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Migraine Symptoms Vary From One Attack to the Next

Migraine Symptoms Vary From One Attack to the Next

With the long list of possible migraine symptoms, it’s not surprising that attacks vary dramatically from one person to the next. The same is true for individuals, too. In a study published last fall—the first to investigate this idea—30 people recorded their symptoms for three consecutive migraine attacks. None of the participants had identical symptoms during all three recorded attacks.

For all three attacks, participants recorded whether or not they had any of these 11 symptoms:

  • One-sided pain
  • Pulsing pain
  • Pain intensity
  • Nausea
  • Vomiting
  • Sensitivity to light (photophobia)
  • Sensitivity to sounds (phonophobia)
  • Sensitivity to odors (osmophobia)
  • Allodynia
  • Cranial autonomic symptoms (like tearing eyes, nasal congestion, and constricted pupils)
  • Premonitory symptoms (warning signs) in the 24-hours prior to the attack.

Not one single person in the study had consistent symptoms in all three of their recorded migraine attacks. For further analysis, researchers reduced the number of symptoms to seven of the eight core symptoms that are used for migraine diagnosis. Still no participant had consistent symptoms for all three attacks. Researchers then reduced the list to only six items (one-sided pain, pulsing pain, nausea, vomiting, photophobia, and phonophobia). Using the restricted list, only two participants had identical symptoms on three consecutive attacks.

Approximately 60% of participants had any one symptom consistently over three attacks. Depending on the symptom, the consistency varied from 23% to 93%. Pain severity was the least consistent symptom. Only 23% of the time was a participant’s pain severity the same. Although vomiting was consistent 93% of the time, it was a symptom in only two attacks. Excluding these two extremes, researchers found that, on average, symptom consistency ranged from 43% to 77%.

Researchers also found variability in responsiveness to medication. Participants were given Frova (frovatriptan) to treat their migraine attacks. Only 39% had the same response to Frova (whether it worked or not) across all three attacks.

This was a preliminary study with a limited number of participants. More research is needed to further investigate the consistency of symptoms in larger populations. Still, these findings can help people with migraine more easily identify whether they’re having an attack or not. It can also help patients who struggle to explain their varying symptoms to doctors.

What’s your experience. Do your symptoms or medication responsiveness vary from one attack to the next?

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.

Viana, M., Sances, G., Ghiotto, N., Guaschino, E., Allena, M., Nappi, G., ... & Tassorelli, C. (2015). Variability of the characteristics of a migraine attack within patients. Cephalalgia, 0333102415613612


  • Janet
    3 years ago

    To answer the question.. Yes, as of late, EVERYTHING varies making it harder to choose the right meds in hopes of relief and not days in bed of the choice I make is wrong, continuing to make migraine a Monster 🙁

  • DonnaFA moderator
    3 years ago

    Hi jones8900. Have you considered keeping a migraine journal to help you pinpoint what works best for which symptoms and under varying circumstances? I hope you find the information helpful. Thanks for being here! All Best, Donna ( team)

  • Cocodog
    3 years ago

    Yes! I have the “left hatchet head and ice pick on same side” headache. I have the “post nasal dam burst and the pain inside of my 2nd left toe” headache. I have the “no pain headaches with severe brain fog” headache. I have the “swell up like a toad” headache”. I have the “scintillations then you die” headache. I have the “extreme fatigue eye pain hot flashes and chills” headache. I have the “your getting one, no your not, yes you are, now it’s gone, surprise it’s back” headache. And the @one tooth hurts turns into a trigeminal nightmare” headache. Such diversity.

  • DonnaFA moderator
    3 years ago

    Hi Cocodog! Thanks for bringing a little humor, it made me smile. -All Best, Donna ( team)

  • Cyndi Hackett
    3 years ago

    I must be (as always) the odd duck. For me, the severity of symptoms may vary but my symptoms are virtually the same EVERY time. Pain at the peak of both eyebrows, pain across shoulders & neck, sensitivity to: light,sound,smell, & chemicals, burning sensation when washing hands (feels like I’ve recently handled jalapenos), and ‘hair’/scalp pain. Every time.

  • lmsandoval
    3 years ago

    I definitely share the experience of having several different symptoms and pain levels with each migraine. I recently had an insurance change and now I have to go through the whole process again of getting the right medications and doses and within the constraints of what my insurance company with cover. That coupled with having to start with a new set of doctors is very frustrating and makes my migraines even worse due to more stress. I now have to explain again to a whole new set of doctors who often think I should be “cured” by now.

  • Joni
    3 years ago

    I’m relieved to hear I’m not the only one with inconsistent pain and symptoms. Lately, my pain tends to flow like waves, in and out, high and low, there and gone. I can happily answer ‘no’ to a “do you have a headache today?” question, and ten minutes later, I’m at a pain level 6. That’s hard to explain to others in a way that they can understand and believe. I’ve also noticed that with the pain on such a roller coaster, my other symptoms, like vertigo, nausea, ringing ears, aphasia, are worse and more consistent. Weird.

  • Janet
    3 years ago

    Yes, my symptoms and medication responsiveness vary…it’s just more of the ongoing horror of migraine. Sad really..
    Janet Jones

  • Laura
    3 years ago

    My migraines have never been consistent. And throughout the years they’ve changed, sometimes better, sometimes worse.

  • Jojiieme
    3 years ago

    “But I thought you were getting better?”
    “No, we just had things a little more under control”
    ” Oh right”, with ‘that’ look….

    I love my support team; I never need to go through this with them because they understand exactly what is in the article. Even when I stump them, and we can’t figure out the next step for a bit, they never expect my next episode will be like the last and carefully explain that we’re all learning together.
    My life is a science experiment. Sometimes tedious, but still life.

  • Nicole
    3 years ago

    I am glad this study was done. I have been frustrated at the doctors so many times because my migraines have changed and it is hard to explain to a doctor. Thank you for posting it!

  • Luna
    3 years ago

    Thanks, Kerrie. Great information. Now there is proof for what I have come to recognize in myself.

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