What causes a migraine? How to tell the difference between a headache & a migraine

Cropped Image Of Woman Suffering From Migraine

What causes a migraine?

It’s a question few of us can answer despite the fact that 30% of people will have migraine symptoms at some point in their lives. And in Tennessee, those numbers may be even higher with four cities — Nashville, Knoxville, Chattanooga and Kingsport — ranking as migraine hot spots.

Dr. Susan Owensby, a family medicine physician and medical director for BlueCross BlueShield of Tennessee, spoke with WellTuned to explain.

What is a migraine?

Dr. Owensby: Migraines are a chronic condition that causes headaches that are far more intense and debilitating than your everyday headache. Symptoms usually include extreme, pulsing pain that’s so severe it disrupts your normal daily activities. Migraines often begin in childhood, adolescence or early adulthood, and attacks can last for hours or days.

What are the symptoms of a migraine?

Dr. Owensby: The most common symptoms of a migraine are:

  • Nausea and vomiting
  • Sensitivity to smell, sound, light or touch
  • Pain that:
    • Throbs or pulses
    • Affects one or both sides of the head
    • Feels as if it’s wrapped around your skull, like a band squeezing your head and applying constant, uncomfortable pressure

There are also other symptoms that can let you know a migraine is coming (auras), such as floaters in your vision, dizziness or weakness on one side of the body. Symptoms of a migraine can be so intense that some people confuse the start of a migraine with a stroke.

Stages of a migraine

Migraines may progress through 4 stages, though not everyone experiences each stage.

1. Prodrome

When: 1-2 days before

Warning signs:

  • Constipation
  • Cravings
  • Stiff neck
  • Extreme thirst
  • Increased urination
  • Excessive yawning
  • Drastic mood changes (depression to ecstasy)

2. Aura

When: Before or during a migraine, building over time and lasting up to an hour

Warning signs:

  • Vision loss
  • Seeing shapes, spots or flashes of light
  • Pins and needles sensation in arms and legs
  • Difficulty speaking and controlling movements
  • Hearing noises or music
  • Weakness or numbness on one side of the body

3. Attack

When: The migraine itself, lasting from 4-72 hours if untreated

Warning signs:

  • Pain that throbs or pulses
  • Sensitivity to light, sound, smell and touch
  • Nausea and vomiting

4. Post-drome

When: After a migraine, lasting up to a day


  • Feeling drained and confused OR feeling elated
  • Brief pain brought on by sudden head movement

What causes migraines?

Dr. Owensby: Migraines tend to run in families. If one or both of your parents get migraines, there’s a 50-75% chance you will too.

There’s also a vascular component. We have blood vessels all over our skull and in our face. When our bodies ask them to dilate, there’s a large rush of blood to the head and back of the skull, which can bring on a migraine. Conversely, if all those blood vessels are asked to constrict, there may be a lack of blood flow, which can also trigger a migraine.

Finally, there are lifestyle components. Stress can make you more prone to headaches, as can sleep disturbance, dehydration, changes in eating or activity and an increase in alcohol or tobacco use. These are some of the causes experts said may have contributed to Tennessee’s migraine hotspots.

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Are some people more likely to get migraines than others?

Dr. Owensby: Females are more likely than men to get migraines, and especially females between ages 30-50. It’s possible there’s a hormonal component, or women may just be more likely to report the problem to providers.

Are there any signs a headache is NOT a migraine?

Dr. Owensby: Typically migraines aren’t responsive to over-the-counter treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) or pain relievers. While muscle or tension headaches often respond well to ibuprofen, migraines have more neurological components.

Also, just because you have migraines, it doesn’t mean you won’t also have other kinds of headaches related to tension, sinuses, PMS or other conditions. The symptoms for each type of headache will just be different.

What should you do if you think you have migraines?

Dr. Owensby: Put together a family history of migraines and keep a headache diary. Use an app to track your headaches including time and details, or simply write down the details.

Try to identify patterns:

  • Are your headaches happening at a certain time of day?
  • Do you wake up with a headache?
  • Do they come on during work or during the evening when you’re winding down?
  • Do they happen before or after you eat? Could they be related to food allergies?
  • Do they happen most often in spring or fall? If so, they may be allergy or sinus headaches.

Be sure to track any other symptoms that happen at the same time as the headache:

  • Did you also feel dizzy or lightheaded?
  • Sick to your stomach?
  • Have diarrhea or feel thirsty?
  • Smell anything unique?

The more detail you can put into your headache diary, the more helpful it will be when your primary care provider (PCP) decides which labs and imaging you need.

How are migraines treated?

Dr. Owensby: Migraines are treated by identifying and avoiding triggers, as well as with medication.

There are 2 main classes of medication:

  1. Abortive therapies, which are medications you take when a migraine starts to alleviate on symptoms, and
  2. Preventative therapies, which may be used for frequent, severe migraines if you can identify the warning signs.

Can you prevent migraines?

Dr. Owensby: Some people can, if you identify your triggers, which can be anything from food to allergies to lifestyle. Migraines can be very debilitating, so it’s important to take the time to zero in on what’s causing yours, which will help you and your PCP identify whether you need therapy or medication to prevent or stop migraines.

            5 tips for preventing migraines

What else should people know about migraines?

Dr. Owensby: One of the most important things to know is that migraines are a chronic condition. If you have them and something changes, contact your PCP.

You may need emergency treatment or reevaluation if you experience:

  • Worsening pain or abrupt, severe headaches
  • An increase in frequency
  • New neurologic symptoms (droopy face, increased confusion)
  • Headaches that don’t respond to treatment, therapy or medication
  • Fever, stiff neck, seizures, double vision, weakness, numbness or difficulty speaking
  • Headache after a head injury
  • Headaches that worsen after coughing, exertion or sudden movements
  • New headache pain after age 50

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Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.

Filed under: Mind & Body


Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).