What Are the Symptoms of a Migraine Attack?
Migraine is a complex neurological disorder, not simply a bad headache. The ICHD-3 criteria define a typical attack as throbbing, one-sided head pain lasting four to 72 hours, worsening with movement, plus nausea or light and sound sensitivity. But migraine can affect vision, balance, digestion, mood, and cognition across all four phases of an attack.
The Four Phases of a Migraine Attack
Phase 1: Prodrome (Early Warning Stage)
The prodrome begins hours to three days before head pain arrives and acts as an early warning system. Recognizing these signals can allow you to take acute medication sooner and reduce attack severity.
Common prodrome symptoms:
- Excessive yawning
- Fatigue and low energy
- Neck pain or stiffness
- Mood changes. irritability, low mood, or unusual elation
- Brain fog and difficulty concentrating
- Food cravings, particularly for sweet foods
- Increased thirst and frequent urination
- Nausea and sleep disturbances
- Increased sensitivity to light or sound
Phase 2: Aura
About one-third of individuals with migraine experience aura, reversible neurological symptoms caused by cortical spreading depression, a slow wave of abnormal electrical activity across the brain. The symptoms can last for 5 - 60 minutes, generally before the headache but sometimes during or after it as well.
Types of aura include:
Visual aura (most common): flashing lights, zigzag lines (fortification spectra), blind spots, colored spots.
Sensory aura: numbness or tingling spreading from hand to face; phantom smells.
Speech aura: difficulty finding words (aphasia), slurred speech.
Motor aura (hemiplegic migraine only): temporary weakness or paralysis on one side.
Brainstem aura: dizziness, tinnitus, hearing loss, double vision, altered consciousness.
Silent migraine (aura without headache) , all aura symptoms occur, but no head pain follows.
Phase 3: Headache (Acute Phase)
The headache phase lasts four to 72 hours without treatment. Symptoms of the head and face include throbbing or pulsing pain (usually on one side), pressure around the eyes and sinuses, and pain in the jaw, ear, and neck.
Sensory sensitivities are prevalent and can be disabling.
- Photophobia is sensitivity to light, even screens.
- Phonophobia: sensitivity to sound.
- Osmophobia is sensitivity to scents.
- Allodynia is pain from normally non-painful touch, such as hair brushing or wind on skin
Other symptoms include nausea, vomiting, motion sickness, nasal congestion, ear pressure, and tinnitus.
Phase 4: Postdrome (Recovery Stage)
After head pain fades, most people enter a recovery phase lasting 24 to 48 hours, often described as a migraine hangover. Common postdrome symptoms include exhaustion, muscle weakness, brain fog, residual dull headache, continued light and sound sensitivity, and mood shifts. Returning to normal activity too quickly can sometimes trigger another attack.
Migraine Symptoms That Are Often Missed
Migraines’ wide symptom range frequently leads to misdiagnosis. Neck pain is often blamed on tension rather than recognized as a prodrome symptom. Nasal congestion during attacks causes many people to self-diagnose “sinus headache”, a term that research suggests applies to very few true sinus conditions; most are migraine. Unexplained tooth pain, ear pressure, or jaw discomfort during attacks is also common and delays diagnosis.
Red Flag Symptoms That Require Urgent Medical Attention
Migraine is a headache disorder that has no serious causes. However, some headache symptoms can indicate dangerous diseases such as a stroke, aneurysm, or meningitis. Seek emergency assistance if you experience any of the following:
- Thunderclap headache, maximum intensity within one minute (medical emergency)
- Headache with fever, neck stiffness, or rash
- New or sudden vision loss
- Weakness, numbness, or slurred speech not matching a typical aura pattern
- Headache after a head injury
- Headache worsening with coughing, straining, or exercise
- Positional headache (worsens when standing up or lying down)
- New headaches in adults over 65 or children under five
- Headache in someone with cancer, HIV, or immune suppression
- Any abrupt change in your usual headache pattern
Conclusion
The first step to managing migraine is to realize that migraine is a neurological event involving the entire body, not just the head. Identifying individual symptoms during all four phases of a migraine, such as the yawning of the prodrome phase and the "hangover" of the postdrome phase, can help you predict when you will experience a migraine and advocate for more effective treatment. While all symptoms of migraine are manageable parts of the disease, you should always be on the lookout for "red flag" symptoms that need immediate medical care.
