Migraine commonly causes moderate or severe throbbing head pain, nausea and sensitivity to light or sound. It can affect one or both sides, and an attack may include symptoms before and after the headache. Some people have aura; many do not. The pattern across attacks matters more than any single symptom. 1234
Get emergency help for a sudden extremely severe headache, new weakness, trouble speaking, confusion, a seizure or sudden loss of vision. Fever with a stiff neck or symptoms after a significant head injury also need urgent assessment. Having migraine does not make a new neurological symptom safe to ignore. 2
What does a migraine feel like?
Pain may pulse or throb and become worse during ordinary activity. Nausea, vomiting and intolerance of normal light or sound can make it hard to work, read or move around. Pain does not have to stay behind one eye or on one particular side. Where the pain occurs cannot, on its own, tell you whether it is migraine. 13
When describing a headache to a clinician, include where it hurts, how long it lasts, other symptoms and whether movement makes it worse.
Stages of a migraine attack
| Part of an attack | Possible experience | What to keep separate |
|---|---|---|
| Before the headache | Changes in energy, mood or concentration | A possible warning is not the same as aura |
| Aura, when present | Temporary visual, sensory or speech-related changes | New neurological symptoms must not be self-diagnosed |
| Headache phase | Pain with nausea or light/sound sensitivity | Head location alone cannot identify migraine |
| After the headache | Fatigue or difficulty concentrating | The end of pain may not be the end of the episode |
Not everyone experiences all of these, and aura can occur without a headache. The sequence can vary between attacks. 12
A headache diary can include when symptoms began, when the pain stopped and when you felt able to return to your usual activities.
How long can a migraine last?
An attack often lasts from several hours to three days. NHS guidance advises urgent medical advice for an attack lasting more than 72 hours or aura lasting over an hour. Symptoms during pregnancy or soon after birth also need prompt assessment. These are reasons to seek help, not targets to wait for when an emergency warning is present. 2
Tell your clinician if the headache has been continuous or if it has stopped and returned.
Migraine aura
Aura may include flashing or changing visual patterns, tingling or temporary speech difficulties. Typical aura usually lasts less than an hour. However, a symptom matching an aura description does not rule out another cause, particularly when it is new or different from the person's established pattern. 23
Seek urgent help for new problems with vision or speech. Do not wait for a headache to follow or assume the symptoms are aura.
What can trigger migraine?
Inherited susceptibility and biological processes contribute to migraine. A trigger is something associated with a particular attack. Sleep disruption, missed meals, stress, hormonal changes and changes in caffeine intake may be relevant, but no universal forbidden-food list explains everyone’s attacks. 35
A diary of symptoms, sleep, meals and medicines may help you and your clinician notice patterns. Include days without a headache too; a single episode does not establish a trigger.
How is migraine diagnosed?
Assessment considers the history, recurring pattern and examination. Tests may be needed to investigate other causes, but a scan is not automatically required for every familiar recurring headache. 1
Before an appointment, note how many days you have headaches, which days you take medicine and how symptoms affect daily life. Mention anything that has changed from your usual pattern.
Common questions
Can migraine affect both sides of the head?
Yes. One-sided pain is common, but both sides can be affected. Neither one-sided nor two-sided pain establishes the diagnosis. 4
Can you have migraine without aura?
Yes. Aura is not required, and its absence does not make an attack unimportant. 1
What treatment is available?
Migraine treatment can help relieve an attack or reduce future attacks. Our migraine treatment guide explains the difference. You can use the appointment worksheet to prepare questions for a routine visit; do not delay urgent care to complete it.
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