A migraine is far more than a bad headache. It’s a neurological event that unfolds in stages, producing a wide range of symptoms that can include throbbing head pain, nausea, light sensitivity, visual disturbances, and deep fatigue. An untreated migraine attack typically lasts 4 to 72 hours, but the full experience, from the earliest warning signs to the recovery period, can stretch over several days.
Early Warning Signs: The Prodrome
Many people experience subtle changes one to two days before the head pain begins. These early signals are easy to miss or chalk up to a rough day, but recognizing them can give you a window to act before the pain hits. Prodrome symptoms include:
- Mood shifts ranging from irritability and depression to unexpected euphoria
- Food cravings, particularly for sweets or carbohydrates
- Neck stiffness
- Increased thirst and urination
- Frequent yawning, even when you’re not tired
- Constipation
These symptoms are driven by changes in the brain’s signaling chemistry that precede the pain phase. If you notice a pattern of yawning and neck stiffness consistently appearing a day before your attacks, that’s your prodrome, and it’s one of the most useful patterns to track.
Aura Symptoms
About 15% of people with migraines experience aura, a set of temporary neurological disturbances that typically develop gradually over several minutes and last anywhere from 20 minutes to one hour. Aura usually appears before the headache, though it sometimes overlaps with the pain phase.
Visual aura is the most common type. You might see zigzag lines, flickering lights, bright spots, or expanding blind spots in your field of vision. Some people describe tunnel vision, blurred vision, or a shimmering “visual snow.” Less commonly, objects may appear larger or smaller than they actually are.
Aura can also affect other senses and functions. Pins-and-needles sensations may travel up one arm or across one side of the face. Some people experience temporary numbness, weakness on one side of the body, or difficulty finding words and speaking clearly. In rare cases, people report hearing phantom sounds or music. Each of these symptoms builds slowly rather than striking all at once, which is one way doctors distinguish aura from more serious neurological emergencies like stroke.
The Headache Phase
The attack phase is what most people picture when they think of a migraine. The pain is moderate to severe in intensity, often pulsating or throbbing, and it tends to worsen with routine physical activity like walking or climbing stairs. It commonly affects one side of the head, though it can involve both sides, especially in children and adolescents.
The pain builds in intensity over the first few hours and, without treatment, can persist for up to three days. Routine movement, bending over, or even turning your head can make it significantly worse. Many people find themselves retreating to a dark, quiet room because the pain makes normal activity impossible.
Nausea and Sensory Sensitivity
The headache rarely arrives alone. In studies of migraine patients, roughly 78% experience nausea during an attack, and about 41% vomit. These stomach symptoms can be severe enough to prevent you from keeping down food, water, or oral medication, which is one reason migraines are so difficult to treat once they’re fully underway.
Sensitivity to light affects around 70 to 74% of people during an attack. Sensitivity to sound is even more common, reported by roughly 80 to 86% of patients. Some people also develop heightened sensitivity to smells and touch. A normally tolerable perfume can become nauseating, and the weight of a blanket on your skin may feel uncomfortable. These sensory symptoms often linger even after the worst of the head pain has started to fade.
What Causes These Symptoms
Migraines involve activation of the trigeminal nerve, the major pain-signaling pathway for the head and face. When this nerve is activated, it releases a protein that triggers a cascade of events in the brain: blood vessels in the protective lining around the brain become inflamed and sensitized, and pain signals amplify. This sensitization process explains why even mild stimuli, like light or gentle touch, become painful during an attack. It also explains why the pain tends to escalate: the longer the nerve stays activated, the more sensitized the entire pain pathway becomes. Newer migraine treatments work by blocking this protein’s activity in the trigeminal system, which can stop or prevent attacks.
The Recovery Phase
After the headache fades, many people enter a postdrome, sometimes called a “migraine hangover,” that lasts up to a day. About 52% of migraine sufferers report significant fatigue during this phase. Roughly 35% have difficulty concentrating, and 29% experience lingering mood changes. You might feel drained, foggy, or “washed out” for hours after the pain resolves. Some people describe feeling oddly euphoric. Sudden head movements can briefly trigger the pain again, so the recovery period calls for taking things slowly.
How Migraines Differ in Children
Children and teenagers experience migraines differently than adults. Their attacks are often shorter, and the pain is more likely to affect both sides of the head rather than just one. Kids may not be able to describe the throbbing quality of the pain, so they might simply say their head hurts “a lot.” Nausea, vomiting, and sensitivity to light are common in younger patients, and some children experience abdominal symptoms (stomach pain, nausea) more prominently than head pain, which can make the diagnosis easy to miss.
Symptoms That Signal Something More Serious
Most migraines, while debilitating, are not dangerous. But certain headache symptoms can point to a more serious underlying condition and should be evaluated urgently:
- Sudden, explosive onset. A headache that reaches maximum intensity within seconds, sometimes called a thunderclap headache, can signal a vascular emergency like a brain aneurysm.
- New neurological symptoms such as weakness, numbness, or vision changes that are different from your usual aura pattern.
- Fever, night sweats, or signs of infection accompanying the headache.
- First severe headache after age 50, which is more likely to have a secondary cause.
- Headaches that are clearly getting worse over weeks in either severity or frequency.
- Headaches that change with body position or worsen with coughing and straining, which can indicate pressure problems inside the skull.
- New headache during or shortly after pregnancy, which warrants evaluation for vascular or hormonal complications.
If your headaches fit a consistent migraine pattern you’ve had for years, these red flags are less likely to apply. They matter most when something about your headache is genuinely new or different from what you’ve experienced before.