What Are the Four Stages of a Migraine?

Reviewed on 1/25/2022
Woman with migraine headache pinching top of her nose
The four main stages of a migraine include prodrome (warning signs), aura (visual disturbances), headache, and headache termination.

A migraine headache is a neurological disorder that causes severe head pain along with other symptoms such as sensitivity to light, sound, or smells.

There are four main stages of a migraine

  1. Prodrome: warning signs before a migraine
    • Subtle changes in sensations such as an unusual taste or smell
    • Fatigue
    • Muscle tension 
    • Mood changes
  2. Aura: visual disturbances that come before the headache phase
    • Geometric patterns or flashing, colorful lights
    • Blind spots (scotomas)
    • Loss of vision on one side (hemianopsia)
  3. Headache
    • May last 4-72 hours
    • Usually occurs on one side of the head, but may occur on both sides
    • Throbbing pain 
    • Nausea
    • Vomiting
    • Sensitivity to light (photophobia) 
    • Sensitivity to sound (phonophobia)
  4. Headache termination
    • Pain usually goes away with sleep, even if the migraine is not treated

Other signs that may linger after the pain goes away (postdrome) may include: 

  • Fatigue
  • Problems concentrating
  • Inability to eat

What Causes Migraine?

The cause of migraine is unknown, but genetics and environment are factors. 

Common migraine headache triggers include: 

  • Stress, which is a trigger for up to 70% of people with migraine
  • Poor sleep
  • Hormones
    • Changes in estrogen levels for women can lead to “menstrual migraines”
  • Caffeine use or withdrawal
  • Alcohol
  • Weather changes or changes in barometric pressure
  • Certain foods and drinks, such as chocolate, processed foods with monosodium glutamate (MSG), foods with histamine, cheese and other dairy products, artificial sweeteners such as aspartame, cured meats, and foods with a strong smell
  • Dehydration
  • Bright lights (photophobia) 
  • Certain smells such as perfumes, strong food smells, chemicals, and gasoline
  • Medication overuse 
    • Taking acute migraine prescription medication more than 10 days out of a month can in itself cause more migraine attacks
  • Certain prescription medications, such as nitroglycerin and estrogen
  • Anxiety
  • Hunger/skipping meals
  • Anger
  • Exposure to smoke
  • Fatigue
  • Depression
  • Concussions and traumatic brain injuries

What Is the Treatment for Migraine?

Treatment for migraine headaches includes: 

  • Non-medical treatments
    • Ice 
    • Heat
    • Adequate hydration
    • Rest
    • Deep breathing
    • Darkened room/covering your eyes
    • Massage
    • Biofeedback
  • Pain relievers (analgesics)
  • Other medications
    • Triptans
    • Trigger point injections
    • OnabotulinumtoxinA (Botox)
  • Anti-nausea medications (antiemetics)
  • Selective serotonin 1F receptor agonist
  • Calcitonin-gene related peptide (CGRP) antagonists
  • Ergotamine preparations
  • Neuromodulation
    • Transcutaneous supraorbital nerve stimulation 
    • Transcranial magnetic stimulation (TMS) 
    • Remote electrical neuromodulation 
    • Noninvasive vagus nerve stimulation (nVNS) 
  • Peripheral nerve blocks
    • Occipital nerve blocks 
    • Sphenopalatine ganglion blocks 
Reviewed on 1/25/2022
Image Source: iStock Images