What is migraine? Symptoms, stages and how it differs from other headaches

The pain pulses behind one eye. Light feels sharp, the smell of food makes you queasy, and even the fan sounds too loud. You lie down in a dark room and wait. Later, someone says, 'It is just a headache. Take a tablet and carry on.'

If this is familiar, you may be living with migraine. It is far more than an ordinary headache, and it is real. This article explains what migraine is, how an attack unfolds, and how it differs from other headaches. It cannot tell you whether you have it. Only a doctor can do that.

What migraine is

The International Headache Society describes migraine as a common, disabling primary headache disorder. 'Primary' means the headache is the condition itself and not a sign of another illness. The NHS says it is not known exactly what causes migraine, but that it involves changes to nerves and blood vessels in the brain, and that it is more likely if a close family member has it.

The World Health Organization notes that migraine is often lifelong and that it usually begins around puberty. Attacks tend to come in episodes, with gaps between them. Many people find their attacks slowly ease as they get older. The NHS says this often happens after menopause in women.

The four stages of an attack

A migraine attack can have up to four stages. Researchers call them the premonitory (or prodrome), aura, headache and postdrome phases. Not every person has every stage, and not every attack follows the same pattern.

• Early warning signs (prodrome). The NHS lists feeling very tired and yawning a lot, craving certain foods or feeling thirsty, mood changes, a stiff neck and needing to pass urine more often. These can start hours, or up to 2 days, before the head pain. A 2018 review (Dodick) says the premonitory phase can begin as early as 3 days before the headache.
• Aura. Temporary changes such as zigzag lines, flashing lights, pins and needles, or trouble speaking. Each aura symptom usually lasts 5 to 60 minutes. A 2018 review says an aura phase occurs, in some attacks, in about one-third of people with migraine.
• The headache. In adults, the International Headache Society describes attacks lasting 4 to 72 hours if untreated or if treatment does not work. The NHS says attacks usually last between 4 hours and 3 days.
• Recovery (postdrome). After the pain fades, many people feel drained, foggy or low. In a 2021 research study of 53 people, 98% reported some postdrome symptoms with their spontaneous attacks, most often neck discomfort and tiredness. The paper notes these symptoms can last up to days. The IHS says this phase is less well studied.

What an attack can feel like

The NHS describes the main symptoms of a migraine attack as a throbbing headache, often on one side of the head and often worse when you move around, feeling or being sick, and being very sensitive to light and sound. Many people also describe wanting to lie still in a dark, quiet room.

How doctors recognise it, in plain language

For migraine without aura, the International Headache Society's classification (ICHD-3, 2018) sets out criteria. They are for doctors, so please treat this as information and not a checklist for yourself.

• You have had at least five attacks like this.
• Each attack lasts 4 to 72 hours when untreated or when treatment has not worked. In under 18s, attacks may last 2 to 72 hours.
• The headache has at least two of these four features: one-sided, pulsating, moderate or severe pain, and made worse by (or makes you avoid) routine activity such as walking or climbing stairs.
• During the headache, you have at least one of: nausea or vomiting, or both sensitivity to light and sensitivity to sound.
• It is not better explained by another diagnosis.

What is aura?

Aura is a set of temporary neurological symptoms. They usually come before the headache, though they can also come with it. NICE says typical aura symptoms include visual changes such as flickering lights, spots or lines, or partial loss of vision. They can also include numbness or pins and needles, and speech difficulty. The International Headache Society says visual aura is the most common type and occurs in over 90% of people who have migraine with aura, at least in some attacks.

Aura symptoms are fully reversible. They usually build up gradually over at least 5 minutes, and each one lasts 5 to 60 minutes. The NHS says aura symptoms should not last longer than 1 hour.

How migraine differs from other headaches

Doctors separate headaches by their features. NICE's guideline sets them out in a table, and the International Headache Society classification adds detail.

• Tension-type headache. Usually on both sides, pressing or tightening rather than pulsating, mild to moderate, and not made worse by routine activity. There is no nausea or vomiting. It is often what people mean by a 'normal' headache.
• Cluster headache. Severe or very severe pain around or above one eye, or at the temple, lasting 15 to 180 minutes, with a red or watery eye, a blocked or runny nose, or a drooping eyelid on the same side. People are often restless or agitated. Attacks come in series (cluster periods) that can last weeks or months.
• Migraine. Moderate to severe, often pulsating, often one-sided, worse with activity, with nausea or sensitivity to light and sound.

What about 'sinus headache'?

Many people believe their headaches come from the sinuses. A 2004 study (Schreiber and colleagues, Archives of Internal Medicine) screened 2,991 people who said they had 'sinus' headache and had no earlier migraine diagnosis. About 88% met criteria for migraine (80%) or migrainous headache (8%), after a clinic assessment that found no evidence of infection. Sinus pressure, sinus pain and nasal congestion were common symptoms. That does not mean sinus infections never cause headaches. It means that if your headaches keep returning without fever or thick nasal discharge, it is worth asking a doctor whether migraine fits.

How common is migraine?

Numbers vary by study method, so treat them as rough. The WHO's 2021 data say headache disorders affect about 40% of people worldwide (3.1 billion), and say migraine ranked third in overall neurological disease burden in 2021. A Global Burden of Disease 2021 analysis (Wijeratne and colleagues, Cell Reports Medicine, 2025) estimated 1.2 billion people with migraine and 2.0 billion with tension-type headache in 2021. Migraine causes more disability, even though tension-type headache is more common.

In India, a 2015 door-to-door survey of 2,329 adults aged 18 to 65 in and around Bengaluru (Kulkarni and colleagues, Journal of Headache and Pain) found a one-year migraine prevalence of 25.2%, compared with a global mean of 14.7% quoted by the authors. A 2024 survey of Delhi and the National Capital Region (Chowdhury and colleagues, same journal) found 26.3%. These are two regional studies, not a national count. The Delhi authors argue the figures may reasonably apply to India as a whole.

Who gets migraine?

Migraine can affect anyone, but women are affected more often. The WHO says it is more common in women, possibly due to hormonal influences. In the Karnataka survey, women had about twice the odds of migraine compared with men. In the Delhi survey, the observed figures were 35.7% of women and 15.1% of men reporting migraine in the past year. The WHO also says migraine most often affects people aged 35 to 45.

Some women notice attacks around their periods. The NHS says these menstrual migraines are often longer and more severe than attacks at other times.

How a doctor diagnoses it

There is no single test for migraine. NICE says doctors should diagnose it from the headache features in its table, and it recommends against sending people with an established migraine diagnosis for brain scans only for reassurance. A doctor will ask about your attacks, your family history and your medicines, and will usually examine you. NICE suggests a headache diary kept for at least 8 weeks, noting how often headaches come, how long they last, how severe they are, what medicines you take, and any link to periods. Tests or scans may be advised if something suggests another cause.

When to see a doctor

The NHS advises seeing a GP if attacks are severe or getting worse, last longer than usual, happen more than once a week, are hard to control, or regularly come before or during your period. Migraine cannot be cured, but the NHS says treatment can help ease attacks and reduce how often they happen.