Chapter 3, Episode 2: Phases of a Migraine Attack


This content has been medically reviewed by Dr. Simy Parikh.

Migraine attacks occur in phases. The phases include: prodrome, aura, acute, resolution, postdrome and interictal. While the phases usually happen in sequence, they can overlap. A person may experience all phases or only a few phases, and they can vary with each attack. 

The first phase, called the prodrome or premonitory phase, begins anywhere from a few hours to three days before the onset of the headache phase. Common symptoms include irritability, depression, fatigue, mood changes, food cravings, frequent urination, thirst, increased sensitivity to light or sound, brain fog, yawning and more. Being aware of prodromal symptoms can help some people be prepared for the phases that may follow. 

About a third of people with migraine experience the next phase known as an aura. 

During an aura, people may have visual disturbances, such as flashing lights, blank spots or zig-zag lines. They may have difficulty with thinking or speech, smell phantom odors, feel numbness, tingling or weakness, or temporarily lose their balance. Aura symptoms completely resolve, typically within 60 minutes of starting.  

Next is the headache or “acute” phase. The most well-known and common symptom is moderate to severe head pain that may have a throbbing quality. It commonly occurs on one side of the head but can occur on both sides. Symptoms associated with the headache phase include sensitivity to light and sound as well as nausea, and/or vomiting. The headache phase typically lasts from four to seventy-two hours.

Some groups are beginning to recognize a phase known as resolution which occurs when the headache phase comes to an end. Not all people notice a distinct resolution phase but it is more prevalent after sleep. 

The next phase of a migraine attack is called the postdrome which many people call “the hangover”. After the worst pain of the migraine attack ends, patients often experience nagging symptoms such as fatigue, brain fog, continued sensitivity to light and sound, nausea, a stiff or sore neck, muscle weakness and/or mood changes. They may also have low-level head pain. The postdrome phase usually resolves within twenty-four hours. 

Lastly, the interictal period is the time in between migraine attacks, when a person is not experiencing any migrainous symptoms. People who have less frequent migraine attacks have longer interictal periods. However, people who have frequent attacks may not have a clear interictal state and the postdrome and prodrome phases may overlap. Protective factors, such as a balanced diet, regular exercise, consistent meal and sleep schedules, and migraine preventive medications can increase a person’s time in the interictal state. 

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This video is sponsored in part by Amgen, Biohaven, Impel Pharmaceuticals and Collegium Pharmaceuticals.



*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.