A migraine is a neurological disorder characterised by recurrent attacks of moderate-to-severe head pain, typically throbbing or pulsing, often one-sided, and accompanied by nausea and sensitivity to light and sound. It differs fundamentally from tension-type headache in mechanism, severity, and the functional disability it causes.
The defining features of migraine
Clinicians diagnose migraine using the ICHD-3 (International Classification of Headache Disorders) criteria. A migraine without aura requires at least 5 attacks meeting: 4–72 hours duration; at least 2 of (unilateral location, pulsating quality, moderate-severe intensity, worsened by routine activity); and at least 1 of (nausea/vomiting, photophobia and phonophobia).
Migraine with aura — affecting about a third of sufferers — includes reversible neurological symptoms that precede the headache by 20–60 minutes: visual disturbances (zigzag lines, flashing lights, blind spots), sensory changes, speech difficulties or muscle weakness.
Headache types at a glance
| Type | Location | Quality | Duration | Associated symptoms |
|---|---|---|---|---|
| Migraine | Usually one-sided | Throbbing/pulsing | 4–72 hours | Nausea, photo/phonophobia, aura |
| Tension headache | Both sides, band-like | Pressure/tightening | 30 min–7 days | Mild photo or phonophobia (not both) |
| Cluster headache | Around one eye | Stabbing, excruciating | 15–180 min | Red eye, tearing, nasal congestion (same side) |
| Sinusitis headache | Over sinuses | Pressure | Days | Congestion, fever, facial tenderness |
Common migraine triggers
- Hormonal changes — particularly around menstruation; many women experience menstrual migraine
- Sleep disruption — both too little and too much can trigger an attack
- Skipping meals or fasting — particularly in those prone to hypoglycaemia
- Dehydration
- Strong sensory stimuli — bright lights, loud sounds, strong smells
- Alcohol — particularly red wine and spirits
- Stress — both acute stress and 'let-down' migraines after stress resolves
- Weather changes — particularly falling barometric pressure
What doctors investigate
Migraine is a clinical diagnosis — there is no blood test or imaging that confirms it. However, your doctor will order brain imaging (MRI) if headaches are new and unusual, change suddenly in character, are accompanied by neurological symptoms that persist beyond the aura, are triggered by coughing, exertion or Valsalva manoeuvre, or are associated with fever and neck stiffness.
A headache diary — documenting dates, duration, severity, triggers and medications — is the single most useful diagnostic tool and should be kept for at least 2–3 months before a specialist appointment.
"A headache diary is worth more than most tests for migraine. Patterns matter more than single readings."
Dr. Lina Haddad, CMO, Looms
Treatment options
Acute treatments include triptans (first-line for moderate-to-severe migraine), NSAIDs and anti-nausea medications. Preventive treatments — considered when attacks occur 4 or more days per month — include beta-blockers (propranolol), antidepressants (amitriptyline), anti-epileptics (topiramate) and the newer CGRP monoclonal antibodies (erenumab, fremanezumab).
Keeping a headache diary and tracking treatments in your health record allows you to identify what works over time — far more informative than recalling history in a brief consultation.