The 4 Stages of a Migraine Attack

TL;DR: A migraine attack unfolds in up to four stages. The prodrome, or warning phase, comes hours to a day before the pain, with signs like yawning, cravings, mood changes, and neck stiffness. The aura, in about a quarter to a third of people, brings reversible visual or sensory changes lasting 5 to 60 minutes. The headache is the pain phase, often one-sided and throbbing, with nausea and light and sound sensitivity, lasting 4 to 72 hours. The postdrome, the migraine hangover, leaves you drained for a day or two. The most useful skill you can build is recognizing your own prodrome, because treating in that early window gives the best chance of cutting an attack short.

Migraine is not a single event but a process that plays out over hours to days, and knowing its stages turns a mysterious ordeal into something you can act on. The earlier in that process you treat, the better it tends to go, so the stages are worth learning by heart.

What are the four stages of a migraine?

Not everyone experiences every stage, and the stages can blur into one another, but the sequence tends to run: prodrome, then aura for those who get it, then the headache, then postdrome. Recognizing where you are in that arc is what lets you treat at the right moment rather than only once the pain has arrived.

Stage 1: The prodrome (the warning phase)

The prodrome is the earliest stage, and it can begin hours to a full day before any pain. It is your brain signaling that an attack is coming, often before you consciously connect the dots. Common signs include:

• Yawning that comes in repeated waves for no clear reason.
• Food cravings, often for something sweet or specific.
• Mood changes, from irritability or low mood to an unusual burst of energy.
• Neck stiffness or a tight, achy feeling in the neck and shoulders.
• Trouble concentrating, a foggy or fuzzy quality to your thinking.
• Increased thirst and frequent urination, or heightened sensitivity to light and sound.

This is the most valuable stage to know, because it is the best window to treat. Acting here, before the pain takes hold, gives the strongest chance of stopping the attack.

Stage 2: The aura

Aura affects roughly a quarter to a third of people with migraine, and it does not happen with every attack even in those who get it. It is a set of temporary, fully reversible neurological symptoms that usually build gradually over five minutes or more and last up to an hour before, or as, the headache begins.

The most common aura is visual: shimmering zigzag lines, blind spots, or flashing lights that drift across your vision. Others include tingling or numbness that spreads across a hand or face, trouble finding words, or, less often, weakness. Aura can be unsettling the first time, and any new aura, or one with weakness, deserves a medical evaluation to confirm what it is.

Stage 3: The headache

The headache is the stage most people mean when they say migraine. The pain is often one-sided, throbbing or pulsing, moderate to severe, and worsened by routine movement, which is why lying still in a dark, quiet room helps. It usually comes with at least one of nausea or vomiting, sensitivity to light, and sensitivity to sound.

Untreated, this phase lasts anywhere from 4 to 72 hours. It is the point of peak disability, when most people cannot work or function normally and when care is most often sought. Treating well before this stage, in the prodrome or early aura, is what can keep it from reaching full force.

Stage 4: The postdrome (the migraine hangover)

After the pain lifts, many people are not back to normal right away. The postdrome can last a day or two and feels like a hangover: fatigue, a drained or washed-out mood, difficulty concentrating, and a lingering brain fog. Some people instead feel briefly euphoric or unusually refreshed.

Gentle recovery helps here, hydration, rest, easy movement, and steady meals, rather than rushing straight back to full speed. Recognizing the postdrome as part of the attack, rather than a separate problem, takes some of the discouragement out of it.

Why does treating in the prodrome matter most?

Because a migraine is easier to stop before the pain machinery fully engages than after. Once the trigeminal pain system is sensitized and the headache is at full force, it is harder to turn around. Treatment started in the warning phase, whether an acute medication, a neuromodulation session, or a rescue plan you have worked out with your clinician, has the best odds of aborting the attack or blunting it.

Brain-imaging work supports this. The premonitory phase already shows changes in deep brain regions that regulate the attack, which means the biology is underway before you feel pain, and so is your window to intervene.

How do you learn your own prodrome?

The prodrome is personal, so the goal is to learn your particular pattern. A simple headache diary, on paper or in an app, that notes what you felt in the day before each attack will start to reveal your signals, whether that is yawning, a craving, a mood dip, or a stiff neck. Once you can name your warning signs, you can build an if-this-then-that plan: when the pattern appears, you act.

This is where a whole-person approach earns its keep, because the same diary also surfaces triggers and patterns that feed prevention, and it helps sort your attacks from other headache types.

Guidance from the Clinic

"The single change that helps my migraine patients most is learning their warning phase. When someone can tell me they yawn and crave chocolate the afternoon before an attack, we have a window, and a plan that starts there beats one that waits for the pain every time. Your body usually tells you it is coming; the skill is listening."

Scientific References

1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211.
2. Maniyar FH, et al. Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks. Brain. 2014;137(Pt 1):232-241.
3. Goadsby PJ, Holland PR, et al. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622.

Related at Fishtown Medicine

• Neuromodulation for Migraine - a drug-free way to treat early and prevent attacks
• Migraine vs. Tension vs. Cluster Headache - telling the types apart
• Drug-Free Migraine Prevention - lowering how often attacks come
• Migraine in Women - when attacks track the hormonal cycle