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Understanding Migraine
The four phases of a migraine attack
An attack often begins a day or two before the pain, and its effects can linger after it ends.
4 min read · 4 research sources · Based on the Mastering Migraine courses by Dr. Adam Harcourt
A migraine attack is not a single event. It usually unfolds in phases, and recognizing them can help you act earlier 1.
1. Premonitory (warning) phase
This can start 24 to 48 hours before the headache. Common signs include yawning, tiredness, trouble concentrating, food cravings, a stiff neck, frequent urination, irritability and sensitivity to light. Brain imaging shows real changes in the hypothalamus and brainstem during this phase, before any pain begins 1.
One important insight: some things people think are triggers may actually be early symptoms. Craving chocolate, for example, may be a sign the attack has already started, rather than the cause of it 1,2.
2. Aura (in roughly a quarter to a third of people)
Aura is a temporary, reversible neurological symptom, most often visual: zig-zag lines, shimmering spots, or blind spots that spread over 5 to 60 minutes. It can also involve tingling, numbness or speech difficulty 3. Aura is linked to a slow wave of nerve-cell activity across the surface of the brain, called cortical spreading depression 1.
3. Headache phase
The pain is often one-sided and throbbing, worse with movement, and comes with nausea and sensitivity to light and sound. Untreated, it typically lasts 4 to 72 hours in adults 3. During this phase the brain can become sensitized, which is why skin, hair or the neck may hurt to touch (called allodynia) 1.
4. Postdrome (“migraine hangover”)
After the pain eases, many people feel drained, foggy or achy for a day or more. This is part of the attack and deserves rest and recovery.
What you can do with this
Tracking your early warning signs in a headache diary can help you and your care team time treatment better. The American Headache Society advises treating early in an attack for the best results 4.
This article is educational and does not replace a personal evaluation. Talk with your clinician before making changes to medications, supplements or diet.
Research cited on this page
- Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. PubMed 28179394 · DOI
- Nowaczewska M, Wiciński M, Kaźmierczak W, et al. To Eat or Not to Eat: A Review of the Relationship between Chocolate and Migraines. Nutrients. 2020;12(3). PubMed 32110888 · DOI
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. Source · DOI
- American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019;59(1):1-18. PubMed 30536394 · DOI
Mastering Migraine is an educational resource and is not a substitute for individualized medical care. Always talk with your own doctor before changing medications, starting supplements, or beginning a new treatment.
