Migraine: Recognize symptoms early

Quick overview: Frequently asked questions and answers

How can you recognize an impending migraine? Signs of this can include tiredness, irritability, cravings, difficulty concentrating or increased yawning.

How long does a migraine attack last? Usually 4 to 72 hours. In some cases it can last for several days.

How is migraine different from tension headaches? Migraine headaches are usually one-sided, pulsating and more intense than tension headaches, which tend to be bilateral and oppressive.

At a glance:

Migraine: The main symptom is headache

Headaches are considered the main symptom of a migraine. However, they differ from classic tension headaches and can vary greatly in their severity. Typical symptoms of migraine headaches and other main characteristics of an attack are:

• throbbing, pounding or pulsating headaches
• usually only one side of the head is affected
• increased discomfort during movement
• the pain can spread to the other side of the head during the attack or be felt in the area of ​​the eyes

The moderate to severe headaches usually last between 4 and 72 hours. They start off mildly – usually from the forehead and the back of the eyes, sometimes from the ear – and quickly become more severe. In a third of people with migraines, the pain extends over the entire head.

Any movement, including coughing or sneezing, increases the pain. This is an important distinguishing factor from tension headaches, for example, which can be relieved by exercise in the fresh air.

Other symptoms: Migraine is more than just a headache

The headaches are typically accompanied by other symptoms:

Those affected have the need to retreat to darkened rooms, to isolate themselves completely or to sleep.

Which symptoms occur also depends on the phase of the migraine attack.

Symptoms of a migraine over time

A migraine can be different for each person. A typical symptom is a slow increase and decrease in symptoms (migration). The attack can basically be divided into four phases. Although they are often not clearly defined and cannot always be clearly separated, they can still help to recognize a migraine.

1. Early phase of a migraine

Certain signs can indicate a migraine. These usually affect migraine patients 4 to 48 hours before the attack. Possible symptoms of the early phase of migraine (prodromal phase) are:

• fatigue
• increased yawning
• Cravings (especially for sweets)
• increased sensory perception
• increased irritability
• increased sweating or shivering

Such precursors can be identified in around 30 percent of people with migraines. A migraine diary can help to identify individual symptoms as precursors of migraines and thus be able to counteract an attack at an early stage with appropriate treatment.

2. Aura phase of migraine

In 10 to 15 percent of sufferers, a migraine attack is preceded by an aura. This refers to neurological symptoms that occur immediately before the onset of the headache and often last for 15 to 30 minutes. These are usually visual symptoms such as

• Flashes of light,
• double vision,
• black spots or
• blurred vision.

However, speech disorders or abnormal sensations such as tingling or numbness may also occur, and in rare cases even paralysis.

3. Headache phase

As the name suggests, headaches are the main symptoms. These can last for 4 to 24 hours – if the symptoms persist for longer, this is referred to as status migrainosus. The pulsating migraine headaches are often accompanied by:

• Nausea (80 percent)
• Vomiting (40 to 50 percent)
• Photosensitivity (60 percent)
• Sensitivity to noise (50 percent)
• Sensitivity to smell (10 percent)
• Loss of appetite

Nausea and vomiting also cause migraine medication to leave the body and not work. During this phase, sufferers usually withdraw, seek sleep and dark rooms.

4. Recovery phase

When the symptoms of a migraine attack slowly subside, most sufferers feel tired and worn out. In this recovery phase (post-drome phase), the body needs rest and time until the symptoms have completely disappeared.

For some patients, the gradual disappearance of migraine symptoms is accompanied by an increased urge to urinate. It can take 12 to 24 hours before you are completely fit again after a migraine attack.

Migraine symptoms in children and the elderly

The symptoms of a migraine in children differ slightly from those in adults. The attacks are usually shorter, but last at least an hour. Other accompanying symptoms may also occur. These include

• an accelerated pulse,
• Paleness or redness of the skin,
• Durst,
• Appetit,
• Urge to urinate or
• Fatigue.

An increased body temperature can also be a symptom of migraine. Migraine headaches, which usually occur on one side in adults, are often bilateral in children, typically in the forehead area.

However, headaches often do not occur, especially in children. Migraines then manifest themselves mainly through regular attacks of dizziness, nausea and vomiting, diarrhea and stomach pain.

In older people, migraine attacks become less frequent and the headaches are not as severe. They often disappear completely. However, aura symptoms are more common in seniors with migraines. They are often the only migraine symptom.