Migraine Phases

For people with migraine disease, understanding as much as possible about migraine is essential. That knowledge lets us work with our doctors as treatment partners, and it helps give us the foundation we need to make treatment decisions when we have a migraine attack.

A migraine attack can have up to four phases, and each of them has many potential symptoms. Not everyone experiences all four phases or all of the symptoms, and one attack can vary from the next. Some symptoms can occur during more than one phase. Let’s take a look at the four possible phases and some of the potential symptoms of those migraine phases.

Migraine phase 1: Prodrome

The prodrome is the first potential phase of a migraine attack, and it can begin hours or days before other phases. It’s sometimes called “preheadache” or “premonitory phase.” Between 30% and 40% of people living with migraine experience the prodrome, and for those living with migraine, it can be very helpful because it can serve as a yellow light of sorts, a warning that an attack is coming. Once you know what some of the prodrome symptoms are, you may find that you experience it, but never realized it.

Possible prodrome symptoms include:


Phase 2: Aura

Even though it’s experienced by only about 25% of people living with migraine, the migraine aura may be the most often discussed phases of the migraine attack. The possible visual symptoms are the best known, but there are many possible symptoms, visual and others. Migraine aura can also serve as a warning and, in some cases, allow people living with migraine to treat the migraine early enough to stop it before it progresses to the headache phase.

The possible symptoms of migraine aura include:

  • Alice in Wonderland Syndrome: a rare form of migraine aura in which the distinctive symptom is a type of metamorphosia, a distortion of body image and perspective, which people living with migraine know, while it’s occurring is not real. “Alice in Wonderland” syndrome can occur at any age, but it is more commonly experienced by children.
  • allodynia: hypersensitivity to feel and touch to the point that what would be “normal” is painful
  • aphasia
  • auditory hallucinations: hearing sounds that aren’t actually present
  • confusion
  • decrease in or loss of hearing
  • dizziness
  • hemiplegia: one-sided paralysis (occurs in hemiplegic migraine only)
  • olfactory hallucinations: smelling odors that aren’t actually present
  • one-sided motor weakness (occurs in hemiplegic migraine only)
  • parasthesia: prickling, stinging, burning, numbness, and/or tingling, usually of the extremities or face
  • vertigo: sensation of whirling or spinning, not to be confused with dizziness
  • visua symptoms can include:
    • wavy lines (sometimes described as “looking like heat rising from pavement”)
    • “blank” or tiny blind spots
    • blurry vision
    • partial loss of sight
    • phosphenes: brief flashes of light that streak across the visual field
    • scotoma: an area of decreased or lost vision. Some people describe scotoma as being like having tiny blank spots in their vision. Some compare it to tiny snowflakes.
    • unilateral (one-sided) (occurs in retinal migraine only)

Phase 3: Headache

The symptoms of the headache phase are frequently, but not always, the most debilitating of a migraine attack. It’s important to note that symptoms are not limited to the head; they may affect other parts of the body as well. The pain in this phase can range from mild to severe, which can lead people with mild pain to not recognize that they’re having a migraine. A migraine attack can occur without the headache phase. When that occurs, the descriptive terms “acephalgic” or “silent” are applied (i.e. acephalgic migraine without aura, acephalgic migraine with aura, acephalgic basilar-type migraine, etc.).

Symptoms and characteristics of the headache phase may include:

  • headache
  • frequently unilateral (one-sided). The head pain can shift from one side to the other, become bilateral (on both sides), or be bilateral entirely
  • often pulsating or throbbing
  • worsened by physical activity
  • duration of four to 72 hours in adults, one to 72 hours in children
  • Because the trigeminal nerve becomes inflamed during a migraine, and because of its location, pain may occur around eyes, in the sinus area, and the teeth and jaw.
  • confusion
  • dehydration
  • dizziness
  • depression, anxiety, panic
  • diarrhea or constipation
  • fluid retention
  • hot flashes and / or chills
  • nasal congestion and / or runny nose
  • nausea and / or vomiting
  • neck pain
  • osmophobia (heightened sensitivity to odors)
  • phonophobia (heightened sensitivity to sound)
  • photophobia (heightened sensitivity to light)
  • vertigo

Phase 4: Postdrome

Many people mention feeling “hung-over” after a migraine. This is often actually part of the migraine, the postdrome. Most people living with migraine have some symptoms after the headache phase, symptoms that may last hours or even a couple of days.

Postdrome symptoms may include:

Putting it all together

As you can see, migraine attacks can be quite complex with many varied symptoms. Here are some points to remember:

The symptoms of a migraine can also be symptoms of other health issues including TIA, stroke, and aneurysm. If our migraine patterns change, if we experience new or disturbing symptoms, or if we’re having the worst migraine we’ve ever had, it’s important to check in with our doctors to be sure that all the symptoms are migraine and not another condition or even that needs attention.

Written by: Teri Robert | Last reviewed: August 2014.
View References