Migraine is not simply a severe headache. It is a neurological condition in which the brain’s pain pathways become temporarily oversensitive, so an attack follows a recognisable pattern rather than appearing at random. In this guide, Dr. Ergenekon Karagöz, a specialist in internal medicine, explains what a migraine attack typically feels like, how long it lasts, what tends to set it off and which warning signs mean head pain should be assessed without delay.
What migraine is
Migraine is a disorder of the nervous system with a strong inherited component. In people who carry that predisposition, everyday factors such as broken sleep, a skipped meal or a sudden drop in stress can disturb the chemical balance involved in pain regulation, and a wave of altered nerve activity spreads across the brain. The result is pain that is usually one-sided and throbbing, often with nausea and a strong dislike of light and sound.
Because the mechanism sits in the nervous system, migraine behaves differently from tension-type headache or from head pain that starts in the neck. Neck-related pain usually begins at the nape and follows posture and screen hours, a pattern described in our guide on where neck-related pain radiates.
Symptoms: how an attack unfolds
Patients most often describe a deep, pulsating pain behind or around one eye or in one temple, which gets worse with movement, bending forward or climbing stairs. Ordinary daylight becomes hard to tolerate, cooking or perfume smells turn nauseating, and at the peak of the attack the only relief is a dark, quiet room. The complaint is rarely only about pain: people describe losing the day, because work, driving and screen use become impossible until the attack passes.
Warning signs before the pain
Hours before the headache begins, some people notice yawning, a stiff neck, food cravings, irritability or trouble concentrating. Many patients learn to read these signals and use them as a cue to rest.
Aura
Aura is a temporary visual or sensory disturbance that appears shortly before or at the start of the pain. It is usually described as flickering zigzag lines, bright spots, a blind patch in the visual field, or tingling that creeps from the fingers towards the lips. Aura builds up gradually and clears within an hour, most often in 20 to 60 minutes. Not every attack includes aura, and the same person can have both types.
The headache phase and the day after
Nausea often accompanies the pain and some people vomit. Digestion slows during an attack, which is one reason treatment taken late tends to work poorly. Once the pain settles, a tired, foggy day frequently follows before concentration, appetite and mood return to normal.
How long a migraine attack lasts
An untreated attack generally lasts between 4 and 72 hours. Some fade within a few hours; others stretch over two or three days and leave the person exhausted afterwards. An attack that keeps its full intensity beyond 72 hours is assessed differently and needs medical attention rather than more painkillers at home.
Common triggers
Triggers are personal: what sets off an attack in one person may be harmless for another. The factors reported most often are:
- Sleep changes: too little sleep, but also sleeping in at the weekend.
- Skipped meals, long gaps between meals and not drinking enough water.
- Stress and, just as often, the release of stress; attacks that arrive on the first free day are a familiar pattern.
- Hormonal changes around the menstrual cycle, pregnancy or menopause.
- Aged cheese, processed meat, alcohol or a sudden change in caffeine intake.
- Flickering fluorescent light, screen glare, strong smells and loud noise.
- Weather and air pressure changes.
- Long hours in a fixed posture at a desk, including loss of the natural neck curve.
A simple headache diary (date, duration, sleep, meals, stress level, menstrual cycle) separates real triggers from coincidence better than memory does.
Which department to see and how migraine is diagnosed
Migraine is diagnosed and followed up by Neurology, and a pain clinic may join the management when pain is frequent or long-standing. No blood test or scan proves migraine: the diagnosis is clinical and rests on the pattern of attacks, their duration, the accompanying symptoms and the family history.
Imaging does not show migraine itself, because migraine leaves no visible lesion. An MRI is requested when another cause has to be excluded, particularly if the headache is new, has changed character or comes with neurological findings. Blood pressure is checked in the same assessment, since poorly controlled hypertension can also cause head pain.
Treatment
Treating an attack
Acute treatment works best when it is started early, while the pain is still building. Simple painkillers, anti-nausea medicines and migraine-specific drug families are all used, and the right choice depends on attack severity, other health conditions and previous response. That decision, including timing and repetition, belongs to the treating doctor.
One point deserves attention: taking acute painkillers on most days of the month can create a separate problem, medication-overuse headache, in which pain becomes more frequent rather than less. Anyone reaching for painkillers regularly should raise it at their next appointment.
Preventive treatment
When attacks are frequent, long or disabling, a preventive medicine taken regularly may be added. Several drug families are used, and the choice is shaped by age, blood pressure, other conditions and tolerance. Preventive treatment is judged over weeks rather than days; the aim is fewer and milder attacks, not a guarantee of pain-free months.
Botulinum toxin in chronic migraine
When headache is present on 15 or more days a month over several months, the picture is described as chronic migraine and the treatment plan changes. Botulinum toxin injected into defined points on the forehead, temples, neck and shoulders is an approved option in this group. The effect is not permanent and sessions are repeated at intervals; suitability is decided after examination.
Everyday measures that support treatment
- Keep a steady sleep schedule, including at the weekend.
- Eat at regular intervals and drink water through the day.
- Keep caffeine intake consistent rather than swinging between none and a lot.
- Reduce glare and screen strain, and take short breaks to change position.
- Stay physically active at a level that suits you.
- Ask your doctor before starting any supplement, including magnesium or vitamin preparations.
A broader look at the condition, including attack types and long-term management, is available in our detailed guide to migraine symptoms and treatment.
When to seek medical help without delay
- Headache that reaches full intensity within seconds, or the worst headache of your life.
- Headache with fever, neck stiffness, rash or confusion.
- Headache that starts after a blow to the head.
- A severe headache appearing for the first time after the age of 50.
- Weakness, numbness, speech difficulty, double vision, unsteadiness, or aura lasting longer than an hour.
- Pain that is worse on coughing or straining, or that wakes you from sleep.
- A clear change in the usual pattern of attacks.
- A new or unusual headache during pregnancy.
Frequently asked questions
Is botulinum toxin a permanent solution for migraine?
No. Its effect generally lasts a few months, so sessions have to be repeated at intervals to maintain the benefit. It is an option for chronic migraine, and suitability is decided by the doctor after examination.
Does migraine show up on an MRI?
Not directly. Migraine does not create a lesion such as a tumour or bleeding, so the scan is usually normal. Imaging is used to rule out other causes; the diagnosis itself is made clinically.
Is migraine hereditary?
Migraine has a strong genetic component, and it is common to find close relatives with the same problem. Inheritance decides the predisposition, not the course: triggers and attack frequency still differ from person to person.
What is the difference between migraine with and without aura?
In migraine with aura, visual or sensory symptoms appear before the pain starts. In migraine without aura, the headache begins directly. Both types can occur in the same person at different times.
Note: This guide is for general information and does not replace medical advice, diagnosis or treatment. Head pain that is new, severe or changing should be evaluated in person by a doctor.
