In short: A migraine is usually a moderate to severe throbbing headache, often on one side, that gets worse with movement and comes with nausea or sensitivity to light and sound. Attacks typically last from 4 hours to 3 days, and around a third of people also get an "aura" such as zigzag lines or flashing lights beforehand. Migraine is diagnosed from your symptoms and history rather than a scan, so a headache diary is one of the most useful things you can bring to an appointment.

This guide, written by a Ready Health prescribing pharmacist, focuses on how to recognise migraine, how it differs from other headaches, and when a headache needs urgent attention.

What are the signs and symptoms of migraine?

Migraine is a neurological condition, not just a bad headache. Symptoms vary from person to person, but common features include:

A pulsing or throbbing head pain, often on one side but sometimes both
Pain that is moderate or severe and made worse by everyday activity such as climbing stairs
Feeling sick or being sick
Being bothered by light, noise and sometimes smells
Wanting to lie still in a dark, quiet room

What are the stages of a migraine attack?

Not everyone has every stage, but a migraine attack can unfold in up to four phases:

Early warning (prodrome): hours or up to 2 days before the pain, some people notice yawning, tiredness, food cravings, thirst, a stiff neck, needing to pass urine more, or mood changes.
Aura: temporary visual disturbances (zigzags, shimmering, blind spots), pins and needles, or difficulty speaking. An aura usually builds over several minutes and should last no longer than an hour.
Headache: the main attack, typically 4 to 72 hours.
Recovery (postdrome): many people feel drained, foggy or "hungover" for a day or so afterwards.

Migraine or another type of headache?

Several common headaches can be confused with migraine. This comparison is a general guide only.

Feature	Migraine	Tension-type headache	Cluster headache
Location	Often one side	Both sides, like a tight band	One side, around or behind the eye
Feel	Throbbing, moderate to severe	Pressing or tightening, mild to moderate	Very severe, sharp or burning
Duration	4 hours to 3 days	30 minutes to several days	15 minutes to 3 hours, often daily in bouts
Other features	Nausea, light and sound sensitivity, worse with movement	Usually no nausea; not made worse by activity	Red, watery eye, blocked nostril, restlessness

Frequent use of painkillers can also cause a medication overuse headache. The NHS advises avoiding painkillers for headache on more than 2 days a week. If you need them more often, speak to a clinician rather than stopping suddenly on your own.

How is migraine diagnosed?

There is no blood test or scan that confirms migraine. A GP or other clinician will usually:

Ask about the pattern, length and features of your headaches
Ask about triggers, your periods (if relevant), medicines and how often you take painkillers
Check your blood pressure and carry out a basic neurological examination
Ask you to keep a headache diary for several weeks

Brain scans are not needed for most people with typical migraine. They are considered if there are unusual features or warning signs. Migraine is called chronic when headaches occur on 15 or more days a month for more than 3 months, with migraine features on at least 8 of those days. Referral to a neurologist may be suggested if the diagnosis is unclear or treatment is not working.

What can trigger a migraine?

Triggers are personal and are not always identifiable. Commonly reported ones include hormonal changes around periods, stress (or the let-down after stress), poor or irregular sleep, skipping meals, dehydration, too much or too little caffeine, and alcohol. A diary helps you spot your own patterns.

How is migraine treated?

Treatment is tailored to how often and how severely attacks happen. Options include simple painkillers or anti-inflammatories taken early in an attack, anti-sickness medicines, and prescription medicines such as triptans. For frequent attacks, a prescriber may discuss preventive treatment. A prescriber will decide which treatments are suitable for you, taking into account your other conditions and medicines.

One important safety point: if you have migraine with aura, combined hormonal contraception (containing oestrogen) is generally not recommended because of an increased stroke risk. Tell whoever prescribes your contraception about any aura.

When should you get urgent help for a headache?

Call 999 if a headache comes on suddenly and is extremely painful, or comes with any of: slurred speech or memory problems, loss of vision or double vision, drowsiness or confusion, a seizure, weakness or drooping on one side, a high temperature with a stiff neck or rash, or a recent head injury.

Get an urgent GP appointment or call NHS 111 if an attack lasts more than 72 hours, an aura lasts more than an hour, or you are pregnant or have recently given birth.

Frequently asked questions

Can you have a migraine without a headache?

Yes. Some people have aura symptoms, such as visual disturbance, without a headache following. A first episode should always be assessed, because these symptoms can resemble other conditions.

Do I need a brain scan for migraine?

Usually not. Typical migraine is diagnosed from your history and examination. A clinician will recommend imaging if there are warning signs or unusual features.

Are migraines linked to periods?

For many women, yes. Menstrual migraine tends to occur in the days around a period and can be longer and more severe. Recording your cycle in your headache diary helps with diagnosis and planning treatment.

Is migraine hereditary?

Migraine often runs in families, although not everyone with a family history will develop it.

Key takeaways

Migraine is a neurological condition with typical features such as one-sided throbbing pain, nausea and light sensitivity.
Diagnosis is based on your symptoms; a headache diary is the most useful tool.
Using painkillers on more than 2 days a week can lead to medication overuse headache.
Sudden, severe or unusual headaches with neurological symptoms need emergency help.
Treatment is individual, and a prescriber decides which options are suitable.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

If headaches are affecting your life, you can book a private GP appointment at Ready Health in Standish, Wigan, to talk through your symptoms. Where specialist input is needed, we can also discuss neurology consultant referrals.