The Signs of Migraine (Some May Surprise You)

Did you know that as many as 3/4 of adults worldwide had a headache in the past year? Among these, some of the most debilitating head pain comes from migraine headaches.

According to the Cleveland Clinic, migraine headaches can be triggered by a number of environmental factors, from stress and certain foods to fatigue or lack of sleep. It can also be triggered by other factors that may be surprising and not always as obvious. 

If you experience head pain regularly, documenting not just your symptoms but the scenario preceding your episodes may help determine if it’s migraine or a more typical headache. It can also help to indicate when it’s time to consult a medical professional for advice and treatment of your pain. 

‍Common Signs of a Migraine

Here are some common warning signs that you might be experiencing a migraine:

• Aura precedes onset of migraine by about an hour and can include visual clues, such as flickering lights, spots, or lines. People with sensory aura may experience numbness or tingling, typically on one side of the body.  
• Head pain is the symptom most commonly associated with migraines. Although it can present in a variety of ways, an online survey by the National Migraine Foundation finds that 50% of people with migraine “always” have throbbing on one side of the head, while 34% say they “frequently” experience the pain this way. 
• Eye pain can frequently induce headaches…but sometimes it’s the other way around. A feeling of pain behind the eyes could be migraine pain.
• Neck pain — stiffness or throbbing pain at the back of the neck — may occur at any stage of the migraine. The National Migraine Foundation survey noted that 38% of people with migraine “always” have neck pain and 31% “frequently” do.
• Stuffy nose, watery eyes, or other symptoms typically connected with sinus-related conditions like cold or allergies, often coincide with a sinus migraine. In fact, one large study found that, among people who complained of sinus headaches, nearly 90% were actually having migraines.
• Over-sensitivity to certain stimuli can occur during a migraine episode. For many individuals, bright lights, loud noises and even certain odors can trigger or intensify the pain of a migraine and cause them to seek a dark, quiet environment. 
• Nausea or vomiting are also common symptoms. In the American Migraine Study of more than 3,700 people, 73% experienced nausea during their migraine attacks; 29%, vomiting. 
• Trouble performing day-to-day activities is a common complaint of people with migraine. Some migraines are triggered by exercise or exertion, but during a migraine attack, even simple, routine activities can intensify or aggravate the pain. ‍

Pre-Migraine Signals

If you’re prone to migraines, be aware of some clues that a migraine could be imminent. This prodrome phase can arrive as little as an hour or as much as two days before a migraine attack (yes, even before aura, if you experience that pre-migraine effect).

• Food cravings: Some people yearn for certain foods pre-migraine attack. A common one? Chocolate, according to Dr. Edmund Messina at the Michigan Headache Clinic. 
• Mood changes: Sudden feelings of depression, irritability, or excitement may signal that a migraine is coming. Researchers found that people with depression were predisposed to more frequent migraine attacks.
• Lack of restful sleep: Waking up tired or having trouble falling asleep can be common even in advance of a migraine episode. Some people develop insomnia because of their migraine, which can lead to a relentless cycle of poor quality sleep that can continue to trigger these headaches. 
• Frequent urination: Going to the bathroom more often than normal — sometimes accompanied by pelvic pain — can signal that a migraine is on the way. 
• Excessive yawning: Yawning every few minutes may warn of an oncoming migraine. 
• Speech difficulty: Some individuals with migraine report "brain fog" or difficulty “getting words out” before (and also during) migraines. If you experience this symptom, it may be linked to your headache; however, if you're experiencing it for the first time, contact a doctor to ensure there’s not potentially a separate underlying cause, such as stroke. 
• Weakness or vertigo: Some people report muscle weakness or numbness on one side of the body preceding a migraine attack; some experience vertigo or trouble balancing. Again, these can be signs of something more serious than migraine, so contact a doctor to be sure.

‍Types of Migraine with Unique Symptoms

Less common types of migraines can have unique and sometimes surprising symptoms. Because some may occur without head pain, you may not even realize you’re having a migraine! 

If your symptoms align with one of these migraine types, reach out to a headache specialist for a treatment plan tailored to you. ‍

Menstrual Migraine

Migraines can commonly affect women with menstrual cycles, due to the proven link between migraine and hormonal changes during menstruation. A menstrual migraine can occur during your period; specifically due to the natural drop of estrogen levels at that time. Women with heavier flows and more painful periods have higher levels of the hormone prostaglandin, also found to contribute to menstrual migraines.  

A menstrual migraine typically occurs two days before, or 3 days into, your period and — like migraine episodes in general — can last from under an hour to a couple days. Women with menstrual migraines often also experience migraine at other times of the month as well. ‍

Hemiplegic Migraine

The term hemiplegic indicates paralysis on one side of the body.  Hemiplegic migraine occurs when nerve cells within the brain cannot intercommunicate properly. Although it’s rare, about half of children with a parent who experiences this type of migraine will also develop it over time. 

During a hemiplegic migraine, an individual will experience temporary weakness on one side of the body, sometimes accompanied by common aura symptoms, such as visual spots and lines, as well as speech difficulties, vertigo, hearing problems, and confusion. 

Because temporary paralysis is also a symptom of stroke, it’s critical to seek medical attention immediately to determine what’s causing the paralysis.‍

Vestibular Migraine

This type of migraine is characterized by a sensation of movement called vertigo. Vertigo can be external (feeling like the room is moving or spinning) or internal (feeling as if you’re swaying). Although the sensation can happen spontaneously, it’s usually triggered by your physical position or head movement, or by a visual experience that can make you dizzy. 

An episode of vertigo can last from five minutes to 72 hours and can be quite disabling to anyone experiencing it. To  rule out vestibular disorders, a case of vertigo or dizziness alone should be referred to an ear, nose, and throat specialist, or to a neurologist who specializes in dizziness and balance disorders. But if symptoms of vertigo are accompanied by migraine symptoms (such as head pain, nausea, or sensitivity to light), consult a general neurologist or headache specialist to understand if or how the two are connected.‍

‍Abdominal Migraine

Symptoms include regular episodes of severe stomach pain that cause you to feel nauseous or to actually vomit. Attacks can last from 2-to-72 hours but, in the absence of head pain, you may not realize this is a migraine. 

Abdominal migraine is most common in young people, affecting about 4 in 100 children, although it can affect some adults. While abdominal migraines tend to disappear as children grow, these same kids often develop migraine headaches later in life. Studies show that about 70% of people who experience abdominal migraine also have periods of migraine headache. If you experience both, a headache specialist can determine the connection between the two. 

‍Visual Migraine

During a pre-migraine aura stage, an individual might experience visual symptoms. But it’s also possible to have acephalgic migraine, a visual migraine without a headache. In these cases, visual symptoms are identical to those that usually accompany a migraine aura…except the severe headache never comes. 

In most visual migraines, symptoms can include sparkly or shimmering effects resembling jagged lines or “fireworks,” or even double vision in rare cases. These symptoms typically last 20 to 30 minutes, then resolve completely. However, if you experience this type of visual effects, it’s important to reach out to a medical professional, as these symptoms may also indicate a condition or disorder other than migraine.

‍Finding Relief

Keeping track of your symptoms —  even smaller clues, changes, or patterns — can inform a headache specialist to help diagnose your migraine, triggers, and risk factors, and begin to bring you relief. 

Note the circumstances before and during your headaches, including such details as the foods you've eaten and your physical activity level when you began to feel warning signs. Your specialist will also ask about your medical history, to understand if there is a family history of migraine or to determine if your migraines might actually be secondary headaches caused by an underlying condition. 

Armed with this knowledge, the specialist can tailor treatment individually to you — a critical step, as every person’s migraine experience is unique to them. The right combination of treatments and lifestyle changes can put you on the right track to relief from frequent or severe migraines.  

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