Migraines can come on suddenly, or may start showing early warning signs.
If you’ve had a migraine before, you know that once a painful, throbbing migraine attack begins, one of the most important questions on your mind is when it will end so you can feel better.
In this article, I’ll explain more about migraines, including how to know if you’re having one, the stages of migraine, how they’re triggered, and how long migraines can last.
I’ll also talk about treatments for migraine, and when to see a doctor or consider prescription medication.
What is a Migraine Attack?
People sometimes use the term “migraine” to mean any bad headache.
Migraines happen when specific changes in the brain occur, leading to the moderate to severe pain that they are known for, as well as other specific symptoms that separate them from other headache types.
How to know if you’re having a migraine?
Symptoms of a migraine tend to be felt on only one side of the head (in about 60-70% of people) or behind the eyes.
They are usually described as pulsating, pounding, or throbbing. Unlike other headache types, migraines may make it hard to function and may even prevent the ability to work, go to school, or drive.
If you have a very bad headache on one side, have sensitivity to light and sound, and you also feel nauseated or are vomiting, it is likely a migraine attack versus a different headache type.
There are four migraine stages.
- Prodrome: Also known as pre-migraine, this occurs in about 75% of individuals experiencing migraines. The prodrome stage happens 24-48 hours before a migraine occurs. It may include light and sound sensitivity, along with other symptoms such as yawning, fatigue, mood changes, sugar cravings, poor concentration, neck pain, constipation or diarrhea, and an increased urge to urinate. A person may experience some, all, or none of these symptoms leading up to a migraine.
- Aura: An aura is a neurological disturbance that may appear a few hours before a migraine, or may happen at the same time a migraine attack starts. Auras can involve changes to your vision (seeing flickering lights, bright lines, blind spots), hearing (tinnitus, noises, music), other senses (numbness, tingling, pins and needles, problems speaking or finding the right word), and motor problems (jerking motions, repetitive motions, weakness on one side of the body, balance problems). Around 25% of migraine patients will also experience aura. If you have never experienced a migraine aura before and these are new symptoms, seek emergency medical care. A physician should examine you to make sure there are no other neurological changes that may indicate more serious diseases, like stroke.
- Headache/Attack: During this phase, the head pain sets in, typically on one side or behind the eyes. It can feel like throbbing, pulsating, or pounding and may worsen with movement, light, sounds, or smells. Attacks may last from a few hours to 3 days. Migraines typically involve other symptoms such as nausea, vomiting, neck pain, and sleep problems.
- Postdrome: After the headache has ended, the post-migraine, or postdrome, stage sets in. It may last a few hours or a few days. The postdrome stage may include symptoms like fatigue. Sudden movements can cause pain where the headache was previously felt. Continue avoiding migraine triggers or overexertion during this time. Some people refer to this as having a “migraine hangover.” It may still be hard to return to normal function until the postdrome phase has ended.
There are many potential causes for migraines. Research has not identified a single factor.
Genetics and environmental exposures play a role. Some people are more prone to migraine than others, or may be more sensitive to certain triggers.
There are many different types of migraine triggers.
Most people who suffer from migraine can identify one or more that seem to set off migraine attacks for them.
Common migraine triggers include:
- Stress: Any type of stress or anxiety can induce a migraine if you are prone to them. In a retrospective study, 80% of those experiencing a migraine could attribute increased stress as their trigger.
- Menstrual cycle changes: Hormone changes associated with the menstrual cycle can lead to migraine. Typically they are triggered in the days leading up to a period or during a period. They are sometimes associated with symptoms of PMS (premenstrual syndrome).
- Foods: Skipping meals is actually more commonly known to trigger migraines than certain foods. But some foods are associated with a stronger risk for triggering a migraine. These include aged cheeses, red wine, MSG (monosodium glutamate), chocolate, dairy products, alcohol, smoked meats, and artificial sweeteners. For people who have celiac disease, gluten exposure can trigger a migraine.
- Sensory stimulation: Sudden sensory changes to the environment can trigger migraine. These include bright lights, strong smells (like perfumes), and loud noises.
- Weather changes: Barometric pressure shifts can trigger migraine headaches. This can include a sudden temperature change, a storm, or traveling somewhere with a different altitude.
- Sleep changes: Getting too much or too little sleep, compared to what you are used to, can trigger a migraine.
- Caffeine: Suddenly changing your usual caffeine intake, like having a lot more or stopping suddenly, can trigger migraines.
How Long Do Migraine Attacks Last?
Migraine attacks may last for a few hours or up to 3 days. Taking over-the-counter (OTC) pain medications or prescribed migraine medications may shorten the duration.
Taking action during the prodrome phase, such as reducing trigger exposure, may shorten how long the migraine lasts or prevent it all together.
Treatment for migraine depends on what a patient’s triggers are, other health conditions, and frequency of attacks.
If you have developed a migraine, there are some things you can do at home to address pain and decrease the length of the attack:
- Practice relaxation techniques (deep breathing, meditation)
- Rest in a dark, quiet room
- Take a nap or go to bed early
- Place a warm or cool compress on your head— warm compresses help relax tense muscles, while cool compresses having a numbing effect to dull pain
- Drink water
Keep track of the things that seem to trigger migraines.
You can use a journal or an app on your phone to write down what was happening or what you were doing when migraine symptoms started to come on.
This may help you identify and more proactively avoid migraine triggers.
Some supplements may be beneficial for people who get migraines, though they may not work to stop a migraine attack that is already happening.
- Vitamin B2 (riboflavin)
- Coenzyme Q10
Never start taking supplements until you have checked with your doctor.
Even though they are OTC, supplemental nutrients and herbs can still have significant effects and interactions with foods, medications, and even other supplements.
OTC pain relievers may be able to shorten the duration of migraines or help relieve pain.
- Acetaminophen (Tylenol)
- Naproxen (Aleve)
- Ibuprofen (Advil, Motrin)
- Excedrin, which combines acetaminophen, aspirin, and caffeine
If you take other prescription medications for migraine or other health conditions, check with your doctor about which OTC pain relievers are safe for you to take.
Certain prescription medications can either prevent migraines or treat them once they have started.
Your doctor may prescribe medication if you have severe migraines or if they happen frequently.
Medications that are stronger than OTC pain relief and may help with migraine attacks include:
- Triptans (sumatriptan, rizatriptan)
- Anti-nausea drugs (chlorpromazine, metoclopramide, others)
Medications that can prevent migraines include:
- CGRP antagonists (erenumab, fremanezumab)
- Calcium channel blockers (diltiazem, nimodipine, verapamil)
- Beta-blockers (atenolol, metoprolol, propranolol, others)
- Anticonvulsants (gabapentin, levetiracetam, pregabalin)
- Antidepressants (amitriptyline, fluoxetine, paroxetine, sertraline, others)
- Botox injections
There are ways to prevent migraines that don’t involve prescription or OTC medications.
Doctors sometimes recommend lifestyle changes represented by the acronym “SEEDS”:
- S: Sleep—make sure you get enough, but not too much
- E: Exercise—moderate, but not too intense, 3-5 times per week for 30-60 minutes
- E: Eating—regular, healthy meals along with normal water intake and low or consistent caffeine intake
- D: Diary—keep track of how you feel and the things that tend to trigger migraines, so you can avoid them
- S: Stress relief—mindfulness, relaxation, therapy, or other things that help you avoid stress or anxiety
Acupuncture is an alternative therapy that may also help prevent migraines.
When to See a Medical Provider
Seek immediate medical attention if you experience any of the following:
- A sudden, new, severe headache that is felt all over
- Severe headache with other symptoms like stiff neck, disorientation, confusion, seizures, double vision, weakness, paralysis on one side of the body, or problems speaking
- Headache after a fall or head injury
Talk with a healthcare provider if you start having migraines, or have them more frequently.
If you are over age 50 and start having headaches, contact a healthcare provider.
Not all headaches are migraines, and there are many health conditions that can cause headaches.
A healthcare provider can help distinguish between the type of headache you are having and how to treat them.
Sometimes your healthcare provider may refer you to a neurologist or other specialist if you require additional testing.
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Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. (2015).
Headache disorders: Differentiating and managing the common subtypes. (2012).
Migraine with aura. (2021).
Analysis of trigger factors in episodic migraineurs using a smartphone headache diary applications. (2016).
Gluten-free diet and migraine. (2020).
Treating severe migraine headaches in the emergency room. (2013).
CGRP antagonists in the acute treatment of migraine. (2004).
Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis. (2019).
Antiepileptic drugs in migraine prevention. (2001).
Botulinum toxin in the management of chronic migraine: clinical evidence and experience. (2017).
SEEDS for success: lifestyle management in migraine. (2019).
Acupuncture for the prevention of episodic migraine. (2016).
The Triggers or Precipitants of the Acute Migraine Attack. (2007).
Dietary Supplements for Headaches: What the Science Says. (2021).