Migraines are common, affecting nearly one in five women and about one in sixteen men in the U.S., according to the Mayo Clinic. But not every migraine looks or feels the same. Symptoms can change as a migraine progresses, and some may be more concerning than others. Knowing what to watch for can help you decide whether to keep tracking your headaches or talk with a doctor about what you’re experiencing.
Key Takeaways
- A migraine may have as many as four stages. It can start with prodrome symptoms, followed by an aura, the headache itself, and then postdrome, or the period after the headache has passed.
- You may not go through all four stages each time. In fact, one migraine can feel quite different from another, even for the same person.
- Migraine is a clinical diagnosis, meaning there’s no blood test or scan that confirms it; a neurologist diagnoses it based on your symptom pattern.
- A sudden, severe headache; a headache with fever or a stiff neck; or a new headache after age 50 are signs to seek care immediately.
- Keeping a record of when migraines happen, how long they last, and what seems to trigger them makes your neurology visit far more useful.
The Four Stages of a Migraine
A migraine capsule: A migraine doesn’t always follow the same course. There are four possible stages: prodrome, aura, the migraine attack, and postdrome. Some people experience only a few of these, and the symptoms may be different the next time a migraine occurs.
The prodrome phase can begin a day or two before the headache itself. At first, it may not be obvious that a migraine is coming. Someone might feel unusually tired, notice a change in mood, have food cravings, or find themselves yawning more than normal. Neck stiffness can also occur. For some people, an aura happens before or during a migraine. It usually comes on gradually and lasts less than an hour. Often, it affects vision, causing flashing lights, blind spots, or zigzag patterns. Other symptoms can include tingling or having trouble finding the words you want to say.
Then comes the migraine attack itself. The pain may throb or pulse and often affects one side of the head. Nausea, vomiting, and sensitivity to light, sounds, or smells can accompany it. Without treatment, an attack may last from four hours to three days. Even when the headache is gone, the migraine may not feel completely over. During the postdrome phase, some people feel tired, mentally foggy, or simply unlike themselves for another day.
What Triggers a Migraine?
Migraine triggers aren’t the same for everyone, so keeping track of your own symptoms can be more helpful than relying on a general list. The Mayo Clinic notes several things that may bring on a migraine, including stress, changes in sleep, skipped meals, bright lights, strong smells, strenuous exercise, and shifts in weather or barometric pressure. Hormonal changes, alcohol, especially wine, and too much caffeine may also play a role. Certain medications and food additives can also play a role.
None of this means a migraine is anyone’s fault, and identifying a trigger doesn’t always mean avoiding it will stop the attacks entirely. It does give your neurologist useful information for building a treatment plan, particularly if attacks cluster around a specific pattern, like the days before a menstrual period or after a poor night’s sleep.
When Migraine Symptoms Mean It’s Time to See a Neurologist
Most migraines, even frequent ones, are appropriate for a scheduled evaluation. If migraine attacks are new, occur more than a few times a month, or aren’t responding to over-the-counter treatment, that’s a reasonable time to book an appointment rather than continue managing them alone. A neurologist who focuses on headache disorders, like the specialists at Neurocare of Nevada, can confirm the diagnosis and build a plan that may include preventive medication, not just something to take once the pain starts.
Some symptoms warrant faster attention. See a doctor right away or go to the emergency room if you experience any of the following, since they can point to a more serious underlying condition:
- An abrupt, severe headache that peaks within seconds, sometimes called a “thunderclap” headache
- Headache with fever, a stiff neck, confusion, seizures, or numbness and weakness anywhere in the body
- Headache that starts after a head injury
- A chronic headache that worsens with coughing, straining, or sudden movement
- New headache pain that begins after age 50
If you’ve had migraines before and the pattern suddenly changes, or the headache feels different from your usual episodes, that’s also worth mentioning to your healthcare provider rather than assuming it’s the same thing you’ve dealt with before. For a closer look at how a neurologist approaches treatment once migraine is confirmed, see our related post on how a neurologist can help with severe migraines.
Frequently Asked Questions
How is migraine diagnosed if there’s no test for it?
Migraine is diagnosed clinically, based on your reported symptoms, their pattern, and your history, rather than a lab test or scan. A neurologist typically screens for headache, sensitivity to light, reduced function during attacks, and nausea to confirm the diagnosis.
What’s the difference between a migraine and a regular headache?
A regular tension headache tends to cause dull, steady pressure on both sides of the head without other symptoms. Migraine usually involves throbbing pain, often on one side, along with nausea, light and sound sensitivity, and sometimes visual or sensory aura beforehand.
Can migraine symptoms change over time?
Yes. Migraine frequency and severity often shift with age, hormonal changes, and lifestyle factors. Someone who had migraines with aura as a teenager may have them without aura later, or the frequency may increase or decrease over the years.
Is it normal to feel exhausted after a migraine ends?
Yes. This postdrome phase can leave you feeling drained, foggy, or unusually tired for up to a day after the head pain resolves. It’s a recognized part of the migraine cycle, not a separate problem, though it’s still worth mentioning to your neurologist if it’s disruptive.
Should I keep a migraine diary before my appointment?
It helps considerably. Tracking when migraines happen, how long they last, what symptoms accompany them, and anything that seemed to trigger the episode gives your neurologist real data to work with, rather than a general impression pieced together from memory.
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