'Key early difference' that means headache is actually a migraine

The occasional headache is typically a minor, fleeting irritation – but when the discomfort becomes severe and persists, it might signal something more concerning, such as a migraine. Migraines need particular treatment and care, so it's crucial not to dismiss them as merely "just a bad headache".

With Migraine Awareness Week (September 22–28) rapidly approaching, we chatted to Debbie Shipley, head of information and support at The Migraine Trust, who offered expert guidance on what genuinely distinguishes migraines from an ordinary everyday headache.

What triggers migraine episodes?

"Migraine is a complex neurological condition, that is understood to be the result of abnormal brain activity affecting nerve signals, chemicals and blood vessels in the brain," explains Shipley. "People with migraines will experience migraine attacks, and while there may be individual triggers for these (such as dehydration or stress), these are not the cause."

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What are the pain features that make migraines different from headaches?

"Migraine attacks often involve moderate to severe head pain," says Shipley. "The headache is typically throbbing and is made worse by movement or light. It is usually on one side of the head, especially at the start of an attack."

The NHS describes severe pain as a constant discomfort that hinders thinking, talking or sleeping and makes it challenging to move, get out of bed, use the loo, wash or dress.

According to the National Institute for Health and Care Excellence (NICE), migraines without aura can only be clinically diagnosed in a person presenting with at least five attacks fulfilling the following criteria:.

Headache lasting four to 72 hours in adults or two to 72 hours in adolescents.

Headache with at least two of the following characteristics:

Unilateral location (more commonly bilateral in children).

Pulsating quality – may be described as 'throbbing' or 'banging' in young people.

Moderate or severe pain intensity.

Aggravation by, or causing avoidance of, routine activities of daily life (for example, walking or climbing stairs).

Headache with associated symptoms, including at least one of:

Nausea and/or vomiting.

Photophobia (sensitivity to light) and phonophobia (sensitivity to sound).

Headache must not be better accounted for by another diagnosis.

What impact can migraines have on daily life?

While normal headaches usually create a temporary feeling of discomfort, migraines can often have a profound impact on someone's life.

"Migraines can have a huge impact on every aspect of someone's life – from their relationships to their careers and mental health," says Shipley. "Research we launched last year [a survey of 2,028 people] revealed that 89% of people with migraines say their mental health has been affected as a result of the condition, while 49% said migraines has a negative impact on ability to work and 80% saying they participate less in social occasions as a result of the condition."

How long do they usually last for?

While most headaches tend to clear up quickly, migraines typically last between four hours to three days, explains Shipley, and generally follow a set of stages.

"Many people find that their migraine attacks are comprised of distinct phases, each of which varies in duration," says Shipley. "The premonitory phase can last up to 24 hours and can involve physical or mental 'warning signs' of the onset of an attack, such as feeling tired, or craving certain foods."

Some people will experience a migraine with aura, which may include problems with their sight (like seeing zig-zag lines or flashing lights), numbness or tingling, dizziness or difficulty speaking, just before the migraine starts, according to the NHS website.

"The aura phase can last for five to 50 minutes before the headache phase and can include visual or other sensory disturbances," says Shipley. "Up to a third of people with migraines experience this phase.

"During the headache phase, in addition to head pain, it may involve nausea or vomiting, as well as sensory sensitivity. This stage can last from a few hours to three days."

Additionally, some individuals may encounter a range of after-effects in the days that follow a migraine episode, known as the 'Postdrome phase'. "Many people continue to feel unwell, drained or having a 'hangover' type feeling for several hours or even days after the main phase of an attack," says Shipley.

When should you visit a GP?

"It's important that anyone who suspects they may have a migraine speaks with their GP," says Shipley.

The NHS website suggests consulting a GP if:

Your migraines are severe or getting worse, or lasting longer than usual.

You have migraines more than once a week.

You're finding it difficult to control your migraines.

You regularly get migraines before or during your period.

It also recommends that you should book an urgent GP appointment or ring 111 if a migraine continues for longer than 72 hours, if aura symptoms carry on for more than an hour at a time, or if you are expecting.