How Long Do Migraines Last?

Colleen Doherty, MD
·10 min read

Medically reviewed by Smita Patel, DO

Migraine is a complex brain disorder affecting more than 10% of the population worldwide. Prodrome, aura, headache, and postdrome are the four stages of a migraine attack, though a person may not cycle through each.

Migraine stages vary in duration, some lasting minutes and others lasting hours to days. Unique symptoms also mark each phase, common ones being nausea, temporary visual changes, a throbbing headache, and light sensitivity.

This article will discuss how long migraine attacks last and the symptoms you might experience during each stage. It will also provide insight into when to seek medical attention for your migraine and the treatment and preventive options available.

janiecbros / Getty Images
janiecbros / Getty Images

Average Duration of Migraine Attacks

A complete migraine attack—including all four stages (prodrome, aura, headache, and postdrome)—can last more than one day to slightly longer than a week.

That said, most migraine attacks, from start to finish, generally last for one or two days.

Migraine Stages

Migraine attacks occur in four stages, with the headache stage being the most common and the aura stage being the least common.

Prodrome

The prodrome stage may begin three days before a migraine headache. Its symptoms allow some people to accurately predict the headache up to 12 hours before it starts.

Taking migraine medication during this stage may lessen the intensity of the migraine attack or even stop it in its tracks.

Symptoms unique to the prodrome stage are excessive yawning, food cravings, and frequent urination.

Other, perhaps more subtle potential prodrome symptoms include:

  • Mood changes, ranging from sadness to irritability

  • Trouble focusing

  • Unusual tiredness

  • Light sensitivity (photophobia)

  • Sound sensitivity (phonophobia)

  • Insomnia

  • Nausea

  • Constipation or diarrhea

  • Neck and shoulder muscle stiffness

Aura

The aura stage typically follows the prodrome phase and lasts five to 60 minutes. Approximately one-third of migraine headaches are preceded by this stage.

The symptoms of aura are entirely reversible, with the most common ones being visual changes, like seeing shimmering lights, bright spots, or even losing sight temporarily.

Other potential aura symptoms include:

  • Sensory: Tingling and numbness on the face or body

  • Speech: Difficulty finding words or slurring words

  • Motor (movement-related): Weakness or partial paralysis

  • Brain stem–related: Sensation of spinning (vertigo), ringing in the ears (tinnitus), or uncoordinated movements (ataxia)

Migraine aura is caused by a complex brain phenomenon called cortical spreading depression (CSD). Experts suspect that CSD also activates pain receptors within the tissues lining the brain (meninges).



What Is Cortical Spreading Depression?

CSD is an electrical wave slowly spreading along the brain's outermost layer, causing dramatic changes in blood flow and nerve cell activity.



Headache

Migraine headaches last about four hours to three days and are typically throbbing, pulsating, or pounding in quality, although some people describe the pain as burning, drilling, or stabbing. The headache is typically one-sided (unilateral) but can be located on both sides of the head (bilateral).

Migraine headache pain is moderate to severe in intensity, significantly reducing a person's ability to perform daily activities. The pain is also aggravated by movement and accompanied by at least one of the following:

  • Nausea and/or vomiting

  • Light and sound sensitivity

Other potential symptoms during the headache stage include:

  • Anxious or depressed mood

  • Trouble sleeping

  • Smell sensitivity

  • Stuffy nose

  • Neck pain and stiffness

  • Extreme sensitivity to touch (allodynia)

The headache of a migraine attack manifests from activation of the trigeminovascular system (TVS)—a complicated pathway that links trigeminal nerve fibers to the brain's blood vessels.

Once TVS is activated, the trigeminal nerve fibers release proteins like calcitonin gene-related peptide (CGRP) and substance P. These proteins cause inflammation and blood vessel widening, creating the throbbing pain of a migraine headache.

Related: Migraine vs. Headache: Treating the Pain

Postdrome

The postdrome stage signifies the brain's recovery phase. It lasts one to two days and occurs in around 80% of people with a migraine attack.

Symptoms are highly variable in this stage, with over 250 reported, although more common ones include tiredness, thinking and memory difficulties, and neck stiffness. A depressed or even euphoric mood may also occur in this phase.

Interestingly, postdrome symptoms resemble prodrome symptoms, dominated by fatigue, mood changes, and cognitive disturbances. This likeness suggests that similar brain systems are involved in both stages.

Related: Postdrome Migraine: How to Cure a Migraine Hangover

Finding Relief for Migraines

You can find relief for acute migraine headaches, often through a combination of medication and soothing home remedies.

Medication

Medication for migraine should be taken as soon as symptoms begin. A healthcare provider may recommend an over-the-counter (OTC, not needing a prescription) or prescription drug depending on factors like migraine severity.

OTC drugs for migraine headaches include:



Take Precaution

Due to potential harm, only take medication, including OTC drugs, under the care of a healthcare provider. A medical provider can let you know if the drug is suitable for you or if it could cause harmful interactions with other substances you take.



A prescription drug, like the triptan Imitrex (sumatriptan) or the combination NSAID/triptan Treximet (sumatriptan/naproxen), is often warranted for moderate to severe migraine headaches.

Triptans work by stimulating the brain chemical messenger serotonin, thereby reducing inflammation and tightening blood vessels around the brain.

Research has found that triptans relieve headaches within two hours in 76% of people enduring an acute migraine attack.

Alternatives to triptans are Reyvow (lasmiditan), which has a similar effect without causing blood vessel narrowing, and calcitonin gene-related peptide (CGRP) receptor blockers, including:

Because Reyvow and the CRGP receptor blockers do not tighten blood vessels, they may be a safer option for people with an increased cardiovascular risk.

CGRP blockers minimize inflammation within the membranes surrounding the brain by blocking the docking site for CGRP, a protein that amplifies pain signals during a migraine attack.

Studies show that only around 20% of people with migraines achieve pain relief two hours after taking one of the above CGRP receptor blockers. However, the drugs appear to become more effective over the following six hours or so.

Learn More: Medications for Treating Migraine Headaches

Home Remedies

In combination with medication, various home remedies may help soothe a migraine headache, namely:

  • Napping in a dark, quiet room or using earplugs and an eye mask to mimic this environment

  • Placing an ice pack on your forehead or a frozen neck wrap

  • Drinking lots of water, especially if your headache is accompanied by vomiting

Alongside traditional migraine therapies, limited research suggests various Chinese herbal medicine formulations may help treat migraines. Raw ginger or ginger extracts may also be beneficial, especially for someone who cannot take migraine medication.

Learn More: 9 Alternative Migraine Treatments

Preventing Future Migraines

Avoiding triggers, engaging in healthy lifestyle behaviors, and taking medication (in some cases) can help prevent migraines.

Trigger Avoidance

Triggering factors are reported in over 75% of people with migraines, and avoiding or learning to cope with personal triggers is crucial to migraine prevention.

Examples of common migraine triggers include:

Related: The Migraine-Estrogen Connection

A migraine diary is a valuable tool for pinpointing unique migraine triggers. In it, record your daily routine, such as your meals, sleep schedule, and activities.

If a migraine attack occurs, report your symptoms, the impact on daily functioning (e.g., in bed all day vs. being able to attend work/school), and the medication you used to ease the attack.

Healthy Lifestyle

In addition to identifying and eliminating triggers, a healthy lifestyle can help prevent migraine attacks. Experts recommend the following behaviors:

  • Exercise 30 to 60 minutes three to five times a week.

  • Eat well-balanced meals at least three times a day and avoid skipping meals.

  • Drink seven to eight 8-ounce glasses of water per day.

  • Stop caffeine or take in less than 200 milligrams daily (mg/day), equivalent to one to two cups of brewed coffee.

  • Maintain the same bedtime and wake-up times and avoid naps.

Moreover, since stress can trigger or aggravate migraine attacks, consider incorporating one or more stress-reducing techniques, like cognitive behavioral therapy or mindfulness, into your migraine care.

Related: Can a Migraine Diet Help Prevent and Manage Symptoms?

Medication

You might be a candidate for preventive migraine medication if you experience debilitating migraine attacks or cannot tolerate or obtain adequate relief from acute migraine drugs.

Moreover, preventive medication should be considered if you use acute drugs, like NSAIDs or triptans, more than two or three times per week.



What Can Happen With Migraine Medication Overuse?

Medication overuse can lead to rebound headaches or contribute to the conversion to chronic migraine, also called transformed migraine.



Several oral medications—initially developed for other health conditions—may be tried for migraine prevention. Preventive migraine drugs with the highest degree of effectiveness include:

These drugs have unique side effect profiles and must be taken daily. Keep in mind it can take two to six months to experience the drug's full benefit.

Various CGRP blockers may also be used to prevent migraine, such as:

  • Nurtec ODT (rimegepant) is a dissolvable pill taken once every other day.

  • Aimovig (erenumab), Ajovy (fremanezumab), or Emgality (galcanezumab) are injections administered either once a month or every three months, depending on the drug or dose.

  • Qulipta (atogepant) is an oral pill taken once daily.

  • Vyepti (eptinezumab) is an intravenous (IV) drug administered every three months.

CGRP blockers for migraine prevention generally take effect within a month or two of use. They are typically well-tolerated and associated with fewer side effects than traditional oral migraine medications.

Learn More: CGRP Inhibitors for Preventing Migraines

When to Get Help for a Migraine

Call a healthcare provider if your migraine headache is debilitating and lasts more than 72 hours, even if you have periods of remission (12 hours or less) with sleep or medication.

You may be experiencing status migrainosus, also known as intractable migraine, requiring care in an emergency room or hospital.

Treatment for intractable migraines often requires a combination of intravenous fluids and medications, such as antiemetics (drugs that treat or prevent nausea and vomiting), corticosteroids, anti-seizure drugs, and NSAIDs.

Furthermore, see a healthcare provider if you are experiencing new migraine headaches and are pregnant, postpartum, over age 65, or have a history of human immunodeficiency virus (HIV) or cancer.



Seek Emergency Medical Attention

Go to an emergency room or call 911 if your migraine or other headache develops suddenly and feels like the "worst headache of your life."

Also, seek emergency care if your migraine or other headache is associated with:

  • Seizure

  • Weakness or sensory changes on one side of your body

  • Severe vomiting

  • Fainting

  • Fever or stiff neck

  • Painful eye

  • A significant head or neck injury/trauma



Learn More: When Should You Worry About a Headache?

Summary

Migraine attacks have four distinct stages—prodrome, aura, headache, and postdrome. Unique durations and symptoms mark each stage. For example, the headache phase lasts between four and 72 hours and is associated with a throbbing headache, nausea and/or vomiting, and light and sound sensitivity.

Most migraine attacks last one to two days, although, in rare instances, they may last slightly longer than a week.

While there are numerous migraine treatments and preventive therapies, seek medical attention if your migraine headache lasts more than 72 hours, even if you have periods of remission (12 hours or less) with sleep or medication.

Read the original article on Verywell Health.