A throbbing headache on one side, and light becomes unbearable
Migraine. Caused by brain hyperexcitability and trigeminal nerve activation.
A throbbing, pulsating pain takes over one side of your head, and even a touch of light or sound makes it worse. Nausea may come with it, and sometimes flickering lights appear in your vision before the pain begins.
Quick answer: Migraine is a headache caused by brain hyperexcitability and activation of the trigeminovascular system. Studies have reported a link between the condition of the neck and shoulder muscles and how often migraines occur, so assessing the musculoskeletal system together with your symptoms can be helpful. We examine the neck and shoulder using a three-step circulation approach that calms, then activates, then integrates.
See a doctor quickly in these cases
Go to the emergency room immediately if:
- A headache with weakness in one arm or leg, or difficulty speaking, which may signal a stroke
- Clouded consciousness, or a sudden feeling that you might collapse
Seek prompt care if:
- The worst headache of your life starts suddenly
- Fever and a stiff neck appear together
- A new headache develops or worsens after an injury
Typical aura. Not an emergency, but evaluation is advised
- Flickering lights or zigzag lines in your vision before a headache
- Tingling or unusual sensations in the hands or feet before a headache
- These are not emergencies, but if it is your first time, we recommend an evaluation to confirm the cause.
3 Key Points on This Page
- What causes migraine and how it differs from tension headache
- How the condition of the neck and shoulder muscles affects migraine
- How to manage migraine in everyday life
These headaches may point to migraine
- Throbbing pain on one side, or mostly one side. It pulsates, beating in time with your heartbeat.
- Worse with movement. Climbing stairs or moving around intensifies the pain.
- Nausea or vomiting. Your stomach feels unsettled with the headache, or you actually feel sick.
- Extreme sensitivity to light (photophobia). Bright light is hard to bear, and you want to darken the room.
- Extreme sensitivity to sound (phonophobia). Even quiet sounds feel unpleasant.
- Aura appears first, in some people. Flickering lights in your vision or tingling in the hands and feet come before the headache.
- Worse after changes in sleep, meals, or stress. A headache follows the day after poor sleep or a skipped meal.
- Temporary relief with painkillers, but it returns. Medication eases it, but the pain comes back a few days later.
Why does migraine happen?
The core mechanisms of migraine are activation of the trigeminovascular system and brain hyperexcitability (central sensitization). When the brain becomes overly reactive to external stimuli, light, sound, and smells that once went unnoticed can trigger pain.
Major triggers include too little or too much sleep, skipped meals, stress, hormonal changes, bright light, and strong smells. Triggers differ from person to person, so understanding your own pattern is important.
Studies have reported a link between the condition of the neck and shoulder muscles and how often headaches occur. Because muscle tension or postural imbalance in the neck may affect how frequently migraine attacks happen, a musculoskeletal assessment can be helpful as a supportive measure.
Migraine vs Tension Headache
| Migraine | Tension headache | |
|---|---|---|
| Location | Mostly one side | Both sides |
| Quality of pain | Throbbing | Tightening |
| Movement | Worsens | Little change |
| Nausea | Often present | Rare |
| Light/sound sensitivity | Very sensitive | Mild |
The two types can also occur together, so accurate differentiation matters. Learn more about tension headache →
Is it migraine, or another type of headache?
Severe headache is not always migraine. Tension-type headache and cervicogenic headache share overlapping features and are often confused.
Migraine
- Usually one-sided, throbbing or pulsating pain
- Light and sound sensitivity. Nausea or vomiting
- Movement worsens the headache
- May be preceded by an aura (visual disturbances, etc.)
Tension-Type Headache
- Pressure or tightening sensation around the whole head
- Little or no sensitivity to light or sound. Nausea uncommon
- Physical activity does not worsen the headache
- Strongly associated with stress and fatigue
Cervicogenic headache changes with neck movement. It typically presents as a one-sided headache starting at the back of the head and spreading toward the eye or temple. It is not rare for migraine and cervicogenic headache to coexist in the same person, making accurate identification of the dominant pattern important.
Our approach at Yonsei SM
Migraine is a neurological condition, so medication may form the foundation of treatment. At Yonsei SM, we assess the musculoskeletal system alongside it and take a supportive approach, checking whether neck and shoulder tension may be affecting how often headaches occur.
- Phase 1: Calm (Circulation HD)
We assess points of excess tension in the neck and shoulder muscles and stabilize the nerve and fascial condition. Under ultrasound guidance, fluid is used to gently release tissue that has become adhered. - Phase 2: Wake (Circulation PT)
We strengthen the weakened deep neck muscles and restore postural balance. We also check cervical movement patterns that may be involved in the headache. - Phase 3: Make it stick
We review migraine triggers together (sleep, meals, stress, and posture). This continues into correcting everyday patterns that reduce recurrence.
Important note
Migraine is a neurological condition. Depending on your symptoms, medication may need to be used alongside it. For severe migraine or migraine with aura, we recommend a neurology consultation. Our approach at Yonsei SM addresses the musculoskeletal aspect as a supportive measure and does not replace medication.
Lifestyle Habits for Managing Migraine
- Regular sleep. Go to bed at the same time and get a full 7-8 hours. Keeping weekend sleep similar to weekdays helps too.
- Regular meals. Don’t skip meals. Changes in blood sugar can be a migraine trigger.
- Stay well hydrated. Drink at least 1.5-2L of water a day.
- Keep a migraine diary. Record the date and duration of each headache, along with the previous day’s sleep, meals, and stress. It is useful for identifying your own triggers.
- Be careful with overusing painkillers. Taking painkillers on more than 10 days a month can lead to medication overuse headache (MOH), where the medication itself causes the headache.
- Regular aerobic exercise. Studies suggest that light aerobic exercise three or more times a week may help reduce how often migraines occur.
Frequently Asked Questions
How is migraine different from tension headache?
Migraine is usually a throbbing pain on one side of the head, worsens with movement, and is often accompanied by nausea or sensitivity to light and sound. Tension headache feels like a tightening on both sides and often comes with neck and shoulder tension. The two can also occur together. Learn more about tension headache →
Is it more dangerous if I have aura?
Aura is the phenomenon of flickering lights in your vision or tingling in the hands and feet before a headache, and it appears in about 20-30% of migraine patients. Aura itself does not mean immediate danger, but if you experience it for the first time, we recommend an evaluation to rule out other causes such as stroke. If it is accompanied by weakness or difficulty speaking, go to the emergency room immediately.
Why does my migraine get worse around my menstrual cycle?
Migraine often worsens just before and around the start of menstruation, when estrogen levels drop sharply. This is called “menstrual migraine.” It happens because hormonal changes affect brain hyperexcitability. If it recurs in a regular pattern, anticipating it and managing your lifestyle to reduce triggers can be helpful.
Does treating the neck or shoulder help with migraine?
Studies have reported a link between the condition of the neck and shoulder muscles and how often migraines occur. However, since migraine is a neurological condition, musculoskeletal treatment does not produce the same effect for everyone. A safe approach is to assess your symptoms and musculoskeletal condition together and confirm whether it can help. What is myofascial pain syndrome? →
Can I have migraine even if my MRI is normal?
Yes. Migraine can be diagnosed even when there is no structural abnormality on a brain MRI. Because migraine is caused by functional changes in the brain and nervous system hyperexcitability, the headache can persist even when imaging comes back normal. Q&A: Normal MRI but still in pain →
It got better, then started hurting again. Why does it recur?
Migraine tends to recur when triggers repeat or when stress and sleep patterns break down. Even if the pain temporarily eases, it can return if your daily patterns stay the same. Identifying your recurrence pattern and managing triggers is the key to long-term care. Q&A: Recurrence →
Is it bad to take painkillers often?
Taking painkillers on more than 10 days a month can lead to medication overuse headache (MOH), where the medication itself causes the headache. It becomes a vicious cycle in which headaches actually become more frequent. If you use painkillers often, we recommend reviewing preventive medication or non-drug management options together through a professional evaluation.
Recommended Reading
Migraine Consultation
We assess together whether the condition of your neck and shoulder muscles is affecting your headaches.
Book OnlineReferences
- Ashina M. Migraine. N Engl J Med. 2020;383(19):1866-1876. PMID 33170911
- GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-976. PMID 30353868
- Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine: systematic review and meta-analysis. Cephalalgia. 2016;36(5):474-492. PMID 26229071
- Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31(14):1428-1438. PMID 21890526
- Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019;18(9):891-902. PMID 31377132