Migraine Symptoms: Complete Guide by an ENT Doctor (2026)

Introduction

Migraine is one of the most common and disabling neurological disorders in the world. According to the World Health Organization (WHO), migraine affects roughly 1 in 7 people globally, and the US National Institute of Neurological Disorders and Stroke (NINDS) estimates that more than 37 million Americans live with migraine, with women affected about three times more often than men. Understanding migraine symptoms early is the single most important step toward getting the right treatment, avoiding dangerous mimics such as stroke, and reducing the number of future attacks.

This guide, prepared by an ENT specialist and based on CDC, NINDS, WHO and peer-reviewed neurology sources, explains what migraine symptoms look like at every stage, how they differ from a tension headache or sinus headache, the warning signs that mean you should seek urgent care, and the practical next steps a US reader can take today — including when to call their primary-care physician and when to go directly to the emergency department.

What Is a Migraine?

A migraine is not just a bad headache. The International Classification of Headache Disorders, 3rd edition (ICHD-3) defines migraine as a recurrent primary headache disorder characterised by attacks of moderate to severe, often one-sided, pulsating head pain lasting 4 to 72 hours, usually accompanied by nausea, vomiting and sensitivity to light (photophobia) and sound (phonophobia). Migraine is driven by complex changes in the trigeminovascular system, the brainstem and the release of calcitonin gene-related peptide (CGRP) — a key molecule now targeted by the newest FDA-approved migraine medicines.

Because migraine shares symptoms with sinus headaches, inner-ear disorders and — rarely — stroke, recognising its symptoms accurately is essential. Many patients told they have a “sinus headache” actually have migraine, a finding confirmed by the landmark Sinus, Allergy, and Migraine Study (SAMS) published in Headache journal.

The Four Phases of a Migraine Attack

Migraine typically unfolds across up to four phases. Learning to recognise your personal early-warning pattern lets you treat the attack sooner — the single strongest predictor of a successful outcome.

1. Prodrome (hours to 2 days before pain)

The prodrome is a subtle warning phase experienced by about 60% of people with migraine. Typical features include yawning, food cravings (often chocolate), mood changes, neck stiffness, fatigue, difficulty concentrating and increased urination. Mistaking these as “normal” is extremely common.

2. Aura (5–60 minutes)

About 25–30% of migraine attacks include an aura, usually visual: zigzag lines (fortification spectra), flashing lights, blind spots or temporary vision loss. Sensory aura (tingling), speech aura and, in vestibular migraine, vertigo may occur. Aura symptoms develop gradually over at least 5 minutes — this gradual onset is a key clue that separates aura from a stroke, which usually starts suddenly.

3. Headache (4–72 hours)

The pain phase typically produces a unilateral, throbbing or pulsating pain, moderate to severe, worsened by routine activity such as climbing stairs. Nausea, vomiting, photophobia and phonophobia are almost always present. Some patients also report osmophobia (sensitivity to smells) and allodynia (ordinary touch, like a hairbrush, feels painful).

4. Postdrome (up to 48 hours after)

Often called the “migraine hangover,” the postdrome leaves patients feeling drained, foggy and tender in the head area. Mild cognitive slowing and body aches are typical.

Common Migraine Symptoms

Across the four phases, the hallmark migraine symptoms include:

• Throbbing or pulsating head pain, usually on one side (bilateral in up to 40% of attacks)
• Nausea and/or vomiting
• Photophobia — light sensitivity
• Phonophobia — sound sensitivity
• Pain worsened by physical activity
• Attack duration between 4 and 72 hours
• Need to rest in a dark, quiet room
• Reduced ability to work or study (disability)

The ICHD-3 requires at least five lifetime attacks meeting these features before migraine without aura can be formally diagnosed. If you have never been evaluated, keeping a simple symptom diary over 4–6 weeks is one of the most useful things you can do before seeing your doctor.

Migraine Aura — Visual, Sensory and Speech Symptoms

Aura is a reversible neurological symptom that precedes or accompanies the pain phase. The underlying mechanism — cortical spreading depression — is a slow wave of altered electrical activity across the brain’s surface.

Visual aura

By far the most common. Features include flickering zigzag lines that drift across the visual field, a shimmering “heat haze”, blind spots (scotomas) and tunnel vision. Visual aura typically lasts 15–30 minutes and resolves fully.

Sensory aura

A tingling or pins-and-needles sensation that spreads up one arm into the face. Unlike a stroke, migraine aura marches slowly across minutes rather than appearing all at once.

Speech or language aura

Difficulty finding words (aphasia), slurred speech or a sense that language is “tangled.” Always treat new speech symptoms as a possible stroke until proven otherwise.

Brainstem aura

Includes vertigo, double vision, ringing in the ears (tinnitus) and unsteadiness. This subtype often brings patients to an ENT clinic first.

Migraine with aura is linked to a small but statistically significant increase in ischemic stroke risk, particularly in women under 45 who smoke or use combined oral contraceptives — a point the CDC highlights in its headache risk guidance for women of reproductive age.

Types of Migraine and Their Symptoms

Not all migraine looks the same. The main clinical types defined by the ICHD-3 include:

• Migraine without aura — the most common form (~75%)
• Migraine with aura — attacks preceded or accompanied by neurological aura
• Chronic migraine — headache on ≥15 days per month for >3 months, with migraine features on at least 8 of those days
• Hemiplegic migraine — rare, with reversible weakness on one side; genetic forms exist
• Retinal migraine — monocular visual loss followed by headache
• Vestibular migraine — vertigo as the dominant symptom (discussed next)
• Menstrual migraine — attacks tied to the menstrual cycle
• Status migrainosus — a severe attack lasting >72 hours; often needs ER care

Vestibular Migraine — The ENT Overlap

From an ENT perspective, this subtype deserves special attention. Vestibular migraine is now recognised as one of the most common causes of recurrent vertigo in adults. Patients experience spinning vertigo, imbalance, motion sensitivity and sometimes brief hearing changes, with or without typical head pain. The Bárány Society and the International Headache Society have published joint diagnostic criteria.

Many patients spend years being investigated for Ménière’s disease or benign paroxysmal positional vertigo (BPPV) before vestibular migraine is identified. If you have recurrent dizziness that is worsened by bright lights, screens, poor sleep, hunger or menstruation, ask your doctor specifically about vestibular migraine.

Migraine Symptoms in Children

Children’s attacks are often shorter (as little as 2 hours), more often bilateral and more likely to feature abdominal pain, cyclical vomiting or motion sickness as the main symptom. The American Academy of Pediatrics recommends a careful history, hydration, consistent sleep and a trial of lifestyle changes before medications in most cases.

Migraine Symptoms in Women

Oestrogen fluctuations drive menstrual migraine, which tends to be longer, more severe and more resistant to standard treatment. Pregnancy often improves migraine in the second and third trimesters, while perimenopause may worsen attacks before they fade after menopause.

Migraine vs Tension Headache vs Sinus Headache

Red-Flag Symptoms — When to Seek Urgent Care

Migraine itself is not life-threatening, but several red flags require immediate evaluation. US readers should call 911 or go to the emergency department if any of the following occur:

• A sudden “thunderclap” headache reaching maximum pain in seconds
• Headache with new weakness, facial droop, slurred speech or confusion — think FAST for stroke
• Headache with fever, stiff neck or rash — possible meningitis
• New headache after head injury
• New daily headache after age 50
• Headache that is clearly different from your usual migraine
• Headache during pregnancy with vision changes or swelling — possible preeclampsia

How Doctors Diagnose Migraine

Migraine is a clinical diagnosis. In the US, your primary-care physician or neurologist will take a detailed headache history, perform a neurological examination and apply the ICHD-3 criteria. Imaging (MRI/CT) is reserved for red-flag features; routine scans are not needed in typical migraine, per the Choosing Wisely recommendations of the American Headache Society.

Practical Next Steps for US Readers

1. Start a headache diary: date, duration, triggers, medication used, response.
2. Review common triggers: skipped meals, poor sleep, dehydration, alcohol (red wine), aged cheese, stress let-down, bright screens.
3. Book an appointment with your primary-care physician. If you are uninsured, the HRSA Find a Health Center tool lists federally-funded community health centers that provide sliding-fee care across all 50 states.
4. For acute attacks, over-the-counter options such as ibuprofen or acetaminophen can help early mild attacks, but overuse (>10–15 days/month) causes medication-overuse headache.
5. Ask whether an FDA-approved CGRP-targeting therapy (gepants, ditans, or anti-CGRP monoclonal antibodies) is appropriate if attacks are frequent or disabling.

For a short visual overview, the National Headache Foundation hosts a helpful patient video: watch an introduction to migraine symptoms on YouTube.

Frequently Asked Questions

What are the first signs of a migraine attack?

The earliest signs are prodrome symptoms — yawning, food cravings, neck stiffness, mood changes or fatigue — often appearing hours before the pain. Learning to recognise your personal prodrome allows earlier treatment.

Can migraine cause vertigo without headache?

Yes. In vestibular migraine, vertigo may occur with little or no head pain, which is why many patients are first seen by ENT specialists.

How long does a migraine last?

Untreated, an attack typically lasts 4 to 72 hours. Attacks longer than 72 hours are called status migrainosus and often need emergency care.

Is a migraine a sign of stroke?

Migraine is not a stroke, but migraine with aura slightly raises stroke risk. Any sudden, severe or “different” headache — especially with weakness, speech trouble or facial droop — should be treated as a possible stroke.

Can migraine be cured?

There is no definitive cure, but current FDA-approved preventive and acute medicines, combined with lifestyle changes, can dramatically reduce attack frequency and severity for most people.

What is the difference between a sinus headache and a migraine?

True sinus headache requires signs of infection — fever, purulent nasal discharge. Most “sinus headaches” diagnosed in the community are actually migraine, according to the SAMS study.

Summary

Migraine symptoms include throbbing one-sided head pain, nausea, light and sound sensitivity, and sometimes aura. The attack unfolds in up to four phases: prodrome, aura, headache and postdrome. Vestibular migraine causes recurrent vertigo and is a common ENT presentation. Red-flag features — sudden thunderclap pain, new weakness, speech trouble, fever with stiff neck — require 911 or ER evaluation. Diagnosis is clinical using ICHD-3 criteria, and effective FDA-approved treatments exist.

Conclusion

Recognising migraine symptoms early is the most powerful tool a patient has. A simple headache diary, awareness of personal triggers and a timely conversation with your primary-care physician or neurologist can transform migraine from a disabling, unpredictable condition into one that is well-controlled. If you are in the United States and lack easy access to a specialist, the HRSA community health center network and most urgent-care clinics can start the evaluation. Do not ignore red flags — when in doubt, seek immediate care.

References

1. National Institute of Neurological Disorders and Stroke (NINDS). Migraine Information Page. https://www.ninds.nih.gov
2. Centers for Disease Control and Prevention (CDC). QuickStats: Percentage of Adults Who Had a Severe Headache or Migraine. https://www.cdc.gov
3. World Health Organization. Headache disorders fact sheet. https://www.who.int
4. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia.
5. Lempert T, et al. Vestibular migraine: Diagnostic criteria (update). Journal of Vestibular Research. Bárány Society / International Headache Society.
6. American Headache Society. Choosing Wisely recommendations.
7. US Food and Drug Administration. Approved CGRP-targeting migraine therapies. https://www.fda.gov
8. Mayo Clinic. Migraine — Symptoms & causes. https://www.mayoclinic.org