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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.

1. Headache Classification Subcommittee of the International Headache Society. “The International Classification of Headache Disorders 2nd Edition.” Cephalalgia 2004;24:8-160. 2. Charles, Andrew, MD. “Migraine: Questions and Answers for Patients.” UCLA Headache Research and Treatment Program. 3. Interview: Teri Robert with Andrew D. Hershey, MD, PhD, FAHS; Director, Headache Center, Children’s Hospital Medical Center; Cincinnati, Ohio. February 21, 2010. 4. Wong-Baker FACES Foundation Web Site 5. Lipton, Richard B., MD; Stewart, Walter F., MPH, PhD. “MIDAS.” ACHE, The Fred Sheftell Education Center.


  • Eric Knox
    8 years ago

    Wow, excellent work Terry! Great info! Great references!

  • Lisa Jurcich Kovach
    8 years ago

    No you are not the only one. Their are day when my migraines are not so severe, it depends on the pollen, the noise levels, alot of things. Some are sinus related too. Some days I just lay on the couch and cry. My husband just gets me the ice pack and says I wish you didn’t have to deal with this so much. I do to honey is what I reply.

  • jangordon
    8 years ago

    This is exactly how it is for me.

  • Chris Waters
    8 years ago it works I have terrible migrains and I found a center that does this treatment. Now I am far better than before.

  • Jessica Francese
    8 years ago


  • Chris Waters
    8 years ago

    Jessica Francese copy and paste it into your browser

  • Jessica Francese
    8 years ago

    chris, your link is not working

  • Samira SJ
    8 years ago

    My headaches are exactly the same. Migraine with & without aura & tension headache. At first I thought it was chronic migraine, would rate that 8-10!
    I consulted six different doctors but still no one could figure that out, until I had a phone conversation with a doctor in another country who said its a combination of migraine and tension headache. I wish physicians were more concerned and informed about all types of headaches..

  • Janene Zielinski
    8 years ago

    I am wondering if a migraineur is ever truly without a migraine? I don’t feel chronic because I have many days per month that my pain is light. But, I have symptoms of silent migraine on those days. I feel like I am never without migraine, it just depends on the severity that particular day. Am I the only one that feels that way?

  • Luna
    4 years ago

    Janene, I know that I am never truly without some form of migraine, a lot of it “silent”. No, you are not alone in feeling that way.

  • That M Word: A Migraine Blog
    8 years ago

    Fantastic article – thanks Teri!

  • Teri Robert
    8 years ago

    You’re very welcome!

  • Christina Bosman Fulton
    8 years ago

    The faces rating scale is very interesting. If I go by that scale, headaches that I usually rate a 2 or 3 are really a 5 or 6. Whenever someone asks me this question I never think of zero or one as being no pain but being a low level of pain. Maybe this is why people think my headaches aren’t that bad.

  • Lorie Bosman
    8 years ago

    Don’t wish them on anyone….eel better

  • Lorie Bosman
    8 years ago

    anyone who suffers from migraines knows how BAD they are!

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