Understanding Migraines

Migraine is the most common disabling neurological condition worldwide. A migraine attack typically passes through several phases, though not every patient experiences each one:

• Premonitory phase — subtle warning symptoms in the hours before pain begins, including mood change, fatigue, neck stiffness, food cravings, or yawning.
• Aura — in roughly one-third of patients, sensory symptoms (most often visual) lasting up to an hour, sometimes followed by language or sensory disturbance.
• Headache phase — moderate to severe pain, usually one-sided but sometimes generalized, often described as throbbing or pulsating, lasting from 4 to 72 hours.
• Postdrome — a “hangover” phase after the pain, with fatigue, difficulty concentrating, and lingering sensitivity.

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Common Symptoms of Migraine

• Moderate to severe headache, often one-sided, often pulsating
• Sensitivity to light, sound, and sometimes smell
• Nausea and sometimes vomiting
• Visual disturbances such as flickering lights, zigzag lines, or blind spots
• Tingling or numbness, most often in the face or hand
• Worsening of pain with routine physical activity
• Fatigue and reduced concentration during and after the attack

Chronic Migraine

Migraine is described as chronic when headaches occur on 15 or more days a month for at least three months, with features of migraine on at least 8 of those days. Chronic migraine is a distinct condition from episodic migraine and is associated with significant disability. It often develops gradually, sometimes with overuse of acute pain medications as a contributing factor.

Migraine and Hormones

Migraine is more common in women than in men and is often influenced by hormonal changes. Many women experience migraines that occur in a pattern related to the menstrual cycle, pregnancy, perimenopause, or use of hormonal contraception. Recognising this pattern is helpful because it shapes the choice of preventive strategies.

How Migraine Is Assessed

Assessment is based on a careful history of the headache pattern, family history, triggers,  response to previous treatments, and a physical and neurological examination. Imaging is  generally not required when symptoms fit a typical migraine pattern, but may be ordered when  features are atypical, when symptoms have changed significantly, or when the diagnosis is  uncertain. Keeping a headache diary before your appointment — recording the frequency,  duration, severity, possible triggers, and what helps — is one of the most useful steps in  preparing for a thorough assessment.

When to See a Doctor

A new severe headache that develops over seconds or minutes (often described as “the worst  headache of your life”), a headache with fever and stiff neck, headache after a head injury,  headache with new neurological symptoms such as weakness, confusion, difficulty speaking, or  significant vision changes, or a sudden change in your usual headache pattern — these require  urgent assessment, including consideration of emergency department evaluation.

Frequently Asked Questions