Migraine: Symptoms, Triggers & Treatment — Know the Signs

What does it mean?

Almost everyone gets headaches — but migraine is a different, more disabling condition. It is not "just a bad headache": a migraine attack can knock you out of work, study, or family life for hours or days, with throbbing pain, nausea, and unbearable sensitivity to light and sound. Many people in Pakistan treat every headache with the same painkiller and never get a proper diagnosis — some actually have migraine and suffer needlessly for years, while others worry unnecessarily about a brain tumour when the cause is benign. Understanding the pattern — how migraine differs from an ordinary tension headache, what "aura" means, and which headaches are dangerous — puts you in control.

Common causes

• 1How migraine is defined (ICHD-3, International Headache Society):
  migraine without aura means at least 5 attacks lasting 4–72 hours untreated, with at least two of: one-sided location, pulsating quality, moderate-to-severe intensity, worsening with routine physical activity — plus at least one of: nausea/vomiting, or both sensitivity to light and to sound (IHS criteria summary table).
• 2Tension headache is the common lookalike — and it differs in every feature:
  bilateral (both sides), pressing/tightening like a band (not throbbing), mild-to-moderate, not worsened by routine activity, no nausea or vomiting, and at most one of light/sound sensitivity; attacks last 30 minutes to 7 days (IHS criteria summary table).
• 3Aura is a warning phase, not just "blurry vision."
  About a quarter of migraine sufferers get aura — most often visual (flashing lights, zigzag lines, blind spots), but also tingling/numbness or speech disturbance. Aura symptoms typically build gradually over ≥5 minutes, each lasts 5–60 minutes, and the headache follows within 60 minutes (IHS criteria summary table). Aura without headache can also occur.
• 4Common triggers (NHS):
  hormonal changes/periods, stress and tiredness, anxiety and depression, skipping meals, too much caffeine, and too little exercise. A headache diary helps identify your personal pattern (NHS — Migraine).
• 5Menstrual migraine is real and common.
  The drop in oestrogen just before menstruation is a known migraine trigger; in some women attacks occur only from about 2 days before bleeding until 3 days after (pure menstrual migraine), and these attacks are often harder to treat. Taking extra care with other triggers (sleep, meals, hydration) around period time helps (Scottish NHS / SIGN menstrual migraine guidance).
• 6Treatment has two separate aims (NHS):
  (1) acute — stopping an attack once it starts (painkillers such as ibuprofen/paracetamol taken early, triptans, anti-sickness medicines); (2) preventive — reducing how often attacks happen, for people with frequent attacks (options include beta blockers, certain antidepressants, epilepsy medicines, and non-drug approaches like acupuncture or CBT). Your doctor matches treatment to your pattern — this article gives no doses (NHS — Migraine).
• 7Don't overuse painkillers.
  NHS warns: taking painkillers more than 2 days a week can cause medication-overuse headache — more headaches, harder to treat. If you need painkillers that often, see your doctor about preventive options instead (NHS — Migraine).
• 8Chronic migraine
  means headache on 15+ days a month for 3+ months, with at least 8 of those days having migraine features — this needs specialist review, not just more painkillers (ICHD-3 chronic migraine criteria — International Headache Society).

When to worry

Prevention & practical tips

• ✓Get a proper diagnosis. There is no scan or blood test for migraine — diagnosis comes from your history. Keep a headache diary for a few weeks: date, duration, pain type (one side? throbbing?), nausea, light/sound sensitivity, possible triggers, what you took and whether it worked. Take it to your doctor.
• ✓Treat attacks early. At the first sign of migraine, take the painkiller your doctor has advised, rest in a dark, quiet room, and avoid strong smells. Treating late makes attacks harder to stop.
• ✓Manage triggers you can control: regular sleep, regular meals (don't skip), steady caffeine (don't binge or quit suddenly), regular exercise, stress management. Around menstruation, be extra careful with sleep, meals, and hydration.
• ✓If attacks are frequent (several a month) or painkillers stop working, ask your doctor about preventive treatment — don't just increase painkiller use. Remember the 2-days-a-week limit.
• ✓Women with migraine with aura should discuss contraception choices with their doctor, as some hormonal methods carry added considerations — see your doctor; don't decide from the internet.
• ✓Don't self-diagnose a brain tumour from headache alone — but do learn the red flags below, because a small minority of headaches are emergencies.

FAQs

References

• IHS criteria summary table: http://pmc.ncbi.nlm.nih.gov/articles/PMC10860726/table/TAB3/
• NHS — Migraine: https://www.nhs.uk/conditions/Migraine/
• Scottish NHS / SIGN menstrual migraine guidance: https://rightdecisions.scot.nhs.uk/pharmacological-management-of-migraine-sign/menstrual-migraine/?collection=sign-decision-support
• ichd-3.org: https://ichd-3.org/1-migraine/1-3-chronic-migraine/
• NHS — subarachnoid haemorrhage: https://www.nhs.uk/conditions/subarachnoid-haemorrhage/