Overview of the Four Phases of a Migraine Attack

What symptoms are associated with each migraine phase?

Woman having headache
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If you learn to recognize the phases of a migraine you may be able to treat the symptoms early on, limiting the duration of these painful and disruptive episodes. Early treatment may involve taking migraine medication immediately, drinking a caffeinated drink, taking a shower, or resting, and may arrest the progression of a headache to a full-blown migraine.

The Four Phases of a Migraine

A classic migraine has 4 distinct phases: the mood swings and food cravings of the prodrome, the visual distortions of the aura, the pain and nausea of the headache, and the fatigue of the postdrome.

You may not experience every phase each time you have a migraine. In fact, each migraine episode can be different. Research has shown that individuals who recognize the first phase of a migraine were able to predict the onset of a migraine as much as 72 to 93 percent of the time. By recognizing the pattern, the body follows prior to the onset of a migraine, individuals may be able to prevent or avoid them completely.

Phase One: Prodrome

Approximately 30 to 40 percent of people with migraines experience the prodrome phase. Symptoms tend to occur 24 to 48 hours before the actual onset of headache pain. Prodrome symptoms can include:

  • Fatigue
  • Frequent yawning
  • Fluid retention
  • Increased urination
  • Muscle stiffness, especially in the neck, back, and face
  • Constipation or diarrhea
  • Food cravings
  • Depression or irritability
  • Difficulty concentrating
  • Feeling cold

Phase Two: Aura

Approximately 15 to 20 percent of people with migraines experience an aura, or visual distortions, preceding the headache.

You may only experience the aura phase, which is a phenomenon called a "silent migraine." The aura phase usually begins minutes or hours before the onset of headache pain. Visual symptoms during aura can include:

  • Blurred vision
  • Appearance of floaters (tiny specks that float before the eyes)
  • Flashes of light or color, or blurry vision
  • A blind spot or even complete blindness in one eye

Additional symptoms of the aura phase can include:

  • Numbness or tingling of the hands, feet, and/or face (particularly around the mouth)
  • Stiff neck
  • Weakness
  • Vertigo or Dizziness
  • Loss of balance
  • Ringing in the ears
  • Double vision
  • Difficulty talking
  • Slow thinking or confusion
  • Problems with concentration
  • Changes in mood and activity level

Because some of these symptoms can also occur with other conditions, such as a detached retina or stroke, individuals suffering any of these symptoms for the first time should check with their healthcare provider to ensure that their symptoms are the result of a migraine episode and not something more serious or life-threatening.

Phase Three: Headache

This is the phase most commonly associated with migraines. The headache of a migraine is a one-sided, throbbing or pounding pain. It causes between 4 to 72 hours of moderate to severe pain—headaches that last longer than 72 hours are called "status migrainosus," and require immediate medical attention.

The headache is the most disruptive of the phases. To avoid increasing the severity of headache, peoplewho have reached this phase usually stop all activity and lie down in a quiet, darkened room, avoiding all stimulation. In addition to the pulsing head pain, the headache is normally associated with a number of other unsavory symptoms, including:

  • Extreme sensitivity to light (photophobia), sound (phonophobia) and smell
  • Nausea
  • Vomiting
  • Increased pain with physical activity (such as walking or going up or down stairs)

Phase Four: Postdrome

Approximately 68 percent of people with migraines continue to notice a number of symptoms even after their headache subsides. These remaining symptoms may continue for several hours or even days, although the average duration is about a day. Symptoms of the postdrome phase can include:

  • Fatigue
  • Weakness
  • Irritability
  • Anxiety
  • Depression
  • Difficulty concentrating
  • Scalp tenderness

A Word from Verywell

You may keep a journal to record symptoms you experience during a migraine—researchers have show that it may be beneficial in helping you better understand your migraines. Tracking the specific details and timing of your migraine symptoms may allow you to predict the onset of a migraine. By becoming familiar with the way your body reacts to an oncoming migraine, you may be able to prevent the actual onset of an attack.

Sources:

Cutrer, MF, Moskowitz MA. Headaches and Other Head Pain. Cecil Textbook of Internal Medicine. 23rd ed. 2008.

Freedom, T, WM Jay. Migraine With and Without Headache. Semin Ophthalmol. 18. 4 Dec. 2003 210-217.

Gladstein, J. Headache. Medical Clinics of North America. 90.2. 28 Jan. 2006 275-290.

Headache Classification Subcommittee of the International Headache Society, "The International Classification of Headache Disorders." Cephalalgia. 2003. International Headache Society. 20 Mar. 2008.

Lim, C. Headache, Migraine. Ferri's Clinical Advisor. First edition. 2008.

McConaghy, JR.. Headache in Primary Care. Primary Care: Clinics in Office Practice. 34.1. Mar. 2007 83-97.

Pryse-Phillips, William and T. Jock Murray. "Headache." Textbook of Primary Care Medicine. 3rd ed. 2001.

Silberstein, Stephen D. and William B. Young. "Headache and Facial Pain." Textbook of Clinical Neurology. 3rd ed. 2007.

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