Migraine Signs and Symptoms

Migraine Signs and Symptoms


The hallmark symptom of Migraine is the headache, but the pain of this headache is often misunderstood. Pain, although frequently unilateral and reported as behind the eye, can be manifested anywhere in the face, head or neck. The pain can also move to different locations within the same migraine attack.


Migraine often causes heightened sensitivity to various types of external stimuli, such as sensitivity to light (photophobia), sensitivity to sound (phonophobia), sensitivity to smell (hyperosmia), and others. 


Some common migraine symptoms cause people to mistakenly believe they are instead suffering from a “sinus headache.” In fact, Migraine can very often cause both a pressure type pain in the maxillary sinus area, and nasal congestion or watery nasal drainage. Almost 90% of people who believe they are experiencing sinus headache are actually suffering from migraine! As a general rule, if you are not experiencing a high fever your symptoms are almost certainly not a “sinus headache.”


Nausea (with or without vomiting)

Neck pain


Trouble concentrating



However, this list is very far from exhaustive. A full list of possible migraine symptoms would be many pages long, because:


Current medical thinking suggests that internal factors (stress, hormones, illness) and/or external factors (weather, loud noises, certain foods or alcohol) can somehow “trigger” a reaction in the brain. This reaction involves the trigeminal nerves of the face, the blood vessels in the lining of the brain (meninges), the thalamus, the hypothalamus, the brain stem and the cervical nerve root (which is why many experience neck pain with their headaches.)

As the reaction begins, chemical reactions in the brain cause vasodilation of the blood vessels, activation of the trigeminal nerves, and inflammation. This process causes pain in the head and neck and other associated symptoms. If this process is not interrupted with an intervention (behavioral or pharmaceutical), the process continues and the brain becomes hypersensitive.

Scientists believe that people who experience migraines may do so because their brains are hypersensitive to stimuli from the environment (internal and external factors), resulting in a lower resistance to common migraine triggers. Thus, every patient will experience migraine differently, as migraine can present a wide variety of causes, triggers, and symptoms. For example:


Jane never gets nausea with any of her headaches, but she does experience sensitivity to light and noise. Some of her migraines are pounding, but others feel like squeezing or pressure. She reports no dizziness, but lots of fatigue with her attacks. Some of her attacks are severe and require bed rest in a dark room (usually when she is on her menstrual cycle), but with most attacks she can push through and try to function at work or social events. Her migraine attacks can last 3 days. Sometimes her attack medication works well, but sometimes it only dulls the pain. 


John reports that he experiences nausea, but only vomits with some of his headaches. He reports dizziness with most of his headaches, but no visual symptoms such as aura. His headaches are always located behind his right eye and cause a stabbing pain. They last at least 24 hours if he does not treat them at the earliest onset of the attack. He reports that excessive stress is usually a trigger, and he avoids sugar because he feels that it may also be a trigger. 


Their symptoms and triggers differ significantly, but both patients are suffering from the same headache disorder. This uniqueness in presentation is what can make migraine so difficult to correctly diagnose. Remember that consulting a qualified headache specialist is a critical step in receiving appropriate treatment for migraine, precisely because symptoms and triggers can vary widely as shown in these two examples.

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