4 Phases of Migraine


Every individual with migraine experiences their headaches differently. Furthermore, each individual migraine attack may be different from the last.

Still, there is a general pattern that most migraines follow. It involves three principal phases: Premonitory, Headache, and Postdrome. It’s important to know and understand each of these phases so that you can better identify your own migraine pattern, plus any unique triggers or symptoms you may experience.

Timeline of a Migraine Headache: The 4 Phases

Phase 1: Premonitory

Also called prodrome, the premonitory phase features “preheadache” symptoms, which notify the individual that a migraine is impending. Approximately one-third of those with migraines will experience these warning symptoms. They tend to show up anywhere from an hour to one day or more before the migraine itself (the headache phase).

Premonitory symptoms generally include:

  • Having trouble concentrating and screening out distractions

  • Tiredness

  • Excessive yawning

  • Muscle stiffness

  • Nausea

  • Sensitivity to sound

  • Sensitivity to light

  • Mood changes, especially feeling irritable

  • Specific food cravings

  • Difficulty sleeping

  • Difficulty reading or speaking

 

 

Phase 2: Aura

Only one-third of those with migraines experience the aura phase.  Unlike premonitory symptoms, aura symptoms tend to be visual (blind spots or seeing zig-zagging lines) or sensory (tingling in the fingertips that extends up the arm). The symptoms may also be language-related (having trouble coming up with words or speaking for a period of time).  The symptoms generally spread gradually and last up to an hour. The symptoms typically start 20-60 minutes before a headache, though sometimes they start when the headache starts.

 

Phase 3: Headache

The headache phase of a migraine is the most intense and painful period. During this phase, the individual experiences headache pain either on one side of the head or on both sides.  Often, the pain begins on one side of the head and slowly spreads to the other. 

The intensity and duration of the pain will vary from individual to individual. It can also vary from migraine to migraine — sometimes presenting as a dull or mild pain and other times presenting as an acute throbbing or pulsing pain. The headache phase can last anywhere from just a few hours to a few days.

Additional phase 3 symptoms may appear as well, again varying from person to person. These symptoms may include:

  • Anxiety

  • Irritability and aggravation

  • Nausea and vomiting

  • Lightheadedness

  • Fainting

  • Blurred vision

  • Sensitivity to light

  • Sensitivity to sound

  • Sensitivity to certain odors

  • Sensitivity to touch on the face or hair

  • Sensitivity to movement

  • Trouble sleeping

 

Phase 4: Postdrome

The final phase of a migraine attack is the postdrome phase. This phase is often called the “migraine hangover,” and it is experienced by the vast majority of migraine sufferers (up to 80%). Still, the intensity and duration of the postdrome phase can vary from individual to individual and from migraine to migraine.

Typical postdrome symptoms include:

  • A persistent headache (sometimes just as painful as the phase 3 headache itself)

  • Sensitivity to light

  • Fatigue

  • Dizziness

  • A depressed mood

  • Body aches

  • Difficulty concentrating and a lack of comprehension

  • (In some individuals) Feelings of euphoria

 

Again, everyone experiences different premonitory, headache, and postdrome symptoms. It’s a good idea to keep a symptoms journal so that you can track what a typical migraine looks like for you.

 

In the future, when you sense any of the promonitory symptoms coming on, you’ll know a migraine may be on the way. This can give you time to use effective early treatment, which will ideally limit the intensity and duration of the approaching migraine. It’s also wise to ensure that you avoid your unique migraine triggers during this time (e.g. eating specific foods, exposing yourself to emotional stressors, etc.).

 

Keeping track of your headache and postdrome symptoms is smart as well. Understanding the comprehensive specifics of your personal migraine attacks will help you and your medical team find the best treatments possible.