How To Tell If You're REALLY Having Migraines + When It's Time To Get Help

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A frequent question I hear from my patients is “how do I know if I’m having a migraine?”

If you're someone who's ever suffered from a migraine, you’re probably thinking “trust me, you’ll know if you’re having one!" And, as a neurologist who has treated thousands of migraine patients (and suffers from them myself) the difference between a migraine and a regular tension headache seems very clear to me, too.

But this is not always easy, and headache doctors don’t always agree on any particular headache patient. So, if you’re experiencing your first one or you’ve never been diagnosed as a “migraineur," recognizing your head pain as a migraine can be confusing.

If you have recurrent headaches or suspect you may be suffering from migraines, use this guide to migraine symptoms to help you correctly recognize a migraine and decide when it’s time to get medical attention.

Migraine Symptoms

A migraine is a recurrent headache that usually lasts four to seven hours. Compared to other types of headaches, it can range from moderate to severe. Migraines can vary from patient to patient, as well as from episode to episode, but they're typically characterized as having one of the following:

  • An intense pulsing or throbbing component to the pain, as opposed to the more mild, dull pressure of tension headaches.
  • The pain is localized on one side of the head.
  • The pain worsens with movement.
  • You experience sensitivity to light and sound.
  • The headache is accompanied by nausea, vomiting or dizziness.
  • You experience temporary blind spots or other visual disturbances.

You won’t necessarily experience all of the above during a migraine episode, but if you do experience any these symptoms during your headache, it's very likely you are experiencing a migraine.

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The Aura

A less common, but a surefire sign that you’re experiencing a migraine is if your headache is preceded by an aura, or sensory symptoms. The most prevalent type of auras is visual disturbances such as flickering lights, spots or zigzag lines called fortification spectra. Auras last anywhere from 5 to 60 minutes and are completely reversible.

We generally divide migraines into two types: migraine without aura (MWOA) and migraine with aura (MWA). Migraines with aura are actually the less common type of migraine headache (only about 20 percent of migraine sufferers experience an aura). If you don’t experience auras, feel grateful—but don't rule out the possibility of a migraine.

When to See a Doctor

For many migraine sufferers, a migraine is an inconvenience but not a debilitating condition. They use various coping strategies, prevention techniques and over-the-counter drugs to get through the migraine episode and never see a doctor about them.

But for others, these techniques are not enough. The migraine headaches themselves are debilitating and the treatments they are using aren’t enough. Sometimes, migraine becomes intractable. That’s when a person needs a headache specialist.

Because the severity, frequency, and triggers of migraine headaches vary so much from patient to patient, it’s hard to say for sure when it’s time to seek medical attention. But, if nothing else, these are a few guidelines to follow to help you make the decision to seek medical attention:

Immediate Medical Attention

Stop reading my article and go straight to a doctor or emergency room if you are experiencing a headache and any of the following symptoms:

  • fever and chills
  • you’ve been in an accident or struck your head
  • numbness or weakness
  • complete loss of vision
  • problems with your speech or walking
  • pain in the head that is sharp and stabbing
  • if the headache you have is the worst headache of your life

These are signs of conditions much more serious than migraine such as infection, stroke, bleeding, or other serious problems that demand rapid diagnosis and treatment by medical personnel.

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Less Urgent Medication Attention

How many migraines should you experience before you see a doctor? How bad do the migraines need to be to warrant medical attention? What if you're still not sure if what you're experiencing is a migraine?

You can begin to answer these questions by keeping a headache diary. For every headache you have, document when the headache happened; the symptoms you experienced with the headache (for example, aura, nausea, etc.); foods, drinks, or medications you had before the headache began; and any activities you participated in prior to the onset of the headache.

This information and any patterns that develop from it will help give you a more concrete idea of how often you’re experiencing migraines and a clue into what could be triggering them. Note whether you have problems sleeping or have neck problems too. This is important info for your headache doctor to consider when treating you.

Based on your diary, you should consider seeing a headache specialist or neurologist if:

  • you have three or more headaches per week.
  • your headaches continue to worsen or don’t really go away.
  • you’re taking some type of pain reliever or over-the-counter medication almost every day to try to relieve your headaches.
  • your headache symptoms have recently changed.
  • you have more than four headaches a month.

A neurologist or headache specialist will be able to help differentiate a tension-type headache from a migraine as well as take a medical history and perform a complete neurological examination, both extremely important in the successful treatment of headaches. Using this information, they can start understanding what's triggering your migraines, evaluate the underlying contributory factor, and set up the best plan for treatment and management.

Overall, the main thing to remember is if your headaches are disrupting your life, it’s time to take control. Pay attention to your symptoms, listen to your body, and know that migraines aren’t something that just have to be suffered through.

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