Migraine Symptoms: Signs, Stages, Types and When to Worry
The core migraine symptoms are a moderate to severe headache, often one-sided and throbbing, made worse by routine movement, accompanied by nausea or sensitivity to light and sound, and lasting anywhere from 4 to 72 hours untreated. Around a third of people also get an aura beforehand. Migraine is a whole-nervous-system event rather than just a bad headache, and it often starts a day before the pain and finishes a day after it. Below are the symptoms in full, the four stages, the main types, and the warning signs that need same-day care.
The symptom checklist
Features consistent with the NHS migraine guidance:
- Head pain that is moderate to severe, frequently one-sided, and throbbing or pulsating.
- Worse with routine movement, so climbing stairs or bending forward makes it noticeably worse.
- Nausea, vomiting, or both.
- Sensitivity to light, sound and often smell, which drives the urge for a dark, quiet room.
- Duration of 4 to 72 hours if untreated.
- Cognitive fog, including difficulty finding words and concentrating.
- Neck stiffness or pain, which is extremely common and frequently mistaken for the cause rather than part of the attack.
- Visual aura, in around one in three people.
Migraine affects roughly one in seven people, runs in families, and is around three times more common in women.
A quick self-check
Three questions do most of the work. In the last three months, with your headaches:
- Has a headache limited your activities for a day or more?
- Have you felt nauseated or sick?
- Has light bothered you?
Answering yes to two or more makes migraine likely rather than a tension-type or other headache. This format is close to the screening questions clinicians use, and it is a starting point for a conversation rather than a diagnosis.
The four stages of an attack
Stage 1: prodrome, hours to a day before
The early warning system that most people only recognise in hindsight: yawning fits, unusual tiredness or a strange surge of energy, food cravings (chocolate is famous, and often blamed as a trigger when it was actually a warning sign), mood shifts, a stiff neck, and passing more urine than usual.
Stage 2: aura, around one in three people, 5 to 60 minutes
Visual disturbances are the most common form: shimmering zigzags, blind spots, or sparkles spreading across the vision. Less commonly, spreading tingling in a hand or the face, or difficulty finding words. Aura is fully reversible and evolves gradually. Sudden loss of vision or speech is a stroke question rather than a migraine question and needs emergency care.
Stage 3: headache, 4 to 72 hours
The throbbing, movement-hating, light-averse phase, with nausea and a profound uselessness that is hard to explain to an employer. Some attacks, particularly in children, feature prominent nausea and abdominal symptoms with modest head pain.
Stage 4: postdrome, up to 48 hours
The migraine hangover: drained, foggy, tender-headed and washed out. This is part of the attack rather than a personal failing, so plan around it where you can.
Types of migraine
| Type | What distinguishes it |
|---|---|
| Migraine without aura | The most common form. Headache and associated symptoms with no preceding visual or sensory disturbance |
| Migraine with aura | Reversible visual or sensory symptoms in the hour before the headache |
| Silent migraine | Aura with little or no headache, and more common with increasing age |
| Menstrual migraine | Attacks clustered around the drop in oestrogen just before a period, often more severe and longer |
| Vestibular migraine | Dizziness and vertigo dominate, sometimes with little head pain |
| Hemiplegic migraine | Rare, with temporary one-sided weakness. Always needs medical assessment, since it mimics a stroke |
| Chronic migraine | Headache on 15 or more days a month for over three months, with at least 8 having migraine features |
Most people have episodic migraine, meaning attacks on fewer than 15 days a month. If your pattern meets the chronic threshold, it is worth a GP conversation specifically about prevention rather than only treating each attack. The guide to how to stop a migraine covers the difference between rescue and preventive approaches.
Migraine or another headache?
| Feature | Migraine | Tension-type | Neck-driven | Cluster |
|---|---|---|---|---|
| Pain quality | Throbbing, often one-sided | Band-like pressure, both sides | Starts at the neck or base of the skull | Severe, boring pain behind one eye |
| Movement | Makes it worse | Little effect | Neck positions trigger it | Restlessness, pacing |
| Nausea and light sensitivity | Common | Rare | Rare | Watering eye, blocked nostril on one side |
| Duration | 4-72 hours | Hours to days, milder | Varies with neck load | 15 minutes to 3 hours, often in clusters |
Muscular contributors from the jaw, neck and trapezius can trigger headaches or masquerade as them, which is where physiotherapy earns a seat at the headache table.
Common triggers
Triggers stack, so two together frequently tip a threshold that neither would cross alone. The ones that show up most reliably in headache diaries:
- Disrupted or irregular sleep, including lie-ins.
- Skipped meals and dehydration.
- Stress let-down, which is why weekend migraines are so common.
- Hormonal shifts, particularly around menstruation.
- Alcohol, especially red wine.
- Bright or flickering light, and strong smells.
- Weather changes, reported often, though harder to act on.
A two-month diary noting sleep, meals, stress and attack timing is more useful than any list, because it identifies your pattern rather than the average one.
When to see a GP, and red flags
Book a GP appointment if attacks happen more than a few times a month, if they are getting worse, if you are using painkillers on ten or more days a month, which can itself cause medication-overuse headache, or if your usual treatment has stopped working.
Seek same-day medical care for: a thunderclap headache that reaches maximum intensity within seconds, a headache with fever and a stiff neck, new neurological symptoms such as weakness or speech difficulty, headache after a head injury, a brand-new headache pattern over the age of 50, or a headache that is consistently worse when lying down or on coughing.
FAQ: migraine symptoms
What does a migraine feel like?
Usually a deep throbbing on one side of the head that intensifies when you move, alongside nausea and a strong pull towards darkness and quiet. Many people also describe fogginess and difficulty finding words.
How long does a migraine last?
Four to 72 hours untreated for the headache phase, with warning symptoms up to a day beforehand and a recovery phase of up to 48 hours afterwards.
How do I know if it is a migraine or just a headache?
Nausea, light sensitivity and pain that worsens with routine movement are the three features that most reliably separate migraine from a tension-type headache.
Can you have a migraine without a headache?
Yes. Aura can occur with little or no head pain, which is often called silent migraine and becomes more common with age. First-ever visual disturbances still need assessment to rule out other causes.
How many migraine days count as chronic migraine?
Fifteen or more headache days a month for at least three months, with at least eight showing migraine features. Below that it is episodic, even when frequent and disruptive.
Can neck problems cause migraines?
Neck problems can produce their own headaches and can act as a trigger, and neck pain is also a common part of a migraine attack itself. Sorting out which is which is a large part of what an assessment is for.
When should I worry about a headache?
Sudden thunderclap onset, fever with a stiff neck, new neurological symptoms, headache after a head injury, or a new pattern over 50. Any of these need same-day medical care.