Migraines affect about 12% of the US population, per StatPearls. They’re one of the most common headache disorders.
But migraines are more than "just" headaches. The episodes can come with other severe symptoms, including nausea, vomiting, and fatigue. You may start experiencing signs such as mood changes, difficulty sleeping, and trouble concentrating days before the headache begins.
If you experience migraines, it's helpful to know common warning signs, so you can prepare for or try to prevent one.
About 30% of people with a migraine experience aura before or during a migraine episode, per a May 2020 paper published in the journal Current Neurology and Neuroscience Reports.
Almost all people with migraine auras experience visual symptoms such as flickering lights, zigzag lines, or blind spots, per a May 2019 review published in the Journal of Headache and Pain.
A little over a third of people with auras can have hearing disturbances, such as tinnitus (ringing in your ears), music, or noises. About 10% of people experience language changes, such as trouble understanding or finding words, per the May 2019 review. In rare cases, people experience motor auras with weakness on one side of the face or body, per StatPearls.
Auras typically last between five minutes and an hour. They can come within an hour of the headache or along with it, per the May 2020 paper. Some people may experience auras without a headache.
Depression, Irritability, or Excitement
Mood changes can be a sign of migraines. They begin in the prodrome phase—the first phase of a migraine attack that can start several hours or days before the aura or headache phases, per the American Migraine Foundation (AMF). Prodrome differs from auras because it occurs over several hours or days instead of 5–60 minutes.
You may feel depressed, irritable, or hyperactive. You may experience other mood changes, too—people’s prodrome symptoms vary widely, per the AMF. For example, some people experience euphoria—intense excitement or happiness—per an April 2015 study published in the Journal of Neuroscience.
Migraines are also associated with higher rates of mood disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD), per a January 2016 article published in the Journal of Neurology, Neurosurgery & Psychiatry. For example, people who experience migraines are 2.5 times more likely to have depression. Migraines and psychiatric disorders may have the same genetic risk factor.
The presence of psychiatric disorders in people with migraines can make the headache disorder more difficult to manage and increase a person’s risk of chronic migraines—experiencing “15 or more headache days a month with eight of those days involving migraine headaches,” per the National Library of Medicine MedlinePlus resource.
Lack of Restful Sleep
Waking up tired or having trouble falling asleep is common in people with migraines. When migraines strike, it’s tough to get a good night’s sleep. “A lot of people will have insomnia as a result of their migraine,” said Edmund Messina, MD, medical director of the Michigan Headache Clinic in East Lansing.
This inability to sleep can be the start of a vicious cycle. Sleep disturbances are also the most frequently cited migraine triggers, per a February 2022 review published in the journal Frontiers in Neurology.
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Stuffy Nose or Watery Eyes
Some people with migraines experience sinus symptoms, such as a stuffy nose, clear nasal drainage, droopy eyelids, or tearing, Dr. Messina said.
These symptoms commonly lead healthcare providers to diagnose people with sinus headaches—headaches caused by a bacterial or viral sinus infection that resolves within seven days after sinus symptoms, per the AMF. But this is a common misdiagnosis of a migraine, per a June 2019 study published in the Journal of Family Medicine and Primary Care.
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Before a migraine attack occurs, some people crave certain foods. “A common craving is chocolate,” Dr. Messina said. But chocolate may be a migraine trigger, along with certain cheeses, per MedlinePlus.
Food cravings may also be signs of the prodrome phase. Research published in January 2021 in the Journal of Neurology suggested that what people perceive to be migraine triggers (including chocolate) may instead be early migraine symptoms.
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Throbbing Pain on One or Both Sides of the Head
Pulsating pain is a classic sign of migraines. Most people with migraines experience throbbing pain on only one side of the head, per MedlinePlus.
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Migraine pain often burrows in the temples or behind one eye or ear, per the Office on Women’s Health (OWH). You may also experience it around the eye, in the eye socket, per the April 2015 paper.
People may blame it on eye strain, and many will see an optometrist, but that won’t make their headaches better, Dr. Messina said.
"A lot of people will say, 'My neck gets stiff, and then I get a headache.' Well, it's probably the early stage of the migraine," Dr. Messina said. "Or after a migraine, they'll get that neck symptom, or they'll have throbbing pain at the back of their neck."
If you experience a stiff neck along with a headache, fever, nausea, and vomiting, seek medical help immediately, as it may be a sign of a more serious condition, per MedlinePlus.
If you have to urinate often, it can mean a migraine is coming. It’s one of the many symptoms people experience during the prodrome phase, per MedlinePlus. At the same time, you may experience fluid retention—when fluid accumulates in the body’s tissues and cavities, possibly leading to swelling.
Some also experience frequent urination and diarrhea as the headache progresses, per the April 2015 paper.
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Yawning too much is another tip-off that a migraine is about to strike. Unlike regular "I'm tired" yawning, it may be excessive and uncontrollable and occur every few minutes.
In a September 2017 study published in the journal Headache, about 45% of people with migraines experienced yawning, both in the prodrome phase and during the headache. People who yawned were more likely to experience auras, nausea, and vomiting.
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Numbness or Tingling
Some people with migraines have sensory auras. They may have a temporary lack of sensation or a pins-and-needles feeling, typically on one side of the body, moving from the fingertips through the arm and across the face, per StatPearls.
Nausea or Vomiting
According to the International Classification of Headache Disorders (ICHD-3), migraine without aura can be diagnosed only if the person experiences either a combination of nausea and/or vomiting or light and sound sensitivity (more on that later). All four symptoms may be present together during a migraine episode.
For people experiencing migraines with severe pain, nausea, and vomiting, healthcare providers typically administer pain medications non-orally, usually through an injection or infusion, per StatPearls. Antiemetics—nausea and vomiting medications—may be used in addition to pain relievers.
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Light and Sound Sensitivities
During a migraine episode, a person tends to seek refuge in a dark, quiet place. Bright lights and loud noises can trigger a migraine or intensify the pain. The same is true of certain smells. Light sensitivity may also be a symptom of the prodrome phase.
Light and sound sensitivities are also called photophobia (“fear of light”) and phonophobia (“fear of sound”), per StatPearls. They are typically associated with migraines without aura.
About 76% of people who experience migraines report triggers that contributed to the attack, per StatPearls. Exposure to light may trigger a migraine in 38% of people who report triggers. Odors such as perfumes, colognes, and gasoline may trigger about 40% of episodes in people who report triggers. The top trigger was stress (80% of cases).
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Activity Triggers or Worsens Pain
Routine activities such as walking or climbing stairs can make migraine pain worse.
Some migraines are induced by exercise (such as running and weight-lifting) or exertion (such as sexual activity). People with exertion-induced headaches may require a thorough workup to rule out underlying causes, such as a brain aneurysm.
Exercise was a trigger for 22% of people who experienced migraine triggers. Sexual activity was a rare trigger, appearing in only 5% of trigger-induced migraines, per StatPearls.
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Can't get the words out? Speech difficulties can be another sign that a migraine is on its way. Trouble understanding or finding words can be symptoms of an aura, per the May 2019 review.
"A lot of people with migraines will feel like they're blithering," Dr. Messina said. "It's a common description by patients."
If you are experiencing speech problems for the first time, contact a healthcare provider to make sure the problems are not related to a more serious issue, such as a stroke.
Weakness on One Side of the Body
When an arm goes limp, it can be a sign of a migraine. Some people experience muscle weakness on one side of the body before a migraine attack. These may be considered motor auras, per StatPearls.
The weakness can also be a sign of a stroke, so consult a healthcare provider to rule that out as a cause.
Vertigo or Double Vision
One type of migraine, also called a basilar migraine, causes brainstem aura symptoms, per StatPearls. The brainstem is the lower part of your brain that connects the brain to the spinal cord. These migraines come with symptoms that are typically more severe and last longer.
The brainstem-related symptoms include vertigo and double vision, slurred speech, tinnitus, lack of coordination, and confusion. Some may experience a loss of consciousness.
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After the migraine passes, a person may feel like their body has been pummeled.
People with migraines may experience post-headache symptoms such as fatigue, trouble concentrating, weakness, dizziness, lightheadedness, and loss of energy during the post-migraine period. This is considered the postdrome phase, per MedlinePlus.
"It can be very fatiguing," Dr. Messina said.