The Four Phases of Migraine, Explained

January 26, 2024
October 7, 2022
The Four Phases of Migraine, Explained

Understanding the progression of your migraine attack may help you improve your headache management. Identifying early signs of a migraine episode may help with the decision to take abortive treatments sooner to prevent an attack from worsening.

There are four phases of a migraine episode.

The Prodrome Phase of Migraine

The prodrome phase, also known as the “preheadache” or premonitory phase, is the beginning of the migraine. It can last from hours to days, and does not necessarily need to be experienced with every episode.

Symptoms during this phase can vary for each individual. Mood changes can occur where depression, irritability, or lack of focus can be experienced. Some may even experience euphoric symptoms where it is difficult to sit in one place or sleep. In addition, other symptoms include fatigue, sensitivity to light and/or sound, nausea, changes in bowel movements, and muscle tension. Interestingly, some may even have unique features to this phase of excessive yawning, cravings of certain foods, and frequent urination.

Avoiding additional triggers and applying behavioral modifications during this phase can at times prevent the headache episode from manifesting further. Understanding these patterns and tracking these symptoms will help to determine what treatments may be helpful during the progression of your migraine episode.

Migraine Aura

The second phase is the aura where there is a sensory disturbance. Not everyone experiences this before every attack; about one-third of patients with migraine experience migraine aura. This can last from 5 to 60 minutes prior to the onset of headache pain.

The most common aura is visual, where flickering lights may be present or partial visual loss. Other examples of aura include a "pins and needles" sensation on the skin, speech difficulties, and dizziness.

Migraine Headache Attack

The next phase, also known as the headache stage, is the actual headache episode. Keep in mind not everyone who experiences migraine has a headache.

The attack portion of a migraine can range from a few hours to a few days. It usually is described as a throbbing or pulsating sensation and of moderate to severe pain. The headache is located to one side of the head or the entire head, and can move from one side to the other.

Increase in physical activity, exposure to lights, sounds, or smells may worsen the pain during this phase.

The Postdrome Phase of Migraine

The postdrome phase is the final phase, sometimes referred to as the “migraine hangover” -- after the headache has subsided and you begin to recover from the prior phases. This can last for a few days and can be associated with fatigue, body aches, confusion, changes in mood, and difficulty concentrating.

Not everyone may experience these symptoms after each headache episode, although postdrome symptoms occur for about 80% of individuals.

Keeping track of symptoms and triggers is essential in helping you and your care team to better understand your migraine headaches, identify patterns to help improve management, and determine an individualized treatment plan. Using a digital headache tracker can be especially helpful. That's why Neura members get access to a digital tracker that allows every attack to be automatically sent to their medical record and their medical team. If symptoms worsen, our team reaches out to check on you! 

Want to try Neura? Join today to schedule a video appointment with a board-certified neurologist specializing in headache and migraine.

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Jasmine Bhasin, PA-C
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area.
About the Author
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area. Prior to joining Neura Health, she worked in the Department of Neurology at UW (University of Wisconsin) Health where she specialized in migraine and headache disorders. Jasmine began her career in family practice and aesthetics where she adopted an interest in alternative medicine. She continues to focus patient care based on preventative medicine with a holistic approach, where treatment plans are incorporated with non-pharmacologic management such as lifestyle changes, alternative medicine, physical therapy, and supplements. She also performs botox injections, supraorbital nerve blocks, occipital nerve blocks, and trigger point injections. Jasmine completed her undergraduate degree in Human Development at UC San Diego. She went on to receive her Master of Science in Physician Assistant studies from Western University.

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