Understanding Migraines
Most people have experienced a headache at some point, but migraines are a different experience altogether. More than just head pain, migraines are a neurological condition that can affect how you think, see, feel, and function. For some, migraines occur only occasionally. For others, they can become a recurring disruption to work, family life, and everyday activities.
If you live with migraines, it's natural to wonder whether your symptoms are typical, whether your treatment plan is working, or if it's time to seek additional care. Understanding what to expect from migraines, when to talk with your provider, and when to seek immediate medical attention can help you feel more confident and empowered in managing your health.
How Common Are Migraines?
Migraines are one of the most common neurological conditions worldwide, affecting about 1 billion people. They are more common in women, impacting approximately 17% of women compared to about 6% of men. Most people experience migraines between the ages of 20 and 50.
The encouraging news is that nearly 90% of migraine cases can be effectively managed in a primary care setting. However, some patients may benefit from specialized neurological care. Knowing when to escalate care is key.
What Are the Symptoms of a Migraine?
Migraine symptoms can vary from person to person, but most attacks follow a recognizable pattern. Understanding these symptoms can help you identify when you are experiencing a migraine versus another type of headache.
A migraine typically presents as a moderate to severe headache lasting anywhere from 4 to 72 hours. These headaches often include at least two of the following characteristics:
- Pain on one side of the head
- A throbbing or pulsating sensation
- Moderate to severe intensity
- Worsening with routine physical activity, such as walking or climbing stairs
- Nausea and/or vomiting
- Sensitivity to light (photophobia) or sound (phonophobia)
Migraine with Aura
Some individuals experience what is known as a migraine with aura, which includes temporary neurological symptoms that typically develop gradually before the headache begins. These symptoms usually last between 5 and 60 minutes and are fully reversible.
Common types of auras include:
- Visual changes such as flickering lights, zigzag lines, or blind spots
- Sensory symptoms like tingling or numbness, often starting in the hand and moving upward
- Speech or language difficulties, such as trouble finding words
While aura symptoms can feel unsettling, they are generally short-lived. However, any new or changing neurological symptoms should be evaluated by a healthcare provider.
When Should You See a Neurology Specialist?
There are certain situations where a referral to a neurologist may be the right next step. You may benefit from specialty care if:
- Your migraines are not responding to treatment
If standard medications or therapies are no longer providing relief, a neurologist can help explore more advanced options tailored to your needs. - Your headaches are frequent or significantly impact your daily life
Consider a referral if you experience:- Six or more headache days per month
- Four or more headaches per month that interfere with work or daily activities
- Three or more headaches per month that leave you unable to function
- Your symptoms are unclear or changing
If your headache pattern does not follow a typical migraine presentation, or if new or unusual symptoms develop, further evaluation can help confirm the diagnosis and rule out other conditions.
When Is a Migraine an Emergency?
Most migraines, while painful and disruptive, are not dangerous. However, certain symptoms may signal a more serious condition and require immediate medical attention.
Seek emergency care right away if you experience:
- A sudden, severe “thunderclap” headache: This is often described as the worst headache of your life, reaching peak intensity within seconds to one minute.
- New or unusual neurological symptoms: These may include weakness on one side of the body, vision loss, confusion, difficulty speaking, or loss of consciousness.
- Fever accompanied by a stiff neck: These symptoms can be caused by infections such as meningitis or encephalitis and should be evaluated urgently.
When in Doubt, Get Checked Out
While migraines are common, they should never be something you simply have to "live with." If your headaches are becoming more frequent, more severe, or are interfering with your daily life, it may be time to seek additional support.
At JCMG’s Neurology Institute in Columbia, our experienced neurology team provides comprehensive evaluation and treatment for migraine disorders and other conditions affecting the brain, spinal cord, and nervous system. Get to know the Neurology Institute Team at JCMG.org/neurology.
Whether you're experiencing chronic migraines, noticing changes in your symptoms, or finding that your current treatment is no longer effective, we're here to help. If you are experiencing any of these concerns and would like further evaluation, call (573) 635-5264 to schedule an appointment with a JCMG primary care provider, who can help determine the next steps in your care and provide a referral to the Neurology Institute if needed.
Sources and Clinical References
This article is informed by evidence-based research and clinical guidelines, including:
- Robbins, M.S., MD. Diagnosis and Management of Headache: A Review. Journal of the American Medical Association (JAMA).
- Red and Orange Flags for Secondary Headaches in Clinical Practice: The SNNOOP10 List. Neurology.
- Ashina, M., MD, PhD. Migraine. New England Journal of Medicine (NEJM).