One may divide the migraine attack into five phases: the prodrome, occurring hours or days before the headache; the aura, which come immediately before the headache; the headache itself; the headache termination; and the postdrome.

The typical migraine headache is unilateral and throbbing. It may be bilateral and constant at first and later become throbbing. The pain is characterized as throbbing in 85% of patients. However, it should be noted that a throbbing headache is described in other types of headache. The pain of migraine is almost always accompanied by other features such as anorexia. Nausea occurs in up to 90% of patients and vomiting occurs in about one-third of migraineurs.

Many patients experience photophobia, phonophobia, and osmophobia, and seek seclusion in a dark, quiet room. Additional generalized symptoms include blurry vision, nasal stuffiness, anorexia, hunger, tenesmus, diarrhea, abdominal cramps, polyuria (followed by decreased urinary output after the attack), facial pallor (or, less commonly, redness), sensations of heat or cold, and sweating. Localized edema of the scalp, the face, or the periorbital regions may occur; tenderness may occur and be particularly prominent. There may also be tenderness of the scalp, a special prominence of a vein or artery in the temple, or a stiffness or tenderness of the neck. Impaired concentration is common; memory impairment occurs less frequently. Depression, fatigue, anxiety, nervousness, and irritability are common. A sensation of faintness may be experienced. The IHS selects particular associated features as cardinal manifestations for diagnosis.

 

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