Migraines - Symptoms

Migraine is a common neurological disorder characterized by complex and diverse symptoms. Patients may experience different stages of symptoms, from mild prodromal signs to severe pain phases, and even discomfort during the postdrome period. Understanding these symptom variations can aid in early diagnosis and management of the condition.

The severity and presentation of symptoms vary among individuals; some patients may only experience mild headaches, while severe cases may involve neurological deficits. This article will detail the symptoms across various stages of migraine to help readers recognize potential warning signs and determine when to seek medical assistance.

Early Symptoms and Signs

Prodromal Symptoms (Prodrome Stage)

Approximately 30-40% of patients experience prodromal symptoms 24 hours to several days before a migraine attack. These signs may include:

• Emotional fluctuations, such as irritability, depression, or excessive excitement
• Muscle tension, especially in the neck and shoulders
• Frequent yawning or fatigue
• Changes in appetite, such as sudden cravings for specific foods or loss of appetite
• Increased urination or frequency of urination

These signs may be mistaken for general fatigue or stress responses, but for long-term sufferers, these patterned signs can help predict an impending attack.

Aura Symptoms (Aura Stage)

About 25-30% of patients experience neurological warning signs before headache onset, typically lasting 10 minutes to 1 hour. Visual aura is most common, including:

• Visual disturbances: such as flickering lights, wavy lines, or dark spots
• Sensory abnormalities: such as unilateral numbness or tingling
• Speech difficulties: sudden difficulty forming sentences or finding words
• Auditory sensitivity: heightened sensitivity to normal sounds

It is noteworthy that about one-third of aura cases may occur without headache, known as silent aura migraine, which still requires professional evaluation to rule out other conditions.

Common Symptoms

Core Headache Features

Typical migraine pain has the following characteristics:

• Unilateral: about 60% of patients experience pain starting on one side of the head, which may gradually spread to involve the entire head
• Pulsatile pain: a throbbing sensation similar to heartbeat rhythm, which may worsen with activity or positional changes
• Moderate to severe pain: usually rated 4-7 out of 10, and can significantly impact daily activities during severe episodes

The pain can last from 4 to 72 hours, with children often experiencing shorter episodes. Many patients also exhibit autonomic nervous system abnormalities during headache, such as pupil constriction or facial flushing.

Associated Symptoms

During the headache phase, the following physiological responses are common:

• Increased sensitivity to light, sound, or odors (photophobia, phonophobia, osmophobia)
• Nausea or vomiting, occurring in about 75% of patients
• Dizziness or balance disturbances, possibly with visual blurring
• Frequent urination or gastrointestinal motility issues, with some experiencing diarrhea or constipation

These associated symptoms can be more severe than the headache itself, leading patients to avoid environmental stimuli. About 40% of patients rest in bed during the peak of the headache.

Progression and Symptom Changes

Dynamic Changes During Attacks

Migraine symptoms may go through four stages, with a time-dependent progression:

• Prodrome: non-specific symptoms lasting hours to days
• Aura: neurological signs appear in 50% of cases during this stage
• Headache: the core pain phase, possibly with autonomic disturbances
• Postdrome: feelings of weakness after headache relief

It is noteworthy that about 60% of patients do not follow the typical four-stage pattern, with symptoms overlapping or developing in a jump-like manner. Some patients experience persistent cognitive impairment for days after headache relief, known as "brain fog."

Age-Related Symptom Variations

Children often present with bilateral headaches, with aura mainly manifesting as visual disturbances; adolescents may have severe nausea; adults more commonly experience unilateral pulsatile pain; elderly patients may develop neck stiffness or balance issues, which need to be distinguished from stroke.

Women may experience worsening symptoms before and after menstruation, known as "menstrual migraine," with increased pain intensity and duration by 30-50%. Hormonal changes during pregnancy or menopause can also alter symptom patterns.

When to Seek Medical Attention

Emergency Indicators

If any of the following occur, seek emergency medical care immediately:

• First-time severe headache accompanied by paralysis, speech difficulties, or vision loss
• Sudden change in symptom pattern, such as increased pain intensity or duration
• Fever, neck stiffness, or altered consciousness
• Headache following head trauma

These signs may indicate serious conditions such as intracranial hemorrhage or meningitis, requiring prompt imaging examination.

Indicators for Regular Medical Evaluation

Even if not an emergency, consider professional assessment if:

• More than 4 attacks per month, or episodes lasting over 72 hours
• Reduced effectiveness of routine pain medications
• New associated symptoms, such as unilateral limb weakness
• Significant impact on work or quality of life

Early diagnosis can prevent symptom worsening. Neurologists may perform brain imaging or neuropsychological assessments to develop personalized treatment plans.

 

Frequently Asked Questions

Besides painkillers, what other methods can relieve migraine attacks?

In addition to painkillers, try cold compresses on the painful side of the head or neck, or rest in a quiet, dark environment. Some patients find acupuncture or massage of cervical points helpful, but these should be performed by professionals.

Which dietary factors in daily life may trigger migraines?

Certain foods such as processed meats containing nitrates, aged cheeses with tyramine, chocolate, and caffeinated beverages can trigger migraines. Additionally, extreme dieting or prolonged fasting may also provoke attacks. Maintaining a regular diet and avoiding excessive intake of stimulants is recommended.

Can migraine patients safely use alternative remedies or Chinese medicine?

Some Chinese medicines or alternative remedies may interact with conventional medications or worsen symptoms. It is advisable to consult a neurologist or traditional Chinese medicine practitioner before using any alternative therapies and to monitor the condition regularly.

Why do migraines often accompany nausea or visual abnormalities?

The pathophysiology of migraines involves abnormal excitation of the brain's neurovascular system, which can lead to nausea, vomiting, or aura symptoms such as visual waves. These phenomena are usually related to cortical spreading depression, a typical part of the migraine process.

How to distinguish between migraine and tension headache?

Migraines typically involve pulsatile pain, sensitivity to light or sound, and worsening with activity. Tension headaches are often described as a "headband" sensation or pressure, with fewer environmental triggers. If attacks occur more than 15 days per month, a detailed neurological assessment is recommended.