Many people have experienced a migraine attack and dont know it likely because the signs arent always so obvious.

Only half of 40 million people in the U.S. who have migraines actually get diagnosed, said Dr. Andrew Blumenfeld , a double board-certified neurologist and psychiatrist in San Diego.

Some symptoms are obvious, like vision changes, sensitivity to light, and of course, the all-consuming headache. But during a migraine attack even before the pain sets in parts of the brain are losing function, which can affect other areas of your body. This is how symptoms can seem unrelated. And if you experience chronic migraines (more than half the days of the month), you will experience symptoms well beyond the course of the incident.

Below are a few sneaky signs to look out for, plus some other important migraine notes to keep in mind.

Confusion, Brain Fog Or Loss Of Speech

If youve ever been unable to find the right words, youve abruptly lost the ability to express yourself, or you completely forgot what you were talking about mid-sentence, this could be a scary (but common) migraine symptom.

Difficulty with speech, memory loss, confusion [are some of the most] surprising symptoms of migraine, said Dr. Medhat Mikhael , a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California.

Migraines can lead to dysfunction in the language centers of the brain, resulting in a loss of being able to express yourself, Blumenfeld said.

In the cortex where language and vocabulary are stored that part of the brain is switching off during this phase of the migraine, Blumenfeld said.

Dizziness Or Feeling Disoriented

Many patients with vertigo tend to have migraines as well, Blumenfeld said. There are a lot of patients in this particular population who end up also being migraine patients, he explained.

Specifically, they might have whats called vestibular migraines. A vestibular migraine doesnt always include a painful headache, meaning that dizziness on its own can be a symptom or can be associated with regular migraine attacks.

If you have a history of migraines and occasionally have dizzy spells even if some of those dizzy spells dont have migraine pain involved it can still be a migraine attack, especially if there is no other disease to explain dizziness, Blumenfeld explained.

Fatigue

Tired all the time? Migraines may be to blame. Both before and during an attack, as well as in between attacks, chronic fatigue is a symptom of chronic migraines.

The fatigue can be physical, mental or both, Blumenfeld said. You can experience cognitive slowing slow thinking as well as lethargy. If your brain is working slowly, and youre trying to be productive, youre going to get fatigued more quickly. Its all coming from the cortex in the brain.

If fatigue is a major symptom for you, Blumenfeld said treating migraines properly can help you get some of your energy back. Bring up this symptom with your doctor when discussing a medication plan.

Certain medications used to treat migraine can increase fatigue, including some of the older migraine preventative medications, he explained. You might get rid of the headache, but the patient is [wiped] out.