How to Explain Migraines to Someone Who Doesn't Get It

The reason explaining migraine goes badly is that almost every attempt describes the pain, and pain is the one part the listener thinks they already understand. They’ve had a bad headache. They pushed through. They assume you could too.

So the trick is to stop leading with pain.

Lead with the parts that aren’t headache

Three things do the work that “it really hurts” can’t.

It’s neurological, and the pain is one symptom of several. Nausea and vomiting. Vision going strange, or partly disappearing. Sensitivity to light and sound strong enough that ordinary daylight is painful. Difficulty finding words. Numbness or tingling down one side. Some attacks involve no head pain at all, which surprises people and does more to reframe it than any amount of insisting.

It has phases, including a recovery day. Warning signs hours before, the attack, and then a day afterwards of fog and flatness. Most people have no idea this exists, and it explains the thing they’ve actually noticed — that you’re not right the day after either.

It’s disabling in a measurable way. There are validated questionnaires clinicians use to score exactly this: MIDAS counts days lost across work, home, and social life over three months. Saying “the standard clinical measure is days of your life lost, and mine is eleven” lands very differently from “they’re quite bad.”

The analogies that work, and the ones that don’t

Don’t say “it’s like a really bad headache.” You’ve just confirmed their existing model.

Don’t try to win on pain intensity. It becomes a competition, and they can’t verify it.

Do use analogies about capacity rather than sensation:

“Imagine the worst hangover you’ve had. Now imagine it arrives with no warning, twice a month, and lasts two days.”

“It’s less like a headache and more like the flu, if the flu also made light physically painful.”

“The nearest thing is probably food poisoning. You don’t push through food poisoning.”

That last one is the most useful sentence in this article, because it moves the conversation from toughness to impossibility, which is the actual point.

Scripts by audience

A boss or colleague. Keep it operational, not medical. “I have a neurological condition that causes attacks a few times a month. When one starts, I can’t work through it — I lose focus and vision gets affected. If I can step out early and go somewhere dark for twenty minutes, I can often save the rest of the day. If I can’t, I’ll usually need to finish and make it up.” Concrete, bounded, and it tells them what to do. If you’d rather hand them something than keep explaining, how to support an employee with migraines is written for the manager’s side of it.

Family who think you should try harder. Don’t argue with the treatment suggestions. Redirect to what’s already happening: “I’m working on it with my neurologist, and I’m tracking it properly. What would help most is not having to justify it each time.” Repeat as needed. You’re not going to win the argument, and you don’t need to.

A friend who keeps being disappointed by cancellations. Lead with the relationship. “I hate cancelling on you and it isn’t about wanting to. When one starts, I genuinely can’t. Can we do things that are easy to move?”

Children. Short, true, and reassuring: “My head gets very sore and bright lights hurt. It isn’t anyone’s fault, it isn’t catching, and it always goes away.” Then give them a job — fetching the ice pack turns worry into a role.

Someone about to offer a cure story. “That’s kind. I’ve got a specialist and a plan, so I’m good on suggestions.” Said warmly, it ends it.

Say it once, on a good day

The worst time to explain any of this is mid-attack, when talking costs effort you don’t have and the listener is anxious.

Have the conversation when you’re well, and keep it short. One clear explanation on a Tuesday afternoon does more than five fragmented ones from a dark room.

If you’re the partner or family member doing the explaining on someone’s behalf, how to help someone having a migraine covers handling the outside world during an attack, which is often the more useful job.

Numbers end the argument

The single most effective thing for a persistent sceptic isn’t a better metaphor. It’s data.

“I’ve had eleven migraine days in the last month, six of them severe, and I took acute medication on five” is not arguable in the way that “they’ve been really bad lately” is. It also happens to be exactly what a neurologist asks for, so the record does double duty.

That’s the practical reason to keep one, beyond the medical one. Migraine Journal logs an attack in under a minute and produces those figures as a printable summary; a notebook gets you there too, more slowly. How to track migraine triggers covers what’s worth recording.

None of this is medical advice, and if attacks are getting more frequent or changing in character, that’s a conversation for your GP or neurologist rather than your relatives.