Headaches are among the most common health complaints of all. But not every headache is the same: while tension-type headaches are usually perceived as unpleasant but bearable, a migraine attack can significantly disrupt daily life for hours or even days. Knowing the typical migraine symptoms makes it easier to interpret your complaints and to seek targeted medical advice.
What is migraine?
Migraine is a distinct neurological condition that occurs in attacks. In Austria, it is estimated to affect around 10 to 15 per cent of the population, with women being affected more frequently than men. Characteristic features are recurrent headache attacks that are often accompanied by additional symptoms such as nausea and sensitivity to light or noise.
The exact causes are still not fully understood. A genetic predisposition, changes in the balance of certain neurotransmitters (e.g. serotonin) and a temporary hyperexcitability of nerve cells in the brain are currently being discussed.
Typical migraine symptoms at a glance
The complaints of a migraine differ significantly from those of an ordinary headache. The characteristic features include:
- One-sided pain: The pain often affects only one side of the head, but it may switch sides.
- Pulsating, throbbing character: The pain is often described as hammering or pounding.
- Moderate to severe intensity: The symptoms often clearly interfere with everyday activities.
- Aggravation by movement: Climbing stairs, bending down or physical exertion typically make the pain worse.
- Accompanying symptoms: Nausea, vomiting, pronounced sensitivity to light (photophobia), noise (phonophobia) or smells (osmophobia).
- Duration: An untreated attack usually lasts between 4 and 72 hours.
The four phases of a migraine attack
Many sufferers go through several phases during an attack, although these are not always equally pronounced.
1. Prodromal phase
Non-specific signs may appear hours or even days before the actual attack:
- Mood swings, irritability or low mood
- Cravings or loss of appetite
- Tiredness, yawning, difficulty concentrating
- Neck stiffness
2. Aura phase
About 15 to 20 per cent of people with migraine experience what is known as an aura. It usually occurs before the headache, typically lasts 5 to 60 minutes and mainly manifests as:
- Visual disturbances: Flickering, flashes of light, zigzag lines or temporary loss of areas of vision
- Sensory disturbances: Tingling or numbness, frequently in the hand and face
- Speech disturbances: Difficulty finding words
3. Headache phase
In this phase the typical one-sided, pulsating pain is to the fore, often accompanied by nausea and sensitivity to stimuli. Many sufferers retreat to a darkened, quiet room.
4. Postdromal phase
After the pain has subsided, many sufferers still feel exhausted, irritable or unable to concentrate for several hours – similar to the aftermath of a flu-like illness.
Migraine or headache? Distinguishing it from tension-type headache
The question "migraine or tension-type headache?" can be clarified using several features. Tension-type headaches are the most common form of headache and differ from migraine in many respects.
Location and character of pain
- Migraine: usually one-sided, pulsating, throbbing
- Tension-type headache: usually on both sides, pressing or pulling, often like a "tight band" around the head
Pain intensity
- Migraine: moderate to severe, often markedly restrictive
- Tension-type headache: mild to moderate, everyday activities usually still possible
Behaviour during movement
- Migraine: worsens with physical activity, need to rest
- Tension-type headache: no worsening with movement; light activity may even bring relief
Accompanying symptoms
- Migraine: nausea, vomiting, pronounced sensitivity to light and noise, sometimes aura
- Tension-type headache: no or only mild accompanying symptoms, rarely nausea
Duration and frequency
- Migraine: 4 to 72 hours per attack, attacks occurring at irregular intervals
- Tension-type headache: 30 minutes to several days; may also be chronic, occurring on many days per month
Possible triggers of a migraine
Certain factors can encourage an attack, but they vary considerably from person to person. A headache diary can help to identify personal triggers. Commonly mentioned triggers include:
- Stress or the relaxation phase after it ("weekend migraine")
- Changes in the sleep–wake rhythm
- Hormonal fluctuations, for example around menstruation
- Changes in the weather
- Certain foods and drinks (e.g. red wine, matured cheese, chocolate)
- Skipping meals, insufficient fluid intake
- Flickering light, intense smells
When you should seek medical advice
Recognising migraine is the first step towards targeted treatment. Medical assessment is particularly advisable if:
- Headaches occur for the first time at an older age
- The complaints clearly increase in frequency or severity
- Painkillers are taken on more than 10 days per month
- Neurological symptoms such as paralysis, persistent visual disturbances or speech disorders occur
- The headache starts suddenly and very intensely like a "thunderclap headache"
The latter can indicate a serious underlying cause and should be investigated without delay.
What helps with the diagnosis
A diagnosis of migraine is made primarily through a detailed conversation and the description of the symptoms. A headache diary is helpful, in which the following are recorded over several weeks:
- Frequency, duration and intensity of attacks
- Type and location of the pain
- Accompanying symptoms
- Possible triggers
- Medications taken and their effect
Imaging procedures such as MRI or CT are only required in certain cases, for example if the course is atypical or there are neurological abnormalities.
Treatment options at a glance
Migraine therapy is based on two pillars: acute treatment during an attack and prophylaxis to prevent attacks. In addition to medication, non-pharmacological measures also play an important role, such as relaxation techniques, regular endurance exercise, stress management and a regular daily routine. Which therapy is appropriate in each case should be discussed together with a doctor.
Conclusion
Migraine is more than "just a headache". Anyone who is familiar with the typical symptoms – one-sided pulsating pain, accompanying symptoms such as nausea and sensitivity to light, and the phased course – can interpret their complaints more accurately. In everyday life, it is often possible to distinguish migraine from tension-type headache based on the character of the pain, its intensity and the accompanying symptoms. For frequent or particularly distressing headaches, a medical assessment is recommended in order to find a suitable treatment.
This article does not replace medical advice.