How to Describe Migraine Pain to a Doctor

Give six things, in this order: where the pain sits and whether it is on one side, what it feels like, how long an attack lasts if you take nothing, what it stops you doing, whether you get nausea or vomiting, and whether light and sound both become unbearable. Then say how many days a month you get them, and what you have already tried. That is the whole description. Ten minutes of adjectives adds nothing to it.

The reason that particular list works is not that it is comprehensive. It is that it maps onto the definition your clinician is checking your description against.

What is actually being checked

Headache disorders are classified against a published set of criteria, the International Classification of Headache Disorders, currently in its third edition. The entry for migraine without aura asks for attacks lasting between four and seventy-two hours untreated, at least two of four headache characteristics, and at least one associated feature. The four characteristics are: pain on one side, a pulsating quality, moderate or severe intensity, and being made worse by routine activity like walking or climbing stairs. The associated features are nausea or vomiting, or sensitivity to both light and sound together. There is a separate entry for migraine with aura, and aura can also arrive with no headache behind it at all — worth naming explicitly if that has ever happened to you, because it changes which entry you are being read against.

Read that again and notice what it does not contain. There is no field for “the worst pain imaginable”. There is no field for how long you have been coping. Those things are real and they matter to how you are treated, but they are not the part of your account that does the classifying work, which is why a description built entirely out of them can leave a clinician nodding and no further forward.

Which category anything falls into is a judgement for the person in front of you, and there are dozens of entries in that classification. Your job is not to arrive with a diagnosis. It is to hand over a description clean enough that theirs is easy to make.

Say where it is, and whether it moves

“Behind my right eye and along the right side of the back of my head” is a description. “My head hurts” is not. If it swaps sides between attacks, say so, and say whether it ever occupies both sides at once. If it starts in the neck and arrives at the temple twenty minutes later, that sequence is worth a sentence.

People under-report the swapping because they assume it undermines the account. It does not. It is information. Both sides at once, felt as a band or a steady pressure rather than a throb, is one of the places migraine and tension headache come apart — though not on the evidence of a single attack.

The quality words, and why “pulsating” is not a flourish

Reach for one of these and stop: pulsating or throbbing, pressing or tightening, stabbing, burning. The first is asked about by name in the criteria. If it beats with your heartbeat and gets worse when you bend to pick something up off the floor, that is what “pulsating” is describing, and saying it plainly is better than a paragraph of approximation.

Say the quality once and let it go. There is a strong temptation to keep reaching for new metaphors, because the pain feels like it deserves a better sentence than the one you just gave it. Vice, drill, ice pick, someone standing on my eye. It reads as vividness to you and as noise to the person taking notes.

What it stops you doing is the better intensity measure

Zero to ten is a blunt instrument and everyone calibrates it differently. Give it, because it goes in the notes and is useful for comparison over time, then immediately give the thing that makes it legible:

• “I can work through it but I can’t be in the open-plan office.”
• “I can’t stand up long enough to make food.”
• “I lie in the dark and can’t follow a conversation.”

The third of those is telling a clinician something the number could not. And if bending, walking upstairs or moving your head makes it worse, say it in those words, because avoidance of routine physical activity is one of the four characteristics being checked, and almost nobody volunteers it.

The two features people leave out

Nausea gets mentioned. Light sensitivity gets mentioned. Two things routinely go missing.

The first is sound. The criteria treat light and sound sensitivity together, so “I need it dark” is half an answer. If the dishwasher is intolerable, say that.

The second is everything before and after the pain. The yawning, the neck stiffness, the food craving, the irritability the afternoon before. The flatness and the difficulty finding words the day after. These are not the headache, which is exactly why people edit them out of an account of a headache. They are among the more useful things you can report, and they are also the part most often mistaken for a trigger rather than the attack already starting, a confusion worth understanding before you start naming triggers in an appointment.

Give frequency as a count, not a feeling

“Loads” and “most weeks” cannot be compared to anything, including your own answer at the next appointment. Give two numbers: how many days a month you have any head pain at all, and how many of those days you are unable to do your normal activities. Treatment decisions and referral thresholds hinge on that pair far more than on how severe any single attack was.

If you have been keeping any kind of record this is a lookup rather than a memory test. Migraine Journal will give you the attack count and the average duration for a date range, and a printable diary filled in for six weeks does the same job on paper. Without either, say “I think around ten, but I haven’t counted” rather than guessing precisely, because a confident wrong number is worse than an admitted estimate.

Say what you took, when you took it, and what happened

Not just the name. The gap between the first sign and the dose is often the most decision-relevant fact in the whole appointment, and it is the one people skip. “Sumatriptan, usually about three hours in because I try to wait and see, works maybe half the time” is a far more useful sentence than “triptans don’t really work for me”, and it points at a different conversation. If you are unsure whether something is helping at all, judging that honestly takes a few attacks of deliberate record-keeping rather than an impression.

Bring the list of everything you have tried, including what you stopped and why. Include over-the-counter painkillers and how many days a month you use them.

Write it on paper before you go in

Six lines is enough. Location and side, quality, duration untreated, what it stops you doing, nausea and light-and-sound, days per month. Then the treatment list.

Do it the day before rather than in the waiting room. Fifteen minutes into an appointment, under time pressure, with someone waiting for you to finish a sentence, is the worst possible moment to try to summarise two years. The appointment prep sheet is already laid out for it, and the wider question of what to take to a neurology appointment covers what else is worth having in the folder. If you have spent years calling these headaches sinus headaches, the vocabulary above is also the fastest way to find out whether that label was ever right — sinus headache or migraine turns on four things you can record in a fortnight. The other appointment guides start the same way: with a count.

Describing it well gets you through the first half of the appointment. The second half is yours to steer, and the questions worth asking a neurologist are grouped by the decision each one settles rather than by topic.

One last thing, and it is the sentence most worth rehearsing: if anything about your headaches has changed, lead with that. A new pattern, a sudden onset, a headache that is different in kind from your usual ones. Do not save it for the end in case it sounds dramatic, and do not try to work out from the internet whether it is important. Say it in the first minute and let the clinician decide what it means.