In fact, you can experience up to four stages during a migraine episode, each of which can be identified by its own set of symptoms. Understanding the range of symptoms can alert you to whether you’re experiencing a migraine and which stage you happen to be in at the moment.
This article explains the four stages of a migraine and their associated symptoms. The article also describes the symptoms typically associated with migraine subtypes, the potential complications migraines can trigger, and when to see a healthcare provider.
Frequent Symptoms
Migraine episodes include several stages: prodome, aura, headache, and postdrome. You may cycle through all of these stages when you have a migraine or you might experience one, two, or three of them. The headache phase is the most common, while the aura is the least common.
Prodrome
The prodrome stage is characterized by premonitory symptoms of an impending migraine. It can begin hours or days before a migraine episode reaches its peak intensity. Most people who experience a migraine feel some prodromal symptoms. Taking migraine medication during this stage may stop the episode from progressing. Typical symptoms during this stage are:
Constipation or diarrhea Difficulty concentrating Excessive yawning Fatigue Feeling cold Fluid retention, bloating Food cravings Increased frequency of urination Mood changes involving sadness, irritability, or anxiety Muscle stiffness or soreness, especially in the neck Nausea Sensitivity to light, sounds, or smells Vivid dreams
Aura
Approximately one-third of people who experience a migraine go through aura, which usually follows the prodrome stage and lasts for less than an hour. This stage is characterized by neurological symptoms, and it can be quite terrifying, especially when you experience it for the first time. The symptoms of migraine aura can include:
A temporary loss of hearing Auditory hallucinations (hearing things that are not there) Confusion Difficulty finding words and/or speaking Olfactory hallucinations (smelling odors that aren’t there) Partial paralysis Tingling, numbness, or hypersensitivity of the face or extremities Vertigo (a sense that the room is spinning) Visual changes like flashing lights, wavy lines, spots, partial loss of vision, blind spot, or blurry vision
Headache
The head pain of a migraine is often described as throbbing, pounding, or pulsating. You may also experience other symptoms along with the head pain. This phase usually lasts from four to 72 hours. Common characteristics of the headache stage may include:
Dehydration or fluid retention Diarrhea or constipation Dizziness Hemicranial pain (on one side of the head) pain that can shift to the other side or become bilateral Hot flashes or chills Nasal congestion and/or a runny nose Nausea and vomiting Phonophobia (sensitivity to sound) Photophobia (sensitivity to light) Sadness or anxiety
Postdrome
After the most intense phase of a migraine, you may experience the postdrome stage before your migraine attack is completely over. The symptoms of this stage include:
Concentration problemsDizziness or lightheadednessFatigueMood changes, which can include sadness, anxiety, or an elevated moodMuscle achesScalp tendernessStiff neck
Many people describe feeling “like a zombie” or as if they were hungover during this stage. Postdromal symptoms can be associated with abnormal cerebral blood flow and brain activity for up to 24 hours after the end of the headache stage. Even if you do not experience the headache stage, you may still experience a postdrome phase.
Childhood Migraines
Children also experience migraines, and the symptoms can differ from those of adults. If you see the following symptoms in your child, migraines may be the cause, especially if your child has a family history of the condition:
Dizziness Excessive sleepiness Mood swings Motion sickness Nausea Stomachache
Be sure to discuss these symptoms with your healthcare provider. They could be signs of another medical condition. But if migraines are the cause, your child can take medication to help prevent and treat episodes.
Uncommon Symptoms
Rare symptoms are typically associated with migraine subtypes. Though similar to migraine aura, the main difference is that these uncommon symptoms are often the most prominent aspect of a migraine episode:
Weakness, typically in one arm, occurs with hemiplegic migraine. If you have hemiplegic migraines, you may also experience several migraine stages and other aura symptoms. There is a strong hereditary tendency to develop this type of migraine. Stomachaches are a sign of abdominal migraine. More common in children than adults, these stomachaches often occur without a gastrointestinal cause and may involve nausea and vomiting. Eye issues such as double vision, blurred vision, a droopy eyelid, or an obvious inability to move one eye can be a sign of ophthalmoplegic migraine.
Complications/ Sub-Group Indications
Migraines do not typically cause complications, though they can. The most common complications are related to medication use.
Medication Effects
Side effects of overuse can include stomach pain and gastrointestinal bleeding from taking high doses of nonsteroidal anti-inflammatories (NSAIDs). Other medications, including triptans and ergot medications, can cause side effects such as dizziness, tingling, or even vascular complications when taken at higher doses than directed.
Keep in mind that all medications—whether over-the-counter or prescription— can cause side effects even at recommended doses. Rebound headaches (those that occur every day or almost every day) or medication withdrawal headaches can occur when you take migraine medications at high doses or for a prolonged time and then abruptly stop.
Migraine Complications
Complications from a migraine itself include some serious issues that require medical attention:
Status migrainosus: If your migraine lasts longer than 72 hours despite treatment, it’s called status migrainosus. This condition is unlikely to resolve with your regular prescription. Seek medical attention because you may need treatment with intravenous (IV) medication.
Migrainous infarction: An infarction in the brain is a type of stroke caused by lack of blood flow. A migrainous infarction begins with migraine symptoms that can eventually involve stroke symptoms and may produce permanent neurological effects.
Seizure: A convulsive episode that may be characterized by involuntary shaking or jerking may occur as a result of a migraine. The physiological reason for this complication is not well understood.
When to See a Healthcare Provider/Go to the Hospital
Migraines do not normally require emergency medical attention. Nevertheless, when you feel unsure about symptoms, or when your migraine pattern changes, you should seek medical attention.
Urgent Medical Care
Symptoms such as paralysis, loss of sensation, difficulty communicating, loss of vision, and double vision can all be manifestations of a stroke, MS, meningitis, seizures, and other neurological illnesses. If you experience any of these rare symptoms, and they have not been attributed to migraines (or if you’re unsure of their connection), then you should seek prompt medical attention.
Even if you have a diagnosis of migraine, you should have a medical evaluation if one occurs with:
Falling/inability to maintain your balance Head traumaRecurrent vomiting/an inability to keep anything downThe feeling that you’re fighting the worst headache of your life
Summary
A migraine includes four stages, though you may not go through every one of them during your own migraine episodes. The stages include prodome, aura, headache, and postdrome. The headache phase is the most common while aura is the least common. The variant nature of the symptoms makes a bit easier to tell one stage from one another. If you’re new to migraines, it might help to keep a list of the symptoms with you. To give you an idea of the disparity, prodome symptoms often include constipation or diarrhea, fatigue, nausea, and sensitivity to light. The aura stage is often marked by confusion, hallucinations (both auditory and olfactory), tingling or numbness, or vertigo. In the headache stage, you may encounter hot flashes or chills and sensitivity to light or sound. The postdrome stage may trigger dizziness, muscle aches, or a stiff neck.
A Word From Verywell
The intense pain of a migraine may prompt you to take steps you’ve never taken before, like taking supplements or hearing out the advice of a chiropractor, osteopath, or pain management specialist. (Ask your primary healthcare provider for a recommendation, if you’re interested.) In the meantime, it’s worth trying a relaxation technique at the first sign of a migraine: Go to a quiet room, turn off the light, and lie down on your back. Place a heating pad on your head or neck—a tactic known as “temperature therapy.” When you get up, drink a small amount (half a glass) of a caffeinated beverage. All by itself, caffeine has been known to relieve an emerging migraine.
