The Pain of a Migraine Attack

There are still misconceptions about the pain of a Migraine attack. Many people think that the pain is always severe. In reality, the pain can range from mild to severe or be absent altogether. A Migraine attack can occur without the headache phase. When this occurs, the Migraine is described as “acephalgic” or “silent.” You can read more about that in Silent Migraine. For our purposes here, we’re going to speak to those Migraines that do include the headache phase with pain.

Characteristics of Migraine pain:

  • is often, but not always, unilateral (one-sided).
  • is often, but not always, pulsatile (throbbing).
  • is usually aggravated by routine physical activity such as climbing stairs or bending over.
  • may also occur along the three branches of the trigeminal nerve – above the eyes and along the sinus cavities and jaw due to inflammation of the trigeminal nerve that occurs during a Migraine attack. Migraine PainMigraine pain is not caused by vasodilation (dilation of blood vessels) as was once thought. It has now thought to be caused by cortical spreading depression – waves of abnormal activity that spread across the surface of the brain (the cortex), as well as excitation of nerve centers deep within the brain (the brainstem).2

Some of us have multiple headache disorders. For example, I have both Migraine with and without aura and tension-type headaches. There are times when a “headache” begins, but I’m not sure if it’s a Migraine or a tension-type headache. The third point above, Migraine being worsened by activity, can sometimes help me determine which it is. I bend over and touch the floor. That will aggravate the pain of a Migraine, but not a tension-type headache. This is helpful because my treatments are different, and I need to know which one to take.

Rating pain intensity:

Most doctors ask patients to rate their Migraine pain intensity on a scale of 0 to 10; a minority use a 0 to 5 scale.

When working with young children, the Wong-Baker FACES Pain Rating Scale is most frequently used.3 Wong-Baker FACES for childrenSince rating pain is so subjective, many doctors find that they can tell more about their patients by having them rate the level of disability each of their Migraines cause them. For this reason, many doctors ask Migraineurs to record both pain and disability levels in their Migraine diaries/journals.

Dr. Richard Lipton and Dr. Walter Stewart developed the five-question MIDAS (Migraine Disability Assessment) questionnaire to help patients and doctors measure the overall impact Migraines have on our lives. The MIDAS questionnaire can be found many places online where it will score it for you. The five questions are:5

  1. On how many days in the last 3 months did you miss work or school because of your headaches?
  2. How many days in the last 3 months was your work productivity at work or school reduced by half or more because of your headaches? (Do not include days you counted in question 1 where you missed work or school.)
  3. On how many days in the last 3 months did you not do household work (such as housework, home repairs and maintenance, shopping, caring for children and relatives) because of your headaches?
  4. How many days in the last 3 months was your productivity in household work reduced by half or more because of your headaches? (Do not include days you counted in question 3 where you did not do household work.)
  5. On how many days in the last 3 months did you miss family, social or leisure activities because of your headaches?


Migraine pain often has characteristics that differentiate it from headache pain. We’re often asked to rate our pain levels, but that can be difficult given that it’s so subjective and that the Migraine can also have our levels of neurotransmitters such as serotonin and norepinephrine fluctuating, rendering us more emotional. Adding a disability scale to our diary our journal can be helpful to us and our doctors.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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