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Migraine Headache Migraine Headache
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Migraine Headache

According to ICHD-II the migraine headache is a recurrent symptom manifesting in attacks that usually last 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, and worsening during physical activity.

Diagnostic criteria

All headache disorders are classified into major groups. Standardized diagnostic criteria determine whether a headache is migraine or not. The full criteria are available in the section Classification.

Diagnostic criteria of migraine headache: A) At least 5 attacks fulfilling B-D; B) lasting untreated 4-74 hours; C) two of the following: unilateral, pulsating, moderate or severe pain intensity, worsening with physical activity; D) one of the following: nausea and/or vomiting, photophobia or phonophobia; E) not attributed to another disorder.

Migraine stages

An attack of migraine is divided into four distinct stages, plus the interval inbetween attacks.

Sometimes resolution and recovery are treated as separate phases and the migraine interval is not seen as a phase itself. However, interictal changes of cortical excitability is an important concept in migraine secondary to a genetic predisposition. Therefore we want to stress the interval between the migaine attacks as a separate phase.

Prodromal phase

Even if one does not have an aura before the headache, one may have noticed other feelings that make you aware an attack is starting. For example, before an actual attack starts, one may notice that one feels very tired or excatly the opposite, the person has lots of energy. These and other sorts of feelings are noticed by about two thirds of people who suffer from migraine. However, these symptoms may only be apparent when one looks back on an attack. The symptoms usually start several hours or even the day before the attack. They should not be confused with the aura.


In about 10% of the cases neurological or neuropsychological symptoms, called aura, occur before the onset of the headache phase, usually lasting for less than half an hour. People with migraine aura predominantly experience visual or tactile hallucinations. The full range of possible symptoms, however, includes a large variety of other phenomena.

We have devoted a whole section to this phenomena.

Headache phase

Nydia Lilian aka drinkthemadness, The migraine loves me, undated. © 2006 drinkthemadness (see here)

Migraine headaches usually have a "pulsating" quality. The pain is described as "pounding" or "throbbing" in nature, and is usually unilateral.

Lateralization of pain in migraine is due to lateralized brain dysfunction (Afridi et al., 2005).

Resolution and recovery

Most of the time migraines resolve with sleep. Occasionally, and especially in children, vomiting stops migraine.

Migraine interval

There may be cognitive changes during the migraine interval.


Afridi SK, Matharu MS, Lee L, Kaube H, Friston KJ, Frackowiak RS, Goadsby PJ. A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate. Brain 2005; 128: 932-939.
Blau JN. Migraine: theories of pathogenesis. Lancet 1992; 339: 1202-1207.
Blau JN. Migraine postdromes: symptoms after attacks. Cephalalgia 1991; 11: 229-231.
Blau JN. Classical migraine: symptoms between visual aura and headache onset. Lancet 1992; 340: 355-356.
Diamond S, Franklin MA. Headache Through the Ages. Professional Communications, Inc., Caddo, OK 2005.
Podoll K, Robinson D. Migraine Art - The Migraine Experience from Within. North Atlantic Books, Berkeley, California 2009.

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NEW BOOK: Klaus Podoll & Derek Robinson, Migraine Art - The Migraine Experience from Within