The Four Stages of Migraine

Migraines can be debilitating, painful, and make it difficult to carry on with daily activities and responsibilities.

But not every person with migraine will experience the same symptoms or stages of the disorder.

Understanding the four stages of migraine—and which phase or phases you may experience—can help inform your treatment. 

In this article, I’ll outline the four different stages of migraine and their respective symptoms, timelines, and treatment options.

If you’re experiencing symptoms of migraine for the first time or are unsure about which treatment is best for you, reach out to your healthcare provider to discuss your options.

What is Migraine?

Migraine is a headache disorder that affects an estimated 44.5 million adults in the United States.

Many people with migraine experience recurrent attacks of headaches that can cause moderate to severe pain.

But not everyone will experience the same migraine symptoms or stages. 

Though experts still aren’t exactly sure what causes the disorder, many believe that the causes of migraine are related to genetic factors.

There are other factors that can put you at higher risk for migraine, including:

• Sex: People with vaginas are three times more likely to have migraine.

• Medical conditions: Certain conditions can increase your risk of migraine, including depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

There are four phases of migraine, though not every person will go through each phase during a migraine attack. 

Prodrome Stage

Also called the premonitory stage, the prodrome stage of migraine describes the period leading up to a headache attack.

During this stage, several uncomfortable symptoms can occur.

Symptoms

Symptoms that can appear during the prodrome stage include:

• Food cravings
• Increased thirst
• Constipation
• Fatigue
• Mood changes
• Fluid retention
• Frequent urination
• Neck stiffness
• Uncontrollable yawning

Timeline

Symptoms of the prodrome stage generally occur 1-2 days before an attack. 

Treatment

Treatment of the prodrome stage will focus on symptom management.

Depending on the symptoms you experience, treatment options may include:

• Drinking plenty of fluids
• Sticking to a consistent bedtime routine
• Engaging in some type of stress management or relaxation technique
• Exercise and/or gentle stretching

Aura Stage

Around 25% of people with migraine experience aura, a neurological disturbance which can cause unique symptoms. 

Symptoms

Temporary symptoms of migraine with aura can include:

• Visual hallucination, like seeing flashing or bright lights, or zig-zag lines
• Loss of vision
• Muscle weakness
• Changes in speech
• Ringing in the ears (tinnitus)
• Changes in smell or taste 
• Feeling of pins and needles on the skin
• Numbness
• Headache

Timeline

The duration of aura symptoms can vary, but they generally last from 10-60 minutes.

Treatment

To treat pain associated with headache or other symptoms, there are medications that can help—especially when taken at the onset aura symptoms. 

Attack Stage

The most commonly experienced phase of migraine is the attack stage, when a headache can come on gradually and become more severe with time. 

Symptoms

Sometimes referred to as the headache stage, the primary symptom is a moderate to severe headache that can cause severe pain, throbbing, or pulsing.

The headache is often experienced on one side of the head.

Additional symptoms can include:

• Nausea
• Vomiting
• Sensitivity to light and sound
• Worsened pain when you move
• Coughing
• Sneezing
• Stomach pain, loss of appetite, and pale appearance (experienced with abdominal migraine)

Timeline

The attack stage can last from 4 hours to 3 days.

Treatment

There are several treatment options that can help during the attack stage:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a first-line treatment for mild to moderate migraine headaches. But FDA-approved prescription medications like triptans and ditans can also help. Evidence suggests that triptans are most effective when taken early in an attack. For people with migraine with aura, it’s recommended to take triptans at the start of an attack rather than at the start of aura. 

• Cold compress: A cold compress or ice pack can provide relief for many people with migraine.

• Mindfulness-based stress reduction (MSBR): MSBR or other stress management techniques may help you to cope with migraine attack symptoms.

• Ginger: One meta-analysis of randomized controlled studies suggests that ginger may reduce migraine headache pain and other symptoms, including nausea and vomiting. 

Postdrome Stage

Sometimes referred to as a migraine hangover, the postdrome stage refers to the stage after a headache attack. 

Symptoms

People who experience this stage can exhibit symptoms including:

• Fatigue or exhaustion
• Inability to concentrate
• Weakness
• Confusion
• Depression or euphoria
• Lack of comprehension
• Dizziness
• Stiffness in the neck and shoulders
• Tenderness in the scalp

Timeline

The postdrome stage usually lasts 24-48 hours.

Treatment

Prevention is key when it comes to reducing the severity of your symptoms during the postdrome stage.

Keeping a headache diary can help you to keep track of your symptoms, as well as identify any possible triggers you may experience.

Reach out to your healthcare provider to discuss other preventive methods, including medication, acupuncture, and massage.

When to See a Doctor for Migraine

When managing migraine disorder, early treatment is key to limiting the severity of your symptoms.

Reaching out to a provider or neurologist to discuss treatment is the best way to learn more about which options may work best for you. 

In the meantime, consider keeping a migraine diary.

Keep track of when you experience symptoms and which factors, if any, may be triggering them.

Not all severe headaches are a sign of migraine.

In rare but serious cases, a severe headache can be a sign of something else.

If you experience any of the below symptoms, seek immediate medical attention: 

• Fever
• Nausea
• Shortness of breath
• Weakness in the body
• Confusion
• Double vision
• Stiff neck
• The “worst” headache of your life
• A headache prompted by a head injury
• A severe and sudden headache

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