The Phases of a Migraine Attack and Their Symptoms

Patient Expert

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Hello and welcome to MigraineCast the weekly podcast brought to you by and the HealthCentral Network.

When many people think of a Migraine attack, they think only of a very painful headache. The reality is that a Migraine attack usually has several symptoms and those symptoms can be broken down into four phases. Not everyone experiences all the phases, and we might experience symptoms and phases during one Migraine attack that we don't experience during the next.

The four potential phases of a Migraine attack, in the order in which they occur are prodrome, aura, headache, and postdrome.

The prodrome is sometimes called the preheadache or promonitory phrase, as in premonition. It can start hours or even days before the other phases. Statistics show that 30- 40% of Migraineurs experience the prodrome phase, but my personal theory is that if Migraineurs would learn to pay closer attention to their bodies, we'd find that percentage to be higher. Typical prodrome symptoms include:

  • food cravings
  • constipation or diarrhea
  • mood changes - depression, irritability, etc.
  • muscle stiffness, especially in the neck
  • fatigue
  • increased frequency of urination
  • yawning

The second possible phase is the aura. Although it's the phase that's perhaps the most talked-about, it's experienced by only 20-25% of Migraineurs. Aura symptoms vary widely. Some of the visual distortions can be exotic and bizarre. While most people probably think of aura as being strictly visual, auras can have a wide range of symptoms, including:

  • visual - flashing lights, wavy lines, spots, partial loss of sight, blurry vision, and brief flashes of light that streak across the visual field (phosphenes)
  • olfactory hallucinations - smelling odors that aren't there
  • tingling or numbness of the face or extremities on the side where the headache develops.
  • difficult finding words and/or speaking (aphasia)
  • confusion
  • dizziness
  • partial paralysis (only in hemiplegic Migraine)
  • auditory hallucinations - hearing things that aren't really there
  • decrease in or loss of hearing
  • reduced sensation
  • hypersensitivity to feel and touch (allodynia)

The headache phase is generally the most debilitating part of a Migraine attack. It's effects are not limited to the head only, but affect the entire body. The pain of the headache can range from mild to severe. It can be so intense that it is difficult to comprehend by those who have not experienced it. Characteristics of the headache phase may include:

  • headache pain that is often unilateral - on one side. This pain can shift to the other side or become bilateral.
  • Although Migraine pain can occur at any time of day, statistics have shown the most common time to be 6 a.m. It is not uncommon for Migraineurs to be awakened by the pain.
  • This phase usually lasts from one to 72 hours. In less common cases where it lasts longer than 72 hours, it is termed "status migrainosus," and medical attention should be sought.
  • The pain is worsened by any physical activity.
  • phonophobia - sensitivity to sound
  • photophobia - sensitivity to light
  • nausea and vomiting
  • diarrhea or constipation
  • nasal congestion and/or runny nose
  • depression, severe anxiety
  • hot flashes and chills
  • dizziness
  • confusion
  • dehydration or fluid retention, depending on the individual body's reactions

Once the headache is over, the Migraine attack may or may not be over. The postdrome (sometimes called postheadache) follows immediately afterward. The majority of Migraineurs take hours to fully recover; some take days. Many people describe postdrome as feeling "like a zombie" or "hung-over." These feelings are often attributed to medications taken to treat the Migraine, but may well be caused by the Migraine itself. Postdrome symptoms can last up to 24 hours and may include:

  • lowered mood levels, especially depression
  • or feelings of well-being and euphoria
  • fatigue
  • poor concentration and comprehension
  • lowered intellect levels

There can be great advantage to learning about these phases of a Migraine and how to recognize them. Once we know about them and learn to listen to our bodies, if we experience prodrome or aura symptoms, we have a better chance of avoiding the headache phase. In addition, there's always an emotional comfort factor to knowing what is causing us to feel depressed or have other symptoms. Once we learn to recognize these symptoms and use them in our Migraine management, we gain a bit more control over Migraine. Any time we can do that, it's a positive move.

Coping with severe headaches and Migraine disease for over 40 years has brought me to the realization that learning about Migraine disease and headaches can allow us to work with our doctors as treatment partners to gain control over headaches and Migraines rather than them controlling us.

Please join us at for information and support or for a transcript of this podcast. From and the HealthCentral Network, this is Teri Robert reminding you that you can indeed live well, even with Migraine disease and headaches.