Migraine headaches cause intense, often pulsating pain that lasts anywhere from 4 to 72 hours and typically comes with nausea, light sensitivity, or both. But the headache itself is only one part of the picture. A migraine attack can move through up to four distinct phases, each with its own set of symptoms, and not everyone experiences the classic throbbing head pain at all.
The Headache Phase: Core Symptoms
The pain of a migraine is different from a tension headache or sinus pressure. It tends to be moderate to severe, pulsating or throbbing, and often concentrated on one side of the head. Physical activity makes it worse. Something as simple as walking up stairs or bending over can intensify the pain noticeably.
Nausea is almost universal, affecting more than 90% of people with migraine, and roughly 70% experience vomiting during at least some attacks. Sensitivity to light (photophobia) and sensitivity to sound (phonophobia) are so closely linked to migraine that they’re part of the formal diagnostic criteria. Many people retreat to a dark, quiet room during an attack because normal lighting and everyday noise become genuinely painful.
Not every attack checks every box. You might have bilateral pain one time and one-sided pain the next. Some attacks are dominated by nausea with only mild head pain. The pattern can shift from episode to episode, which is part of what makes migraine confusing to live with.
Early Warning Signs (Prodrome)
Hours or even days before the headache starts, your body may signal that an attack is coming. This early phase, called the prodrome, affects a significant number of people with migraine and can include:
- Fatigue and excessive yawning
- Difficulty concentrating or thinking clearly
- Neck stiffness or pain
- Mood changes like irritability or feeling unusually down
- Food cravings, especially for sweets like chocolate
- Increased sensitivity to light, sound, or smell
- Nausea, dizziness, or increased thirst
These symptoms are easy to dismiss as a bad night’s sleep or a stressful day. But once you recognize your personal pattern, prodrome symptoms become a useful early alert. Some people find that treating during this phase, before full pain sets in, makes the attack more manageable.
Aura Symptoms
About one in four people with migraine experience aura, a set of temporary neurological symptoms that typically develop over several minutes and last between 5 and 60 minutes. Aura usually appears before the headache, though it can overlap with the pain phase.
Visual aura is the most common type. You might see zigzag lines, flashing lights, shimmering spots, or a blind spot that gradually expands across your field of vision. These disturbances can make it difficult or impossible to read, drive, or focus on a screen. Sensory aura causes tingling or numbness, often starting in the fingers of one hand and slowly traveling up the arm to the face. Less commonly, aura can affect speech, making it hard to find words or causing slurred language.
Aura symptoms are temporary and fully reversible, but they can be alarming, especially the first time. If you’ve never experienced aura before and suddenly develop vision loss, numbness, or speech difficulty, it’s worth getting evaluated to rule out other causes.
The Migraine Hangover (Postdrome)
After the headache fades, most people don’t feel normal right away. The postdrome phase can linger for hours or even a full day afterward. Common symptoms include deep fatigue, body aches (particularly a stiff neck), difficulty concentrating, dizziness, and lingering nausea. Some people describe feeling “wrung out” or mentally foggy, as if recovering from an illness.
Mood shifts during postdrome are unpredictable. Some people feel unusually euphoric once the pain lifts, while others slide into a low mood. Light and sound sensitivity often persist at a lower level during this phase, so resting in a calm environment still helps. The postdrome is sometimes overlooked, but it’s a real part of the attack and can interfere with your ability to get back to work or daily routines.
Migraine Without Much Headache
Migraine isn’t always about head pain. Vestibular migraine primarily causes episodes of vertigo and dizziness that last anywhere from 5 minutes to 72 hours. You might feel a false sense of spinning, have trouble with balance after turning your head, or feel dizzy in visually busy environments like grocery stores or scrolling screens. Head pain may be mild or completely absent during these episodes.
In children, migraine can look entirely different from the adult version. Young children sometimes have cyclic vomiting syndrome, episodes of intense vomiting lasting hours or days with no clear cause, and normal test results. Abdominal migraine causes sudden belly pain that appears without warning and then disappears, again with no headache. These childhood syndromes are now recognized as migraine-related conditions that often evolve into more typical migraine with headache later in life. When children do get migraine headaches, the attacks tend to be shorter (as brief as 2 hours compared to the adult minimum of 4) and the pain is more likely to affect both sides of the head.
When Migraine Becomes Chronic
Episodic migraine can gradually increase in frequency over time. Chronic migraine is defined as headache occurring on 15 or more days per month for at least three months, with at least 8 of those days having migraine features. That’s a significant threshold. If you’re tracking your headaches and noticing they’re creeping past 10 or 12 days a month, that progression is worth paying attention to, because chronic migraine generally requires different treatment strategies than occasional attacks.
Symptoms That Need Urgent Attention
Most migraine attacks, even severe ones, follow a recognizable pattern for that person. Certain symptoms break that pattern and can signal something more dangerous than migraine:
- Thunderclap onset: pain that reaches maximum intensity within seconds, unlike the gradual buildup of typical migraine
- New neurological symptoms like double vision, loss of consciousness, confusion, or pulsating ringing in the ears
- First severe headache after age 50
- A clear change in your usual pattern, such as headaches that suddenly become more frequent, more severe, or feel fundamentally different
- Headache with fever, unexplained weight loss, or worsening with coughing or straining
Any of these warrant prompt medical evaluation. They don’t necessarily mean something serious is wrong, but they fall outside the expected range of migraine behavior and need to be checked.