Download AppThis is an educational overview rather than medical advice.
A migraine attack can move through as many as four phases. The important word is "can", because not everyone experiences every phase, and popular articles tend to overstate how common some of them are. Understanding the sequence is genuinely useful, both for recognising your own attacks and for acting early. Here is what the evidence actually supports, caveats included.
The premonitory phase
ICHD-3 describes premonitory, or prodrome, symptoms as appearing hours to a day or two before the headache itself, rather than fixing a precise numeric window. The research literature commonly puts this stretch at roughly 2 to 48 hours. Around a third of patients report these symptoms when asked at baseline. Prospective diary studies, where people log symptoms in real time as they happen, push that figure much higher, up to roughly 84 percent (review, 2024). That gap between what people remember and what they capture in the moment is one of the most practically important findings in this whole area. These early signs are easy to miss until you start tracking them deliberately, and once you do, they turn out to be far more common than anyone assumed.
In one large trial, the most frequently reported premonitory symptoms were sensitivity to light at 57 percent, fatigue at 50 percent, neck pain at 42 percent, and sensitivity to sound at 34 percent. Others include yawning, food cravings, mood changes, and difficulty concentrating. Treat those percentages as illustrative figures from a specific study population rather than fixed universal rates, but the list gives a good sense of what to watch for.
Aura, which is a minority experience
Contrary to what a lot of people assume, aura affects only about 1 in 4 to 1 in 3 people with migraine. It is not the norm, and plenty of people with severe, frequent migraine never have it at all. When it does occur, ICHD-3 describes it as developing gradually over at least 5 minutes, with each symptom lasting somewhere between 5 and 60 minutes (Nature Reviews Disease Primers). It is most often visual, such as a shimmering or a blind spot, but sensory symptoms like tingling and speech disturbance are recognised forms too. The gradual build is part of what distinguishes typical aura from more sudden neurological events.
The headache phase
This is the phase most people picture when they hear the word migraine. Untreated, it lasts between 4 and 72 hours. The pain is often one-sided and pulsating, and it usually travels with nausea and a marked sensitivity to light and sound. Movement tends to worsen it, which is why rest in a dark, quiet room is such a common instinct.
The postdrome
After the pain settles, many people go through a postdrome, a stretch of fatigue, poor concentration, low mood, and a hungover sort of feeling that can last about a day. It is a real, measurable part of the attack, and it is a major reason migraine costs people more than the hours of head pain alone would suggest.
Two things worth correcting
A couple of widely repeated claims do not survive a close look. First, aura is not close to universal. It is a minority experience, so framing it as something most people with migraine get is simply inaccurate. Second, the popular line that "80 percent get a prodrome 24 to 48 hours before" overstates the baseline data. What is actually true, and more interesting, is that careful prospective tracking detects premonitory symptoms far more often than memory does. That is precisely why a good diary is so valuable. It surfaces a warning phase that recall tends to hide.
Sources for this piece include ICHD-3, Nature Reviews Disease Primers, and the American Migraine Foundation.