Migraine is one of the most common neurological conditions we see at Axon Headache Clinic in Murdoch, yet it is still widely misunderstood. Many people think of migraine as “a bad headache”, but migraine is actually a complex brain disorder that affects the whole body and often disrupts work, study, family life and mood.
What do we know (and not know) about migraine?
Migraine is caused by abnormal brain activity in people who are genetically predisposed. We know it involves changes in:
- Nerve pathways that process pain and sensory information.
- Chemicals (neurotransmitters and neuropeptides) such as CGRP and serotonin.
- Blood vessels in and around the brain.
However, we do not yet fully understand exactly what happens in the brain during an attack. Older theories focused mainly on blood vessels narrowing and widening; newer research emphasises abnormal brain excitability and waves of altered activity spreading across the cortex, as well as changes in brainstem pain‑control centres. The reality is likely a combination of vessel changes, chemical shifts and altered nerve signalling in a brain that is “wired” to be extra sensitive.
Migraine almost always arises from a combination of:
- Your genes (family tendency).
- Your lifestyle (sleep, diet, stress, activity).
- Your environment (hormonal changes, weather, light, noise, smells and more).
No single factor “causes” migraine on its own; it is the interaction of these pieces that lowers or raises your personal threshold for attacks.
Migraine is not just a headache
Headache is only one symptom of migraine – and sometimes not even the main one. Migraine is better understood as a brain‑wide hypersensitivity state. During an attack, people may experience:
- Hypersensitivity to light, sound, smells and touch (wanting a dark, quiet room; finding normal noise unbearable).
Nausea and/or vomiting. - Dizziness or a sense of unsteadiness.
- Brain fog – difficulty with focus, concentration, word‑finding and clear thinking.
- Severe tiredness and reduced energy.
- Changes in bladder patterns and bowel habits for some people.
- Neck and shoulder discomfort or stiffness.
- Low mood, irritability or increased anxiety, either before, during or after the headache.
These symptoms can begin before the pain, accompany it, or linger after the headache has improved. For many patients, the “migraine hangover” – fatigue, brain fog and sensitivity – can be just as disabling as the pain itself.
What does migraine head pain feel like?
The pain of migraine is very variable and does not have to match a single textbook pattern. It can:
- Be one‑sided, both‑sided, or change sides between attacks.
Affect the front of the head, temples, behind the eyes, the top of the head or the back of the head. - Sometimes involve the face, jaw, or neck and shoulder region.
The quality of the pain can range from dull, pressure‑like discomfort through to pounding, throbbing or stabbing pain. Intensity also varies:
- Some attacks are mild and more of an annoyance.
- Others are moderate to severe and completely disabling, forcing the person to lie down, stop work or seek urgent care.
Neck pain is particularly common. Studies suggest that:
- Around 90% of people with migraine experience neck pain at some point.
- In about half of these, neck discomfort is one of the first symptoms of an attack.
- In the vast majority (around 97%) of patients with both migraine and neck pain, the neck pain is being driven by the migraine itself, rather than a separate neck joint or muscle problem.
This is why treating only the neck rarely solves the issue if the underlying migraine is not addressed.
Migraine symptoms vary between people and over time
Migraine is not a “one‑size‑fits‑all” condition. The combination of:
- Headache location and intensity.
- Associated symptoms (such as nausea, sensitivity to light, dizziness, neck pain, mood changes).
- Triggers (hormones, sleep changes, stress, certain foods, weather shifts, sensory overload).
can look very different from one person to another.
Even in the same person, migraine often changes over time:
- During puberty, pregnancy, perimenopause or menopause.
- With changes in stress levels, work patterns or sleep.
- With ageing and other health conditions.
Some people also have more than one type of migraine at the same time – for example, a “classic” migraine with aura on some occasions and a more “typical” throbbing headache without aura on others. Recognising these patterns helps tailor treatment.
Aura, hemiplegic migraine and the four phases of migraine
Not everyone with migraine experiences aura, but for those who do, it can be very striking.
- Migraine aura usually consists of reversible neurological symptoms that develop gradually over 5–60 minutes and then resolve.
- Visual aura is most common (flashing lights, zig‑zag lines, blind spots, shimmering patterns).
- Some people experience sensory aura (tingling or numbness) or speech/language aura (difficulty finding words or forming sentences).
Aura is not a stroke, but because symptoms can look similar, any new, sudden or unusual neurological symptoms should be assessed urgently, especially in people without a clear previous aura history.
Hemiplegic migraine is a rare subtype where aura includes temporary weakness on one side of the body, sometimes affecting the face, arm and leg, and occasionally associated with speech or visual symptoms. Because hemiplegic migraine can closely mimic a stroke, it needs careful assessment and ongoing specialist management.
Most migraines can be understood in terms of four phases, although not everyone notices all of them:
- Prodrome (pre‑headache phase)
Hours to days before the pain: yawning, food cravings, mood changes, neck stiffness, increased urination, trouble concentrating, or feeling “off”. - Aura (in some people)
Reversible visual, sensory or speech symptoms that develop gradually and usually last less than an hour. - Headache phase
The main pain, which may be one‑ or two‑sided and is often accompanied by nausea, light and sound sensitivity, dizziness and other symptoms described above. - Postdrome (“migraine hangover”)
After the pain settles, many people feel drained, foggy, sore and still sensitive to light and sound for hours or even a day or two.
Understanding these phases can help people recognise an attack early and use treatments at the most effective time.
Migraine, hormones and why it is more common in women
Migraine is more common in women than men, particularly during the child‑bearing years. Hormonal fluctuations – especially changes in oestrogen levels – are a major reason:
- Many women notice attacks around menstruation, ovulation or with changes to hormonal contraception.
- Pregnancy, perimenopause and menopause can all alter migraine patterns, sometimes improving them, sometimes making them worse.
This does not mean migraine is “just hormones”, but hormones are one of the key environmental factors acting on a genetically sensitive brain. Men also experience migraine, and in them, other factors such as sleep, stress, lifestyle and genetic predisposition may play a relatively larger role.
How Axon Headache Clinic can help
At Axon Headache Clinic in Murdoch, we take a whole‑person, brain‑based view of migraine. During your assessment we will:
- Clarify your migraine type(s), including whether aura or hemiplegic features are present.
- Map your typical symptom pattern, triggers and phases of attack.
- Distinguish migraine‑related neck and facial pain from true structural neck problems.
- Discuss treatment options, including acute medications, preventive therapies (oral preventives, botulinum toxin type A, CGRP‑targeting treatments), lifestyle strategies and, where appropriate, procedures such as nerve blocks.
If you or your GP are concerned that your headaches may be migraine, or if your existing migraine has changed or is not responding well to treatment, our team at Headache Clinic is happy to assess your situation and help you build a personalised management plan.