Migraine Myths and What to Expect at Your First Headache Evaluation

Headaches are one of the most common neurological symptoms, but many misconceptions still exist about what migraines look like and how they should be treated. According to headache specialist Emily  Kunstman, PA-C, understanding the facts about migraine disease can help patients recognize symptoms sooner and seek appropriate care.

Common Migraine Misconceptions

One of the biggest misconceptions Emily hears from patients is the idea that headaches are "normal."

"Many people tell me they have 'normal' headaches," she says. "It may be common to experience headaches, but it is never normal for your head to be in pain."

Another common myth is that migraines always occur on one side of the head. While medical textbooks often describe migraine as unilateral head pain, real-life patients do not always fit textbook descriptions.

Migraine pain can occur on one side or both sides of the head and may spread to the eyes, face, sinus area, ears, jaw, teeth, or neck. Because of this, the location of pain alone does not always reveal the cause.

Many people are also surprised to learn that migraine attacks do not always include a headache.

Migraines are a neurological disease that can cause a variety of symptoms. Some patients experience what is known as an acephalgic migraine, or migraine aura without head pain. These episodes may involve visual disturbances, sensory changes, dizziness, vertigo, or balance problems without a traditional headache.

How Do You Know if a Headache Might Be a Migraine?

While every patient is different, certain symptoms can suggest that a headache is actually a migraine.

A headache may be migraine-related if it:

• Is moderate to severe in intensity
• Lasts at least four hours
• Causes sensitivity to light, sound, or strong odors
• Is accompanied by symptoms such as nausea, vomiting, loss of appetite, or changes in bowel habits

If headaches are frequent, disruptive, or associated with neurological symptoms, it may be time to seek evaluation from a healthcare provider.

What to Expect During a Migraine Evaluation

A first headache appointment is much more than a discussion about pain.

During the evaluation, patients can expect a detailed conversation about their symptoms, headache patterns, and possible triggers. Providers will also review any red flag symptoms that could indicate the need for additional testing, such as brain imaging.

The goal is to create a comprehensive treatment plan that addresses both symptom management and prevention. Treatment may include medications, lifestyle modifications, trigger management, and other non-pharmacologic strategies.

Many patients also leave their first appointment with homework.

Keeping a headache diary can be one of the most valuable tools for understanding migraine patterns. Tracking symptoms, triggers, frequency, and severity helps both patients and providers make informed treatment decisions and monitor progress over time.

When to Seek Care

If headaches are becoming more frequent, more severe, or interfering with daily activities, a neurological evaluation can help determine the cause and identify effective treatment options.

Migraines are more than "just headaches." Understanding the symptoms and seeking appropriate care can help patients find relief and improve their quality of life.