What are the phases of migraines?

What may come as a surprise to many – is that migraine headache is not just comprised of a painful phase. In fact, migraine can have as many as four separate phases. The first phase, or prodrome, often begins a few hours before the painful phase but sometimes can start as early as days in advance. It is characterized by a variety of different symptoms that make a migraineur feel generally unwell including but not limited to fatigue, weakness, food cravings, mood swings and change in bowel/bladder patterns.

The second stage is the aura phase. Not every patient will go through all four stages, and many patients do not get an aura. By definition, an aura is a transient neurologic phenomenon lasting from five to 60 minutes. They are most commonly visual symptoms such as zigzag rainbows or bright blinking spots but can also be experienced as a numbness or tingling in an arm, face or leg, or difficulty speaking.

The third phase is the one which most people think of when they reference "migraine" and that is the painful phase. This stage can last anywhere from 4 to 72 hours. The pain is generally moderate to severe, on one side of the head, and characterized as a throbbing or pounding sensation. Very frequently, the pain is accompanied by nausea and a sensitivity to light and/or sound.

Finally, the Postdrome Phase. This immediately follows the painful period and is generally described as a feeling of exhaustion, light headedness, and a soreness of the head and neck. It can last for hours and sometimes as long as days. 

Each migraine sufferer is unique – including not only which of the four phases they may experience but also how long they are in each phase.

There are four phases in a migraine attack, all of which may be present during the attack: premonitory, aura, headache, and postdrome.

Premonitory: Some symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination. Aura: Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed. Headache: A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache. Postdrome (following the headache): Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

All migraines don’t have these phases; but classically migraines begin with a prodromal period which can occur up to a day before the attack.  Symptoms of this include feeling tired or depressed, but a great mood can also be a prodrome. Some have cold hands and feet or frequent urination. Food cravings, like for chocolate are common.

Then about 20% have an aura; usually something visual. Then headache begins, lasting 4-73 hours. Afterwards, many have a postdrome where the headache is gone and they feel “washed out” for another day or so.