A New Understanding of Migraine
If you’ve ever had a migraine, you know that calling it “just a headache” misses the point entirely. Maybe you had to cancel plans, close the blinds, and spend the day in bed. Maybe you felt it coming hours before the pain even started. Maybe the worst part wasn’t the pain at all, but instead the nausea, the light sensitivity, or the foggy, exhausted feeling that lingered for days afterward.
As a Naturopathic Doctor focusing on neurological and mental health, I have supported many people with migraine navigate this complex yet common condition. In fact, I too regularly manage migraine attacks. For me, this is a troubling feature of my perimenopause and menopause. Even as a clinician, it took time for me to fully recognize that what I was experiencing was indeed migraine, and because of the variability in presentation and triggers, to this day I continue to work on my own care plan, tweaking it to find the best outcomes for my individual needs.
Migraine affects roughly 1 in 10 people worldwide (about a billion people globally) and it is one of the leading causes of disability worldwide. Many people go years without a proper diagnosis. In fact, more than 80% of people with migraine wait over a year to be correctly identified, and nearly two-thirds wait more than five years. That’s a long time to wonder what’s happening in your own body.
Migraine Is a Brain Condition, Not Just a Headache
One of the most important shifts in how we understand migraine is this: migraine is a neurological condition, not simply a headache or a pain disorder. Neurologist Dr. Peter Goadsby, one of the world’s leading migraine researchers, describes it as “a disorder of the way the brain deals with what is coming in from the environment.”
This description helps explain why light, sound, smell, stress, hormonal shifts, and even weather can all factor into migrainous phenomena. It explains why migraine attacks don’t feel like other headaches. And it explains why some people are more sensitive to these inputs. We are all wired differently.
The Four Phases of a Migraine Attack
Most people think of migraine as head pain. But a full migraine attack (the preferred medical term, rather than “migraine headache”) can have up to four phases — and the headache itself is just one of them.
This is the “warning” phase. You might experience fatigue, neck pain, food cravings, mood changes, difficulty concentrating, or increased sensitivity to light or sound — all before the headache begins. Recognizing this phase is helpful because it’s often when early intervention is most effective.
I often begin to feel a deep sense of dread, and start to feel tired and foggy-headed in the hours before a migraine attack starts.
*in about 1 in 3 people
Aura involves neurological symptoms — most commonly visual disturbances like zigzag lines or blind spots, but also tingling, numbness, or difficulty speaking. Not everyone with migraine experiences aura. Some people have aura without any headache at all (called acephalgic migraine), which is commonly misidentified.
Like many people, I have migraine with and without aura. Most of the time I usually don’t get a visual aura and instead move directly from prodrome to headache.
This is the phase most associated with migraine. The pain is typically throbbing, often one-sided, frequently accompanied by nausea, vomiting, and extreme sensitivity to light, sound, or smell. It’s worth noting that this phase can change across a lifetime: younger people often experience more intense pain, while older adults may find the headache itself becomes less prominent.
Sometimes called the “migraine hangover.” You might feel exhausted, foggy, and emotionally flat even after the pain has passed. This phase is often underestimated, and can contribute to lost work productivity and social time with loved ones.
The hardest part of this phase for me is a sense of sadness without any clear cause. It lingers and can be confusing. I manage it by reminding myself it’s part of the attack and that my brain is sending me false signals right now.
The Migraine Foundation has created The Purple Timeline to help with understanding your migraine, if you’re looking for a deeper explanation of this experience.
Understanding Migraine Attacks Changes How We Care for People
When we consider migraine as a multi-phase brain condition — rather than just a headache — our approach to care, and to self-care, changes completely. Rather than only reaching for pain relief during the worst of it, there are opportunities to intervene earlier, reduce how often attacks happen, and support your nervous system between attacks.
In the next article, we’ll explore why “just avoid your triggers” is incomplete advice, and talk about a more useful way of thinking about what actually causes a migraine attack to happen when it does.
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