If you think your “really bad headaches” aren’t migraines, you may want to take a closer look at your symptoms—especially if you’re a woman.
More than half of all migraine sufferers are never diagnosed, according to the Migraine Research Foundation. And according to the National Institute of Neurological Disorders and Stroke, migraines are three times more common in women than in men. Crazy, right?
By taking a few minutes to learn about migraines, you can get an idea if you’re dealing with the condition and get treatment that will actually give you relief. Read on for all the signs and symptoms you may be overlooking, plus background on why migraines happen in the first place.
So, what exactly are migraines, and why do people get them?
According to the National Institute of Neurological Disorders and Stroke, a migraine is a brain disease that causes various uncomfortable symptoms that can last anywhere from four hours up to three days. (Yup, three freakin’ days!)
While the exact cause of migraine headaches is unknown, the Migraine Research Foundation says that both genes and environmental factors likely play a role. We also know that the symptoms are brought on by a change in chemical activity that impacts both the central and peripheral nervous systems, explains Jessica Ailani, M.D., director of the MedStar Georgetown Headache Center in Washington D.C.
Eek! How can I tell if I’m having a migraine or just a tension or sinus headache?
Migraine headaches can cause various symptoms before, during, and after the attack. Not all people experience all symptoms, and your migraine may be entirely different than a friend’s.
Symptoms can come on gradually or suddenly. Sometimes they start overnight, causing people to wake up with a migraine, but not always, the Mayo Clinic notes. Basically, every migraine headache is slightly different, and there’s no cut and dry list of symptoms that pertain to everyone. (Annoying, we know!)
All that said, there are a number of ways migraines differ from regular headaches. If you experience any of these symptoms, you’re likely suffering from a migraine and not something that’ll go away by popping some Advil.
Common migraine symptoms you should definitely know about
1. Debilitating throbbing
“Patients will tell me, ‘I can feel my heartbeat in my head,’ or talk about touching their temple and feeling the vein throbbing, or feeling like their head will explode,” Ailani says. A run-of-the-mill headache, however, causes a dull, aching pain that’s more of an annoyance versus something that throws a wrench in your daily life.
2. Pain on only one side of your head
While migraines can be experienced on both sides of the head, the pain is typically only on one side. A tension headache, however, typically presents as pain all over, and a sinus headache presents as pressure around the cheeks, eyes, and forehead.
It’s still unclear why migraines may present as one-sided. One theory has to do with the trigeminal nerves. (There’s one on each side of the brain.) However, only one may be activated when a migraine begins, and as this continues to happen with repeated migraines over time, that one nerve becomes the “quickest, easiest path for the brain,” Ailani explains.
3. Seeing sparking lights or flashes
“When a migraine happens, there’s a slow wave of electrical activity from the back to the front of the brain,” explains Adelene Jann, M.D., a neurologist at NYU Langone Health. “When that happens, there’s also decreased blood flow to the brain, and everything slows down.” In turn, about 25 percent of suffers experience an aura either before or during their migraines, according to the Migraine Research Foundation.
A visual aura causes various forms of distorted vision, including sparkling lights, different colors, pixelated vision, flashes on one side of the visual field, or colorful zigzag lines. These types of vision changes don’t usually happen with a tension or sinus headache.
4. Weakness and tingling
Vision isn’t the only thing impacted by the decreased brain speed. Migraines can also present with a sensory aura, which causes numbness, tingling, or even weakness on one side of the body. Some people may have a speech aura and have trouble finding their words, which is eerily similar to what happens during a stroke, the Mayo Clinic notes. (But to be clear, is totally unrelated.)
5. Next level nausea
Many people who experience migraines feel nausea, dizziness, or even vomit. “Our gut has a nervous system,” Ailani explains. “When you activate the brain nerves, it’ll activate the gut as well.” Experts believe that the gut slows down during a migraine headache, which can lead to nausea. Studies have also found an association between migraines and gastrointestinal disorders, but the connection remains unclear.
6. A heightened sense of smell
When you get a migraine, the brain is hyperexcited, Jann says. “Everything is ramped up, so people notice noises, lights, and smells more.” That’s why you may be able to smell your coworker’s lunch all the way down the hall or hear your roommate’s music through multiple closed doors, according to a Therapeutic Advances in Chronic Disease study. It’s also why many migraine sufferers seek refuge in a dark, quiet, cool room when the pain is at its worst.
7. You’re totally out of it—even after the pain is gone
Everything from depression to irritability to euphoria has been reported before, during, and after migraine headaches, and some people have reported difficulty concentrating, notes a Journal of Neuroscience study. “Before a migraine, you may notice you’re struggling to get through the document you’are reading, and even during and after, you can feel out of it for a little bit,” Jann says. “It has to do with the slowing of the brain.”
8. The throbbing derails your entire life
A migraine is not just a headache. “A migraine is disabling; it interferes with your life,” Jann says. The severity is too intense that you cannot go about your normal day, and you may miss work or social obligations. “You’re trying to do other things, but your brain is like, ‘Sorry, I won’t let you,’” Ailani says. A typical headache, on the other hand, doesn’t usually leave you down for the count.
9. You get crazy fatigued
During all phases of a migraine, “your brain is busy having a party, and that party can be exhausting,” Ailani says. The feeling that no amount of coffee could help perk you up can last a day or two after a migraine passes. “Your brain is trying to clean up the mess, and it takes energy to do that,” Ailani explains.
10. Your neck is stiff
The trigeminal nerve is thought to play a role in migraines, the Mayo Clinic notes. When it’s activated, it communicates with a major pain pathway in the upper region of the spinal cord, Ailani explains. “When that center gets activated, it sends signals upward to the brain, and possibly sends signals into the upper neck, causing pain.”
11. The pain seems like it lasts forever
Migraines can last from four hours up to three days. You may have several a year, a few a month, or even migraines half the month, Ailani says. Regular headaches just aren’t that frequent.
When to seek medical attention
Ailani recommends seeing a health care provider if any of the following rings true to you:
Talk to your primary care provider first. She or he may refer you to a neurologist, who may refer you to a headache specialist. “Either can help you get your migraines under control so as not to run into problems in the future,” Jann says.
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