Migraine Is Not a Headache. Stop Calling It That.

"Oh, you have a headache? Just take an Advil." If you have migraines, you've heard some version of this sentence dozens — maybe hundreds — of times. From coworkers. From family. From doctors who should know better. And every single time, something inside you sinks, because you know they don't understand. They think you're complaining about a headache. You're living with a neurological disease.

Migraine is not a headache. A headache is one possible symptom of migraine — and not even a required one. Calling migraine "a headache" is like calling epilepsy "shaking" or diabetes "being thirsty." It reduces a complex, debilitating neurological condition to its most visible, most dismissible symptom. And this misunderstanding has consequences that go far beyond hurt feelings.

The Neuroscience of Migraine

Migraine is a genetically driven neurological disorder involving abnormal brain activity, neurotransmitter dysfunction, and sensitization of the trigeminal pain pathway. Here's what actually happens during a migraine attack:

• Cortical spreading depression (CSD): A wave of intense neuronal activity followed by suppression spreads across the cortex at 3-5 mm per minute. This is what causes aura symptoms — visual disturbances, tingling, speech difficulties. It's literally a wave of electrical dysfunction rolling across your brain.
• Trigeminal nerve activation: The trigeminal nerve, which innervates blood vessels in the meninges (the membranes covering your brain), becomes activated and releases inflammatory neuropeptides — CGRP, substance P, neurokinin A. This triggers neurogenic inflammation around the brain's blood vessels.
• Central sensitization: As the attack progresses, the central nervous system becomes increasingly sensitized. Normal stimuli — light, sound, touch, movement — become painful. This is why a migraine sufferer in a dark, silent room isn't being dramatic. Their nervous system is amplifying every input.
• Serotonin dysregulation: Serotonin (5-HT) levels drop during an attack, which is why triptans — the most common migraine-specific medications — work by mimicking serotonin at specific receptor sites (5-HT1B/1D).

This is not a headache. This is a multi-system neurological event involving cortical dysfunction, nerve inflammation, neurotransmitter collapse, and central sensitization. The pain — when it even occurs — is a downstream consequence, not the disease itself.

Silent Migraine: When There's No Headache at All

Here's the fact that shatters the "migraine equals headache" myth completely: approximately 15-20% of migraine sufferers experience attacks without any headache whatsoever. This is called "migraine without headache," "acephalgic migraine," or colloquially, "silent migraine."

Silent migraine sufferers experience the full neurological event — aura, cognitive fog, nausea, light sensitivity, fatigue, speech difficulties, even temporary vision loss — without pain. Many go undiagnosed for years because neither they nor their doctors connect these symptoms to migraine. After all, if there's no headache, it can't be a migraine, right? Wrong. Dead wrong.

If migraine were really just a headache, how do you explain the 15% of sufferers who get every other symptom but no pain at all?

The Four Phases of Migraine

A migraine attack isn't a moment — it's a process that can span 72 hours or more. It unfolds in four distinct phases, and the headache phase is just one of them:

Phase 1: Prodrome (Hours to Days Before)

The attack begins long before any pain. During prodrome, you might experience fatigue, mood changes (irritability, depression, euphoria), food cravings (especially for chocolate or carbohydrates), neck stiffness, frequent yawning, increased urination, or difficulty concentrating. Up to 77% of migraineurs experience prodrome symptoms. This is your brain signaling that the neurological cascade has begun.

Phase 2: Aura (5-60 Minutes)

About 25-30% of migraineurs experience aura — transient neurological symptoms caused by cortical spreading depression. Visual aura is most common: shimmering zigzag lines (fortification spectra), blind spots (scotoma), flashing lights, or tunnel vision. But aura can also be sensory (tingling spreading up the arm or face), speech-related (difficulty finding words, slurred speech), or motor (weakness on one side of the body). Aura typically lasts 20-60 minutes.

Phase 3: Headache Phase (4-72 Hours)

This is the phase everyone fixates on — the pain. Typically unilateral (one-sided), pulsating, moderate to severe, worsened by physical activity. Accompanied by nausea, vomiting, photophobia (light sensitivity), and phonophobia (sound sensitivity). It can last 4 to 72 hours untreated. But remember: this phase is optional. Not every attack includes it. And even when it does, the pain is just one component of a much larger neurological event.

Phase 4: Postdrome — The "Migraine Hangover" (24-48 Hours After)

After the pain resolves, the attack isn't over. The postdrome phase — often called the "migraine hangover" — brings fatigue, cognitive difficulty ("brain fog"), mood changes, weakness, and residual sensitivity to light and sound. Many people describe feeling "washed out" or "hollowed out." Studies show that 80% of migraineurs experience postdrome, and it can impair function for one to two full days after the headache resolves.

Add it up: prodrome (1-2 days) + aura (1 hour) + headache (up to 3 days) + postdrome (1-2 days). A single migraine attack can disable someone for nearly a week. Does that sound like "just a headache" to you?

The Economic and Human Cost

Migraine isn't just a clinical issue — it's a public health crisis that doesn't get treated like one:

• 1 billion people worldwide have migraine — making it the 3rd most prevalent disease on the planet (WHO)
• Migraine is the 2nd leading cause of disability worldwide, measured by Years Lived with Disability (WHO Global Burden of Disease Study)
• $36 billion per year in direct and indirect costs in the US alone (American Migraine Foundation)
• 113 million lost workdays per year in the US due to migraine
• Less than 5% of migraine sufferers see a headache specialist — most are managed (poorly) by primary care
• Migraine research receives approximately $0.50 per affected person per year in NIH funding — compared to $280 per person for diabetes

Would you tell someone with epilepsy to "just take an aspirin"? Would you tell someone with Parkinson's to "push through it"? That's what migraineurs hear every day.

Why Language Matters

This isn't a semantic argument. The language we use to describe migraine has direct consequences for patients:

• Minimization at work: Employees who say "I have a migraine" are often treated as if they called in with a headache. This leads to presenteeism (working through attacks), which worsens attacks and reduces productivity
• Underfunding: Calling migraine "a headache" makes it seem minor, which translates to less research funding, fewer approved treatments, and less urgency in drug development
• Diagnostic delay: The average migraine patient waits 6 years for a correct diagnosis. Part of this is because patients themselves minimize their symptoms — "it's just bad headaches" — delaying the conversation with a specialist
• Self-stigma: Migraineurs internalize the dismissal. They feel guilty for canceling plans, apologize for needing a dark room, and push through attacks that should be treated — because they've been told it's "just a headache"

What to Say Instead

Words matter. Here's how to talk about migraine accurately:

• Instead of "migraine headache" → say "migraine" or "migraine attack." Migraine is its own thing. Adding "headache" is redundant and reductive.
• Instead of "bad headache" → say "neurological attack." It reframes the conversation immediately.
• Instead of "Do you get headaches?" → ask "Do you experience migraines?" The distinction matters clinically.
• Instead of "Have you tried Advil?" → say nothing. Or say "I'm sorry you're going through that. What can I do?"

If you're a migraineur, stop apologizing. Stop minimizing. You have a neurological disease, not a bad attitude. The next time someone says "it's just a headache," correct them. Not angrily — but firmly. "It's not a headache. It's a neurological condition. There's a difference."