Migraine is not just a “headache”; It is a complex neurological event that takes place in the brain. Approximately 1 in every 6 people in Turkey and more than 1 billion people worldwide struggle with migraine. It is seen three times more frequently in women than in men. The worst part is that most people do not go to the doctor for years without realizing that what they are experiencing is migraine, saying "it is just stress, it will pass". However, if migraine is diagnosed early, attacks can be alleviated and the quality of life can increase significantly.
In this article, I will explain in detail all the stages of migraine, its hidden symptoms, how it looks different in women and children, and which symptoms require an urgent visit to the doctor. After reading it, you will clearly understand whether what you are experiencing is migraine or not.
What is Migraine? Simple and Accurate Explanation
Migraine is a chronic neurological disease characterized by recurrent, usually unilateral, throbbing moderate to severe headache attacks. The trigeminal nervous system in the brain is overstimulated, inflammation begins in the meninges, and the vessels first narrow and then widen. In this process, inflammatory substances such as "calcitonin gene-related peptide" (CGRP) are secreted and pain begins.
70% of migraine is genetic. If your mother or father has migraine, your chance of having migraine is between 50-70%. This rate increases up to 80-90% in siblings. In other words, migraine is a disease that largely "runs in the family."
What are the 4 Stages of Migraine and the Symptoms of Migraine?
A migraine attack is not just a single pain; In most patients, 4 separate stages are experienced sequentially. Some of these stages can be very insidious and symptoms begin days before the person says "I have a migraine".
1. Prodrome Phase (24–48 Hours Before Attack)
This stage is the most ignored part of migraine. 60–80% of patients experience at least some of the following symptoms before the attack:
- Continuous yawning (yawning every 5 minutes is very typical)
- Excessive cravings for sweet, salty or chocolate
- Sudden changes in mood: either being overly cheerful or very irritable
- Neck stiffness and stiffness (many patients think "my neck is stiff, that's why I have a headache")
- Frequent urination or constipation
- Slight sensitivity to light or sound begins
- Poor concentration, inability to find words
- Excessive sleepiness or, conversely, insomnia
These symptoms come on so slowly and insidiously that most people do not notice them until the attack occurs. However, recognizing the prodrome phase is a very valuable warning for taking preventive medications early and avoiding triggers.
2. Aura Stage (Not in everyone - Only seen in 25-30% of patients)
Aura is a temporary neurological symptom that develops before or during an attack and usually lasts 5-60 minutes. The most common types of aura are:
- In the visual aura; bright lights, flickering lines, stars, flashes in a zigzag pattern in front of the eye
- Blind spot (scotoma): a black or gray area in the field of vision
- Numbness-tingling sensation in the face, hand or tongue (gradually spreads)
- Speech difficulty, confusion of words, inability to form sentences
- Dizziness, imbalance, tinnitus
- Rarely weakness in arms or legs (hemiplegic migraine)
When the aura ends, a severe headache usually begins within 30–60 minutes. Patients experiencing aura usually receive a diagnosis of migraine earlier by saying "I thought something was wrong with my eye, I went to the doctor."
3. Headache (Main Attack) Phase
This phase is the period when classic migraine pain is experienced and can last 4–72 hours (sometimes 1 week).
- The pain is usually one-sided (temple, around the eyes, forehead or nape), and is throbbing.
- Pain is aggravated by movements such as climbing stairs, bending, and coughing.
- There is extreme sensitivity to light (photophobia), sound (phonophobia) and smell (osmophobia). The patient wants to sleep in a dark and quiet room.
- Nausea is seen in 80% of patients and vomiting is seen in 50% of patients.
- It may be accompanied by nasal congestion, runny nose, watery eyes and redness (autonomous symptoms).
- Facial pallor or redness, sweating, and feeling cold are common.
In this stage, the patient completely stops his daily life; Cannot go to work, avoids contact with light and sound.
4. Postdrome Phase (“Migraine Intoxication”)
After the attack ends, 70% of patients experience the following symptoms for 24–48 hours:
- Extreme tiredness and exhaustion (as if you had been hit by a truck)
- Difficulty concentrating, blurred memory
- Neck and shoulder pain continued
- Mood swings (often feeling depressed)
- Still slight sensitivity to light and sound
- Increased or complete loss of appetite
This stage is so typical that patients say, "My migraine is gone, but I couldn't come to my senses."
What are the symptoms of migraine in women? Hormonal Effects
75% of women experience a migraine attack at some point in their lives. The biggest reason for this is the fluctuations in the estrogen hormone.
- Estrogen level drops suddenly 3-4 days before menstruation → Menstrual migraine occurs in 60% of women.
- The frequency of attacks may increase in those using birth control pills.
- Attacks may decrease in the first 3 months of pregnancy and increase again in the last 3 months.
- Migraine subsides in most women after menopause, but may begin again in those taking hormone replacement therapy.
Migraine attacks in women last longer, are more severe, and are accompanied more frequently by nausea and vomiting.
What are the Symptoms of Migraine in Children and Adolescents?
Migraine in children may progress very differently than in adults:
- Pain is usually bilateral and lasts shorter (2–48 hours).
- The most common symptom is abdominal pain (abdominal migraine). The child says “my stomach hurts” instead of “my head hurts”.
- Repeated attacks of vomiting (cyclic vomiting syndrome) are the childhood equivalent of migraine.
- Car sickness and motion sickness are very common.
- If there is a family history of migraine, migraine should be considered when you see abdominal pain + vomiting + pallor attack in the child.
Silent Migraine and Retinal Migraine
Some patients do not have a headache at all, only aura symptoms. This is called “silent migraine” or “migraine without aura.” In Turkey, 70-75% of migraine patients experience (silent) migraine without aura.
In retinal migraine, there is vision loss or flashes in only one eye, and the headache is very mild or absent. This situation should be evaluated urgently because there is retinal vascular spasm.
What are the factors that trigger migraine?
Everyone's trigger is different, but the most common are:
- Stress (most common trigger) and the end of stress (weekend migraine)
- Sleep disorder (sleeping too little or too much)
- Hunger or skipping meals
- Chocolate, aged cheese, processed meat, monosodium glutamate (Chinese salt), aspartame
- Red wine, beer, caffeine withdrawal
- Bright light, flash light, strong perfume smell
- Weather change, southwest wind, sudden pressure drop
- Hormonal fluctuations
Keeping a trigger journal is the most important part of treatment.
When Should You See a Doctor Urgently?
Contact a neurologist within 24 hours if you have any of the following symptoms:
- The most severe headache of your life (“sudden onset” like a “lightning bolt”)
- Headache that occurs for the first time after the age of 50
- Fever with stiff neck
- Weakness in arms or legs, slurred speech
- If vision loss lasts longer than 1 hour
- If you have a history of cancer, HIV, or immunosuppressive drug use
Frequently Asked Questions (FAQ)
1. What are the symptoms of migraine and how long does it last?
Migraine symptoms occur in 4 stages: Prodrome (days before), aura (5–60 minutes), headache (4–72 hours) and postdrome (1–2 days). The total process may sometimes take up to 1 week. The pain is unilateral, throbbing, increases with movement, and is accompanied by nausea-vomiting and light-sound sensitivity.
2. How to distinguish migraine from tension headache?
Tension-type headache is compressive, bilateral, originates from the neck and neck, and does not increase with movement. Migraine is throbbing, one-sided, aggravated by movement, and there is nausea-vomiting and light-sound sensitivity. The patient can do daily activities in tension-type headache, but cannot in migraine.
3. Can you have migraine without aura?
Yes, 70-75% of migraine patients in Turkey do not experience aura. The form that presents only with throbbing headache, nausea and light sensitivity is called "migraine without aura" and is the most common type.
4. Could migraine symptoms be related to the menstrual period?
Absolutely yes. A sudden drop in estrogen levels before menstruation triggers a migraine attack. Menstrual migraine usually starts 2 days before the start of menstruation and eases when menstruation ends. This condition is called pure menstrual migraine and can be largely controlled with preventive treatment.
5. What are the symptoms of migraine in children? Can abdominal pain be a symptom of migraine?
Yes, especially in children between the ages of 4 and 12, migraine often manifests itself as abdominal pain and recurrent vomiting attacks. This condition is called "abdominal migraine" and "cyclic vomiting syndrome". The pain lasts a short time (2–24 hours), is bilateral, and is diagnosed if there is a family history of migraine.
Migraine is a disease that can be largely controlled if it is correctly recognized and treated correctly. If you are experiencing some of the above symptoms, I strongly recommend that you please consult a neurologist and start keeping a migraine diary. Early diagnosis means less pain and a better quality of life.
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