Migraine symptoms and red flags

Migraine can affect the whole body, not only the head. Common symptoms include throbbing or pulsing head pain, nausea, vomiting, sensitivity to light and sound, fatigue, neck stiffness, mood changes, dizziness, and post-attack fogginess.

Aura can include visual changes, tingling, numbness, dizziness, or difficulty speaking. Aura symptoms usually develop gradually and are temporary. New, severe, prolonged, or unusual neurologic symptoms should be treated cautiously because stroke, infection, bleeding, and other conditions can mimic migraine.

Seek urgent or emergency care

Get urgent medical help now if a headache is sudden and extremely severe, especially if it feels like a thunderclap. Also seek urgent help for headache with fever, stiff neck, confusion, seizure, fainting, double vision, new trouble speaking, new vision loss, new weakness or numbness, new balance problems, or drowsiness.

Headache after a head injury, a chronic headache that worsens with coughing or exertion, a new headache after age 50, or a headache pattern that suddenly changes should be assessed promptly.

For migraine specifically, NHS guidance advises urgent help if a migraine attack lasts longer than 72 hours, aura symptoms last longer than one hour, or the person is pregnant or recently gave birth.

See a clinician even if it is not an emergency

Make a routine appointment if attacks are severe, getting worse, happening more than once a week, hard to control, repeatedly linked to menstruation, or interfering with school, work, caregiving, sleep, or basic activities.

Bring a diary if possible. Record attack dates, symptoms, duration, medications, medication timing, menstrual timing if relevant, sleep, meals, hydration, possible triggers, and how much function was lost. See tracking and appointment prep.

Children need extra caution

Children can have migraine, but they may describe symptoms differently. They may have two-sided forehead pain, abdominal pain, dizziness, trouble focusing, irritability, or attacks that are shorter than adult attacks. A child under 3 with headaches, a child with a new severe headache type, weakness, walking changes, swallowing changes, or vision changes should be evaluated promptly.

Sources

• Mayo Clinic: Migraine symptoms and causes
• NHS: Migraine
• American Migraine Foundation: Migraine in children