Nearly 30 million people in the United States have migraines, and three times as many women as men have them.
Migraines are pulsating headaches, often on one side of the head. Physical activity may intensify the pain, but symptoms can vary from person to person and from one attack to the next.
“In patients who have migraines, we’re going to treat all of their headaches as potential migraines,” says Anne Calhoun, MD, partner and cofounder of the Carolina Headache Institute, in Chapel Hill, N.C.
Here are 18 ways to identify migraines.
Some people with a migraine experience aura.
The most common auras are visual, such as flickering lights, spots, or lines. “You may see a little jagged line…that will develop some cross hatches, and it might sort of move in a curved direction,” Dr. Calhoun says.
Auras typically last between five minutes and an hour, with a 60-minute “skip phase” before the headache pain sets in, she says.
Depression, irritability, or excitement
Mood changes can be a sign of migraines.
“Some patients will feel very depressed or suddenly down for no reason,” Dr. Calhoun says. “Others will feel very high.” Dutch researchers recently reported a possible genetic link between depression and migraines, especially migraines with aura.
Data presented at the American Academy of Neurology 2010 annual meeting suggests that moderate or severe depression increases the risk of episodic migraines becoming chronic.
Lack of restful sleep
Waking up tired or having trouble falling asleep are common problems in people with migraines.
Studies have shown an association between lack of restorative sleep and the frequency and intensity of migraines.
When migraines strike, it’s tough to get a good night’s sleep. “A lot of people will have insomnia as a result of their migraine,” says Edmund Messina, MD, medical director of the Michigan Headache Clinic, in East Lansing. This inability to sleep can be the start of a vicious cycle, as research suggests that lack of sleep can also trigger migraines.
Stuffy nose or watery eyes
Some people with migraines have sinus symptoms, such as stuffy nose, clear nasal drainage, droopy eyelids, or tearing, Dr. Messina says.
One large study found that, among people who complained of sinus headaches, nearly 90% were having migraines. (The study was funded by GlaxoSmithKline, which makes migraine medicine.)
Before a migraine attack occurs, some people crave certain foods.
“A common craving is chocolate,” Dr. Messina says
Throbbing pain on one or both sides of the head
Pulsating pain is a classic sign of migraines. The throbbing is often felt on one side of the head.
In an online survey of patients with migraines, the National Headache Foundation found that 50% “always” have throbbing on one side, while 34% say they “frequently” have this symptom.
Migraine pain often burrows behind the eye.
People will blame it on eye strain and many will get their eyes checked, but that won’t make their headaches any better, Dr. Messina says.
“A lot of people will say, ‘My neck gets stiff and then I get a headache.’ Well, it’s probably the early stage of the migraine,” Dr. Messina says. “Or after a migraine they’ll get that neck symptom or they’ll have throbbing pain at the back of their neck.”
In an online survey, the National Headache Foundation found 38% of migraine patients “always” have neck pain and 31% “frequently” have neck pain during migraine headaches. (The Foundation receives support from GlaxoSmithKline, maker of migraine medicine.)
If you have to go a lot, it can mean a migraine is coming.
It’s one of the many symptoms people experience just before a migraine. These warning signs, also known as the prodome phase of a migraine, can arrive as little as an hour or as much as two days before the start of headache pain.
Yawning a lot is another tip-off that a migraine is about to strike.
Unlike regular “I’m tired” yawning, it may be excessive and occur every few minutes.
In one 2006 study in the journal Cephalalgia, about 36% of migraine patients reported yawning was one of the signs of an impending migraine.
Numbness or tingling
Some people with migraines have sensory aura.
They may have a temporary lack of sensation or a pins-and-needles feeling, typically on one side of the body, moving from the fingertips through the arm and across the face.
Some patients have auras without a migraine-type headache or any headache at all.
Nausea or vomiting
According to data from the American Migraine Study II, a mail survey of more than 3,700 people with migraines, 73% experience nausea and 29% have vomiting. (The study was funded by a drug manufacturer.)
A recent analysis of the National Headache Foundation’s American Migraine Prevalence and Prevention study found people with frequent migraine-related nausea have more severe pain and more trouble getting relief from medication than migraine sufferers with little or no nausea.
Light, noise, or smells trigger or worsen pain
In the throes of a migraine attack, the migraine sufferer tends to seek refuge in a dark, quiet place. Bright lights and loud noises can trigger a migraine or intensify the pain. The same is true of certain odors.
“Once you’ve already got a migraine, smells can seem more intense and make it worse,” Dr. Calhoun says. “But a smell can also trigger a migraine in someone who didn’t have one before [he or she] walked past the perfume counter.”
Activity triggers or worsens pain
Routine activities such as walking or climbing stairs can make migraine pain worse.
Some migraines are induced by exercise (running, weight-lifting) or exertion (sexual activity). People with exertion-induced headaches require a thorough workup to rule out underlying causes, such as a brain aneurysm.
Can’t get the words out? Speech difficulties can be another sign that a migraine is on its way.
“A lot of people with migraines will feel like they’re blithering,” Dr. Messina says. “It’s a common description by patients.” If you are experiencing speech problems for the first time, contact a doctor to make sure the problems are not related to a more serious issue, such as a stroke.
Weakness on one side of the body
When an arm goes limp, it can be a sign of a migraine.
Some people experience muscle weakness on one side of the body before a migraine attack. This can also be a sign of a stroke, however, so consult a doctor to rule out any other causes.
Vertigo or double vision
One type of migraine, called a basilar-type migraine, can cause dizziness, double vision, or loss of vision.
Some people with migraines may experience balance problems too. In a recent study, Dr. Calhoun and colleagues found a link between migraine intensity and dizziness or vertigo. The stronger the migraine, the more likely patients were to have these complaints.
“Our best conclusion is that it’s actually part of migraines,” she says. “It’s a migraine symptom.”
After the migraine passes, a person may feel like her body has been pummeled.
In a recent study, researchers interviewed migraine patients and found that they commonly experienced symptoms such as fatigue, trouble concentrating, weakness, dizziness, lightheadedness, and loss of energy during the post-migraine period.
“It can be very fatiguing,” Dr. Messina says.