Migraine without aura
This is the most common type of migraine. Symptoms include the following:
- The headache is usually on one side of the head, typically at the front or side. Sometimes it is on both sides of the head. Sometimes it starts on one side and then spreads all over the head. The pain is moderate or severe and is often described as throbbing or pulsating. Movements of the head may make it worse. It often begins in the morning but may begin at any time of the day or night. Typically, it gradually gets worse and peaks after 2-12 hours, then gradually eases off. However, it can last from 4 to 72 hours.
- Other migraine symptoms that are common:
- Feeling sick (nausea).
- Being sick (vomiting).
- Not liking bright lights or loud noises, so that you may just want to lie in a dark room.
- Other symptoms that sometimes occur:
- Being off food.
- Blurred vision.
- Poor concentration.
- Stuffy nose.
- Tummy (abdominal) pain.
- Passing lots of urine.
- Going pale.
- Scalp tenderness.
- Sensations of heat or cold.
Migraine with aura
This is less common. The symptoms are the same as those described above (migraine without aura) but also include a warning sign, called a migraine aura, which comes on before the headache begins.
- Visual aura is the most common type of migraine aura. It usually affects just one side of your vision and gradually gets bigger over 5-20 minutes. Examples include:
- A temporary loss of part of vision.
- A bright, shimmering light, often in a C-shaped pattern, a bit like looking through an old-fashioned kaleidoscope, or zig-zag lines.
- Objects or letters on a page may seem to rotate, shake, or boil.
- Numbness and pins and needles are the second most common type of migraine aura. Numbness usually starts in the hand, travels up the arm and then involves the face, lips and tongue. The leg is sometimes involved.
- Problems with speech are the third most common type of migraine aura.
- Other types of migraine aura include an odd smell, food cravings, a feeling of well-being, and other odd sensations.
One of the above migraine auras may develop, or several may occur one after each other. Each aura usually lasts just a few minutes before going but can last up to 60 minutes. The aura usually goes before the headache begins. The headache usually develops within 60 minutes of the end of the aura but it may develop a lot sooner than that - often straight afterwards. Sometimes, just the aura occurs and no headache follows (silent migraine). Most people who have migraine with aura also have episodes of migraine without aura.
How long do migraines last?
A migraine attack can typically be divided into four phases:
- A warning (premonitory) phase occurs in up to half of people with migraine. You may feel irritable, depressed, or tired, have food cravings, or just know that a migraine is going to occur. You may have these feelings for hours or even days before the onset of the headache.
- The aura phase (if it occurs).
- The headache phase.
- The resolution phase when the headache gradually fades. During this time you may feel tired, irritable, or depressed, and may have difficulty concentrating.
Typically the headache of a migraine without aura lasts from 4 hours to as long as 72 hours.
A migraine aura usually takes a few minutes to develop then lasts for five minutes to an hour before the headache comes. The headache then starts within an hour of the aura ending and lasts the same as the headache of a migraine without aura.
What is a silent migraine?
Sometimes you will hear people talk about 'silent migraine' or 'migraine aura without headache'. This occurs when you develop a migraine, either with or without aura, that is typical in every other way but doesn't cause a headache. So you experience all of the phases described above but miss out the headache phase. Silent migraine can occur in someone who used to have migraine but can also happen from time to time in people who still get the more typical migraine attacks.
Less common types of migraine
There are various other types of migraine which are uncommon, and some more types which are rare. These include:
Menstrual migraine. Menstrual migraines are migraines that happen at the time of a woman's period. The symptoms of menstrual migraine are just the same as migraine with or without aura; it is the timing of the migraine that makes it a menstrual migraine. You can read more about menstrual migraine in the main migraine leaflet and in the treatment section.
Abdominal migraine. This mainly occurs in children. Instead of headaches, the child has attacks of tummy (abdominal) pain which last several hours. Typically, during each attack there is no headache, or only a mild headache. There may be associated with sickness (nausea), being sick (vomiting), or aura symptoms.
Commonly, children who have abdominal migraine switch to develop common migraine in their teenage years.
Ocular migraine, sometimes also called retinal migraine, ophthalmic migraine or eye migraine, causes temporary loss of all or part of the vision in one eye. This may be with or without a headache. Each attack usually occurs in the same eye. There are no abnormalities in the eye itself and vision returns to normal. Important note: see a doctor urgently if you have a sudden loss of vision (particularly if it occurs for the first time). There are various causes of this and these need to be ruled out before ocular migraine can be diagnosed.
Hemiplegic migraine. This is rare. In addition to a severe headache, symptoms include weakness (like a temporary paralysis) of one side of the body. This may last up to several hours, or even days, before resolving. Therefore, it is sometimes confused with a stroke. You may also have other temporary symptoms of:
- Severe dizziness (vertigo).
- Double vision.
- Visual problems.
- Hearing problems.
- Difficulty speaking or swallowing.
Important note: see a doctor urgently if you get sudden weakness (particularly if it occurs for the first time). There are other causes of this (such as a stroke) and these need to be ruled out before hemiplegic migraine can be diagnosed.
Vestibular migraine may affect up to one in a hundred people. It causes recurring episodes of severe dizziness (vertigo) alongside other typical migraine symptoms and lasts between 5 minutes and 72 hours. The dizziness that you get with vestibular migraine is not an aura. It occurs at the same time as a headache. It can occur in people who get migraine with aura and those who get migraine without aura.
Basilar-type migraine. This is rare. The basilar artery is in the back of your head. It used to be thought that this type of migraine originated due to a problem with the basilar artery. It is now thought that this is not the case, but the exact cause is not known.
Symptoms typically include headache at the back of the head (rather than one-sided as in common migraine). They also tend to include strange aura symptoms such as:
- Temporary loss of vision.
- Double vision.
- Ringing in the ears.
- Jerky eye movements.
- Trouble hearing.
- Slurred speech.
Unlike hemiplegic migraine, basilar-type migraine does not cause weakness. There is an increased risk of having a stroke with this type of migraine. Important note: see a doctor urgently if you develop the symptoms described for basilar-type migraine (particularly if they occur for the first time). There are other causes of these symptoms (such as a stroke) and these need to be ruled out before basilar-type migraine can be diagnosed.
Further reading and references
Migraine; NICE CKS, August 2017 (UK access only)
Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache; British Association for the Study of Headache (BASH) Guidelines, (2010 - reviewed 2014)
Carod-Artal FJ; Tackling chronic migraine: current perspectives. J Pain Res. 2014 Apr 87:185-94. doi: 10.2147/JPR.S61819. eCollection 2014.
The International Classification of Headache Disorders, 3rd edition (beta version).; The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul33(9):629-808. doi: 10.1177/0333102413485658.
Botulinum toxin type A for the prevention of headaches in adults with chronic migraine; NICE Technology Appraisal Guidance, June 2012
Headaches in over 12s: diagnosis and management; NICE Clinical Guideline (September 2012)
Derry CJ, Derry S, Moore RA; Sumatriptan (all routes of administration) for acute migraine attacks in adults - overview of Cochrane reviews. Cochrane Database Syst Rev. 2014 May 285:CD009108. doi: 10.1002/14651858.CD009108.pub2.
UK Medical Eligibility Criteria Summary Table for intrauterine and hormonal contraception; Faculty of Sexual and Reproductive Healthcare, 2016
Furman JM, Balaban CD; Vestibular migraine. Ann N Y Acad Sci. 2015 Apr1343:90-6. doi: 10.1111/nyas.12645. Epub 2015 Feb 26.
Schwedt TJ; Chronic migraine. BMJ. 2014 Mar 24348:g1416. doi: 10.1136/bmj.g1416.
Spigt M, Weerkamp N, Troost J, et al; A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Pract. 2012 Aug29(4):370-5. doi: 10.1093/fampra/cmr112. Epub 2011 Nov 23.
I have had pain and pressure in my eyes and temples for almost a year now. My face feels fuzzy and tingly and I feel woozy a lot of the time. Nothing takes the pain away when it is really bad. Tried...lynn72382
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