Many people have experienced a migraine attack and don’t know it ― likely because the signs aren’t always so obvious.
“Only half of 40 million people in the U.S. who have migraines actually get diagnosed,” said Dr. Andrew Blumenfeld, a double board-certified neurologist and psychiatrist in San Diego.
Some symptoms are obvious, like vision changes, sensitivity to light, and of course, the all-consuming headache. But during a migraine attack — even before the pain sets in — parts of the brain are losing function, which can affect other areas of your body. This is how symptoms can seem unrelated. And if you experience chronic migraines (more than half the days of the month), you will experience symptoms well beyond the course of the incident.
Below are a few sneaky signs to look out for, plus some other important migraine notes to keep in mind.
Confusion, Brain Fog Or Loss Of Speech
If you’ve ever been unable to find the right words, you’ve abruptly lost the ability to express yourself, or you completely forgot what you were talking about mid-sentence, this could be a scary (but common) migraine symptom.
“Difficulty with speech, memory loss, confusion [are some of the most] surprising symptoms of migraine,” said Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California.
Migraines can lead to dysfunction in the language centers of the brain, resulting in a loss of being able to express yourself, Blumenfeld said.
“In the cortex — where language and vocabulary are stored — that part of the brain is switching off during this phase of the migraine,” Blumenfeld said.
Dizziness Or Feeling Disoriented
Many patients with vertigo tend to have migraines as well, Blumenfeld said. “There are a lot of patients in this particular population who end up also being migraine patients,” he explained.
Specifically, they might have what’s called “vestibular migraines. A vestibular migraine doesn’t always include a painful headache, meaning that dizziness on its own can be a symptom or can be associated with regular migraine attacks.
If you have a history of migraines and occasionally have dizzy spells ― even if some of those dizzy spells don’t have migraine pain involved ― it can still be a migraine attack, especially if there is “no other disease to explain dizziness,” Blumenfeld explained.
Tired all the time? Migraines may be to blame. Both before and during an attack, as well as in between attacks, chronic fatigue is a symptom of chronic migraines.
“The fatigue can be physical, mental or both,” Blumenfeld said. “You can experience cognitive slowing ― slow thinking — as well as lethargy. If your brain is working slowly, and you’re trying to be productive, you’re going to get fatigued more quickly. It’s all coming from the cortex in the brain.”
If fatigue is a major symptom for you, Blumenfeld said treating migraines properly can help you get some of your energy back. Bring up this symptom with your doctor when discussing a medication plan.
“Certain medications used to treat migraine can increase fatigue, including some of the older migraine preventative medications,” he explained. “You might get rid of the headache, but the patient is [wiped] out.”
Numbness Or Sensitivity
“I think the most surprising migraine symptom — that people do not recognize as such — is something called allodynia,” said Dr. Huma U. Sheikh, a board-certified neurologist with subspecialty training in headache medicine from Harvard-Brigham and Women’s Hospital. “This is a symptom where ordinary touch can begin to feel irritating or painful.”
She said that if you’ve ever felt like your “hair hurts,” or you’re suddenly sensitized to a necklace or glasses that you wear regularly, this could be “due to hyper-sensitization of the nerves that begin to portray normal sensations as painful.”
Anxiety And Depression
Anxiety and depression are “very common in migraine, and genetically linked — these conditions run in families,” Blumenfeld said. “In the period between attacks, [many people with migraines] tend to get a lot of anxiety — you may be anxious about the next attack, but you may have anxiety and panic attacks independent of worrying about the headache.”
“If you look at the incidents of anxiety and depression, the more frequent the migraines are, the greater the association,” he continued. “In chronic migraine patients, you see anxiety and depression more than a third of the time.”
Digestive Distress And Nausea
Nausea, vomiting and diarrhea can be connected to migraines, both as symptoms themselves as well as in the form of a comorbid condition, Blumenfeld said.
“In migraine attacks, what has been shown is that the emptying of the stomach is delayed, [known as] gastric stasis,” he continued. That can lead to those feelings of nausea and stomach problems.
Before any pain sets in, there’s a first phase of a migraine attack called the premonitory phase, Blumenfeld said.
This is typically comprised of fatigue, neck discomfort, yawning, thirst, and food cravings, including chocolate cravings, he added, carefully pointing out that the chocolate in this instance is “a craving and not a trigger.”
So if you suddenly have a hankering for a brownie or are ready to inhale a bag of M&Ms, this could be a warning. The craving, alongside the other symptoms of this phase, may help you to identify an oncoming attack before the blinding pain commences, giving you an opportunity to find medication.
Many migraine attacks begin with nasal congestion, said Maureen A. Moriarty, a headache specialist and current fellow of the American Headache Society. Stimulation of pain pathways in the trigeminal nerve ― which is part of your nervous system ― creates the congestion, she explained.
“Unfortunately, many people will often become dependent on decongestants in the attempt to alleviate this symptom,” Moriarty said. “Not recognizing this as part of the migraine, they fail to mention the symptom to their provider. It is important to let your provider know if nasal congestion precedes a headache. Control of migraine attacks can control this symptom.”
Ideally, you’ll want to get to a neurologist as soon as possible, but Blumenfeld recognized that this can be an arduous process. Not many specialists are accessible, and symptoms can often be red herrings for other conditions.
There are many cases where it can be hard to pinpoint which experience is a symptom caused by a migraine attack and which ones are simply existing alongside it (known as comorbidities). For example, there can be crossover between symptoms and comorbidities, such as anxiety and depression. Migraines can cause depression, and depression can contribute to a risk for a migraine attack.
This may mean doctors could have to treat you for multiple conditions, which is why it’s important to find someone you trust who is willing to detail an appropriate plan tailored to your situation and needs. Whatever you do, don’t stick with a physician who is making you feel like you’re just “dealing with a headache.”
“It’s not your fault; this is a genetic condition,” Blumenfeld said. “Tell your doctor you think you have migraines.”