What Are the 4 Stages of Migraine and How They Affect You?

Stage 1: The Prodrome – The Subtle Warning

The prodrome is the first of the 4 migraine stages and serves as the brain’s early warning system.

Occurring anywhere from a few hours to a couple of days before the actual pain begins, this phase affects most migraine sufferers, though the symptoms can be vague and easily dismissed.

Think of the prodrome as when your central nervous system sends signals that a significant event is imminent. The symptoms are often non-specific but critical for early recognition. Common signs include:

Mood changes: Feeling unusually depressed, irritable, or, conversely, euphoric.

Neck stiffness: Tension or pain originating in the neck and shoulder muscles.

Frequent yawning: Yawning much more often than usual, usually accompanied by fatigue.

Food cravings: An intense desire for specific foods, particularly sweet or carbohydrate-rich items.

Increased urination or constipation: Changes in bowel or bladder habits.

This phase is neurologically crucial because it is your window for intervention. Recognising these symptoms allows you to initiate preventative or abortive treatment before the pain phase locks in, giving you the best chance of minimising the attack’s overall impact.

Unfortunately, because the pain hasn’t started, many patients overlook this stage, missing a crucial opportunity for early relief.

Stage 2: The Aura – Visual and Sensory Shifts

The second stage of migraine, the aura, is the most dramatic and, thankfully, only experienced by about 20 to 30 % of migraine sufferers. The aura consists of focal, temporary neurological symptoms that develop gradually and usually last between five minutes and an hour.

They are a direct result of a wave of electrical activity (cortical spreading depression) moving across the visual cortex. The most common form is a visual aura, which can manifest as:

• Scintillating scotomas: Flickering blind spots that expand or change shape, often appearing as shimmering zigzag lines, coloured lights, or stars.

• Vision loss: Temporary partial or complete loss of vision.

Beyond vision, auras can also involve other senses, leading to:

• Sensory changes: Feelings of tingling, numbness, or “pins and needles” (paresthesia) typically start in one hand and spread up the arm and sometimes across one side of the face.

• Speech and language disturbances: Difficulty finding words or slurred speech (dysphasia).

Understanding that the aura is a reversible, transient event is essential. It is a clear sign that the migraine process is underway and that the primary headache is about to follow.

Stage 3: The Attack (headache phase) – The Main Event

This is the core of the migraine experience and the stage most commonly associated with the term. The headache phase is typically characterised by moderate to severe, pulsating, or throbbing pain.

While the pain can be bilateral (on both sides), it is often unilateral, focusing on one side of the head, brow, or temple. During this stage, the pain intensity makes it difficult or impossible to perform routine activities.

Inflammation and releasing pain-inducing neurotransmitters cause increased sensitivity across the body’s sensory systems. This leads to the hallmark associated symptoms:

Nausea and vomiting: Affecting nearly 80 % of sufferers, this is a central feature of the attack phase.

Photophobia (Light sensitivity): Finding even standard indoor lighting painful or unbearable.

Phonophobia (Sound sensitivity): Ordinary noises become irritating or painful.

Osmophobia (Smell sensitivity): Strong odours can trigger or intensify the pain.

The attack phase can last anywhere from 4 to 72 hours. This is when acute migraine medications (such as triptans) are most necessary to interrupt the pain cycle. Understanding your triggers and the earliest signs of the prodrome is key, because treatment is most effective at the beginning of this phase.

Stage 4: The Postdrome – The Migraine Hangover

Once the excruciating pain subsides, the final 4 stage of migraine, the postdrome begin. Often referred to as a “migraine hangover,” this phase can be just as debilitating as the attack itself, lasting for up to two days.

Though the throbbing pain is gone, the brain is still recovering from the intense neurological event it just endured. Symptoms of the postdrome include:

Profound fatigue: Feeling drained and having a severe lack of energy.

Cognitive fog: Difficulty concentrating, thinking clearly, or focusing (“brain fog”).

Muscle aches: Stiffness, especially in the neck and shoulders.

Mood changes: Some people feel elated, while others feel sluggish or depressed.

This final stage is a crucial reminder that migraine is a systemic neurological illness.

The brain needs time to reset and restore its chemical balance after the storm of the attack. Rest, hydration, and avoiding potential triggers are essential during the postdrome to ensure a complete recovery.