From prodrome to postdrome: the stages of migraine

From prodrome to postdrome can last days: migraine is so much more than just the headache phase.

The postdrome stage of migraine can take days to shake

What happens during a migraine attack?

Even if you don’t have an aura before the headache, you may have noticed other feelings that make you aware an attack is starting. A migraine attack can actually be divided into four distinct stages, although you may not have all four phases. There are two stages that may be present before the headache begins.

Stage 1: prodromal phase

Before the actual attack starts, you may sometimes notice that you feel very tired and yawn a lot more. Although before other attacks you may have had the opposite feelings, with lots of energy and a sense you can get all your work done in half the normal time. Some people find that they recognise the start of a migraine attack when they approach the housework with great enthusiasm!

You may also find you crave certain foods – often sweet.

These sorts of feelings are noticed by about two thirds of sufferers but you might only recognise them when after the attack. Relatives and friends may be more aware of these subtle changes in mood or behaviour than you are.

These symptoms usually start several hours or even a day before the attack.

Stage 2: aura

As mentioned above, an aura before an attack is experienced by about 20 to 25 per cent of migraine sufferers and can last from a few minutes to up to an hour.

There may or may not be a gap between the end of the aura and the start of the headache phase.

Stage 3: headache

The headache may stay in one place or shift to affect different parts of the head, even swapping sides.

The most common accompanying symptoms are nausea and a dislike of light and/or sound.

Some people become more sensitive to certain smells, and strong smells may even trigger an attack. Most people are off their food, but some are extra hungry in spite of the nausea.

Stage 4: recovery

After the headache has gone, feelings of lethargy and generally being ‘washed-out’ remain. It can take a couple of days to get over this.

Some people are luckier and find they have extra energy immediately after an attack, which may have something to do with the feeling of relief!

Find out more about the stages of migraine, from prodrome to postdrome, with our How to Live With Migraine factsheet.