (or both), in or around your eyes or behind your cheeks 
- headache that causes a throbbing, pounding, or pulsating sensation
- head pain that gets worse when you move
- nausea/vomiting
- increased sensitivity to light, noise or smells

“Some people ask about less common symptoms because a migraine can feel so overwhelming and it’s hard to know what is due to migraine and what isn’t,” says Dr. Ann.

###  Can migraine cause fever?

No, migraine doesn’t cause fever. If you experience, or someone else experiences, a headache with fever and other symptoms such as a stiff neck and confusion, this could be a sign of something more serious and you should get emergency medical attention.  

###  Can migraines cause dizziness?

Yes, they can. You might get dizziness during the postdrome phase which comes after the actual headache. Dizziness can also be a symptom of vestibular migraine. 

##  What do women say migraine feels like?

Anyone who’s had a migraine or gets them regularly will know how bad they are, but it can be hard to get across just how painful and debilitating they really feel. 

“It can be easy for people who haven’t had one to think it’s just a headache and not understand how migraine stops someone in their tracks,” says Dr. Ann.

If you’re wondering whether you might get migraines, or you want to explain to people in your life what it’s like, or help explain to your doctor how much it affects your life, here’s how some women have described their migraine attacks online:

“The top of my skull feels like it’s being pressed down on”

“The first symptom is a disturbing aura that takes over my vision. It’s as if there’s a glass shattered in front of me and I can’t see. My vision literally disappears or I see a psychedelic pattern. That lasts for about 20 minutes”

“I thought I was having a stroke or some kind of brain failure because my vision went out in my right eye” 

Others describe the pain as “stabbing”, “intense” and “pounding” 

###  Celebrities with migraines

- __Serena Williams__’ migraines updates appeared in the press when she said she realized stress "or just overworking at my computer" was a major trigger. She says she gets “throbbing pain” and that until she found the right treatment for her, the migraines were “debilitating and…really awful to deal with"

- __Khloe Kardashian__ migraine updates appear regularly in the media. She previously tweeted: “I wish people understood how debilitating migraines can be. I get so frustrated when people tell me to push through and it’s just a bad headache. If only they knew!! That feeling is torturous and indescribable”

- __Comedian Whitney Cummings__ speaks out about her migraines on Twitter and in interviews. Managing to get them diagnosed and under control, she told People Magazine: “I remember being like, do people just move through the world without a throbbing head? The absence of migraines felt like an opioid. That's how wild it was”


##  Different types of migraines explained

There are different kinds of migraines that can give you different symptoms and you may need specific treatments. Keeping a symptom diary can help you and your doctor work out which kind of migraines you have.

###  Ocular migraine

- [ocular migraine](/health-library/conditions/retinal-migraine) – also called retinal migraine – is rare. Symptoms can be similar to the aura stage of a migraine, so it can be hard to tell the difference. But ocular migraine doesn’t usually last as long as aura and it usually only affects one eye
- it causes short attacks of blindness in part, or all, of one eye 
- some people also get flashing lights or blurring of parts of their vision
- it happens a few times in a day and lasts from around 5-20 minutes
- these symptoms are usually followed by a headache within an hour of getting them
- vision returns to normal after the attack
- losing sight in one eye could be a sign of something more serious. If your eyesight suddenly deteriorates or you lose vision in one eye, particularly if it’s the first time it’s happened, go to the emergency department 

###  Menstrual migraines

Research shows that almost 2 in 3 women with migraines get them around the same time as their period. These menstrual migraines:

- can come on between the 2 days before, and day 3 of, your period
- can be more severe, last longer and are more likely to happen again the next day than attacks that happen outside your period 
- tend to cause greater light sensitivity than migraines you get at other times of month. They usually happen without aura 
- are thought to be caused by a rapid drop in estrogen levels that happens just before your period
- can be less responsive to treatment. It’s not clear why but it may be because of estrogen’s effects on other chemicals. Read about treating menstrual migraine in our article, how to prevent migraines. 

#### Are migraines linked to hormonal or menstrual conditions?  

Here’s what the research tells us:

- migraine may share a link with [polycystic ovary syndrome (PCOS)](/health-library/conditions/polycystic-ovarian-syndrome).  A 2021 review of studies says that some disorders, such as sleep apnea and vascular disease, are more likely if you have PCOS – and these disorders might cause migraine (or make it worse) if you have PCOS. But more research is needed to better understand the link between migraine and PCOS
- there may also be a migraine and [endometriosis](/health-library/conditions/endometriosis/#what-causes-endometriosis) connection. A 2020 review of research studies found a significant association between endometriosis and migraine risk. One theory for the link is that endometriosis can stimulate neurons in your brain which may potentially trigger migraine attacks 

#### Menstrual migraine and the menopause

- changing estrogen levels during the perimenopause (the time from when your periods become irregular to when they stop completely) can increase your likelihood of getting menstrual migraine and migraine in general 
- your menstrual cycle may shorten during the perimenopause and this can lead to more menstrual migraines 
- once your periods stop with menopause you may find that your migraines also stop – but it’s not immediate. That’s because your ovaries can still produce different levels of estrogen for several more years

Read more about hormonal headaches in perimenopause. 

###  Vestibular migraine

- vestibular migraines are rare but they affect 5 times more women than men
- during an attack you may get vertigo – a feeling that you’re falling, spinning or moving, even though you’re still – dizziness and/or balance problems 
- these migraines don’t necessarily include headache
- you can still experience light sensitivity and also ear pain or pressure 

Other symptoms can include those which you’d get with other types of migraine, such as:

- brain fog 
- fatigue 
- diarrhea 
- excessive yawning
- tingling 
- visual blurring 
- sweating

You may also get symptoms which are unique to vestibular migraine, such as:

- motion sickness
- dry mouth
- scalp tenderness

See a doctor urgently if you experience sudden dizziness or scalp tenderness for the first time. 

###  Abdominal migraine

- abdominal migraine – or stomach migraine – causes stomach ache, nausea and vomiting rather than head pain. Experts aren’t sure what causes these migraine attacks 
- they mostly affect children aged between 7–10 and they’re more common in girls
- they usually stop once children become teenagers 
- they can be hard to diagnose – so keep a symptom diary and give as much information as you can to your child’s doctor
- they can be hereditary. if you’re worried about your child’s stomach aches and migraine-like symptoms, talk to your doctor and mention if you have a family history of migraine 
- they can lead to typical migraines. 50-70% of children either have typical migraines at the same time or go on to develop them as teenagers 

#### Symptoms of abdominal migraine 

- moderate to severe pain in the middle of your stomach around your belly button
- loss of appetite
- nausea
- vomiting
- a pale appearance 
- migraine symptoms, like headache and sensitivity to light and noise 

#### Common triggers of abdominal migraine

Studies haven’t found as strong a link between food and abdominal migraines. But there is evidence for:
- stress
- poor sleep
- travel
- motion sickness
- missing a meal


##  Working with your doctor to diagnose migraines

“If you’re regularly experiencing migraine symptoms, or they’re particularly severe, you should see a doctor,” says Dr. Ann. 

Although there’s no specific test to diagnose migraines your doctor should be able to identify them based on your symptoms. 

If you’ve recorded your migraine patterns in a diary, using this information can help you and your doctor work out what’s wrong. 

If you haven’t recorded your patterns, your doctor may ask you to keep track of them. 

Here are some questions recommended by the [American Migraine Foundation](https://americanmigrainefoundation.org/resource-library/what-is-migraine/) which you can try to answer in your migraine diary, to help you get a diagnosis and on track with treatment:

- when did your migraines first begin?
- how many times in a week/month do you get these attacks?
- how severe are they – mild, moderate, or severe?
- what else accompanies the pain – nausea, vomiting, sensitivity to lights or noises?
- how long do they last?
- how much do these attacks keep you from doing activities or stop you from being at your best when doing activities?
- have you ever had a brain CT or MRI?
- what medications or other therapies have you tried?
- do you know of a close relative who’s bad head pain?

##  Treatments from your doctor

Treatment can involve preventing attacks as well as relieving symptoms during a migraine attack. “There is also self-care that includes trigger management,” says Dr. Ann.

To find out about treating a migraine as it’s happening, read our article on how to get rid of a migraine. To stop different types of migraine from happening in the first place, read our article, how to prevent migraines. 

###  When to see a doctor urgently

See your doctor urgently if you:
- develop a new headache and you’re over 50 
- have a tender scalp
- develop a headache that’s not going away or keeps getting worse
- have a migraine or migraine symptoms lasting longer than 72 hours
- have a headache that’s triggered by coughing, sneezing, bending or exerting yourself
- are pregnant and develop a new headache

###  When to call for an ambulance

Call for an ambulance or go to the emergency department immediately if you or someone else experiences:

- paralysis or weakness in one or both arms and/or one side of the face
- slurred or garbled speech
- a very severe headache or the worst headache you’ve ever had
- headache along with a fever, stiff neck, persistent vomiting mental confusion, seizures, double vision or a rash
- sudden blindness in one eye or double vision
- problems with balance or sudden vertigo with a headache
- a bad headache following a head injury
- aura for the first time whilst taking combined hormonal contraception
- aura that lasts longer than 60 minutes or affects only 1 eye
- persistent vomiting
- a severe headache that gets worse on lying down or standing up

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a medical expert as soon as possible.


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References

 Christina Quaine

Colette Harris

Dr Ann Nainan

Article information

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Migraines are tender headaches on one side of the head that have specific triggers and causes nausea and vomiting