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Migraine Symptoms: What to Expect During an Attack

· 7 min read
Pressure Pal Team
Pressure Pal Team
Health & Weather Insights Team

Migraine is far more than a bad headache. It's a neurological event that affects your entire body — before pain arrives, during the attack itself, and even after it ends. Understanding migraine symptoms at each stage helps you recognize what's happening, respond earlier, and explain your experience more accurately to doctors and loved ones.

The Full Spectrum of Migraine Symptoms​

Most people think of migraine as simply "severe head pain." But the full picture is much broader. Depending on the individual and the attack, migraine can involve:

  • Warning signs hours or days before pain
  • Visual or neurological disturbances
  • Severe throbbing head pain (often unilateral)
  • Nausea, vomiting, and gastrointestinal disruption
  • Extreme sensitivity to light, sound, and smell
  • Cognitive difficulties and mood changes
  • Lingering fatigue and brain fog after pain resolves

Let's walk through each phase.

Phase 1: Prodrome (The Warning Stage)​

When it happens: 1–48 hours before head pain begins

The prodrome is the earliest phase of a migraine — a set of subtle changes that signal an attack is coming. Many people don't recognize prodrome symptoms as migraine-related until they've tracked their pattern over time.

Common Prodrome Symptoms​

  • Mood changes — irritability, anxiety, depression, or unusual euphoria
  • Fatigue and yawning — unexplained tiredness, excessive yawning
  • Food cravings — particularly for sweet or salty foods
  • Neck stiffness — tension in the back of the neck and shoulders
  • Increased thirst or urination
  • Difficulty concentrating — brain fog, forgetfulness
  • Heightened sensory sensitivity — beginning to feel bothered by lights or sounds before pain starts

Why it matters: The prodrome is your best window for effective intervention. Abortive medications (like triptans) work best when taken during prodrome or at the very first sign of pain — not once a headache is severe. Tracking your prodrome symptoms helps you catch this window reliably.

Phase 2: Aura (Neurological Symptoms)​

When it happens: Typically 20–60 minutes before or at the start of head pain

Affects: Approximately 25–30% of migraine sufferers

Aura consists of fully reversible neurological symptoms that develop gradually (usually over 5–20 minutes) and resolve within 60 minutes. They're caused by a phenomenon called cortical spreading depression — a wave of electrical activity followed by suppression that moves slowly across the brain's cortex.

Visual Aura (Most Common)​

  • Scintillating scotoma — a shimmering, crescent-shaped blind spot that slowly expands
  • Fortification spectrum — zigzag, arc-shaped lines of flashing light (named for resemblance to aerial views of medieval fortifications)
  • Visual snow — static-like flickering across the visual field
  • Partial vision loss — a section of vision that blurs or disappears temporarily
  • Tunnel vision

Sensory Aura​

  • Numbness or tingling that spreads slowly (often from hand → arm → face → tongue)
  • Pins-and-needles sensations
  • These symptoms typically follow the same spreading pattern as visual aura

Language Aura (Aphasic Aura)​

  • Difficulty finding words or speaking fluently
  • Confusion with reading or writing
  • Temporary word-retrieval difficulties

Motor Aura (Rare — Hemiplegic Migraine)​

  • Temporary weakness on one side of the body
  • Can mimic stroke symptoms — requires medical evaluation if new or severe

Important: If you experience aura symptoms for the first time, particularly weakness on one side or sudden speech difficulty, seek medical attention promptly to rule out stroke.

Phase 3: The Headache (Attack Phase)​

When it happens: After or during aura; can begin without preceding aura Duration: 4–72 hours if untreated

This is the phase most people associate with migraine, though as you can see, it's just one part of the full experience.

Head Pain Characteristics​

  • Location: Often unilateral (one side of the head), though it can shift sides or be bilateral
  • Quality: Throbbing, pulsating, or pounding — worsens with movement
  • Severity: Moderate to severe — typically rated 6–10 on a pain scale
  • Worsening: Aggravated by routine physical activity (walking, climbing stairs)

Nausea and Vomiting​

Nausea affects up to 90% of migraine sufferers during an attack. Vomiting occurs in approximately 30%. This is one of the most debilitating aspects for many people — it can prevent oral medications from being absorbed and make eating or drinking impossible.

Sensory Sensitivity​

  • Photophobia (light sensitivity): Occurs in up to 80% of attacks; even dim light can feel painful
  • Phonophobia (sound sensitivity): Loud sounds and even normal conversation can intensify pain
  • Osmophobia (smell sensitivity): Strong smells — perfume, food, cleaning products — can trigger or worsen nausea and pain

These sensitivities drive the classic migraine behavior of retreating to a dark, quiet room.

Other Physical Symptoms​

  • Neck and shoulder pain (common; sometimes precedes head pain)
  • Scalp tenderness — even light touch to the head or scalp hurts (called allodynia)
  • Pale or flushed skin
  • Nasal congestion or runny nose (can be mistaken for sinus headache)
  • Cold hands and feet
  • Difficulty concentrating — cognitive function is significantly impaired during an attack

Phase 4: Postdrome (The "Migraine Hangover")​

When it happens: After the headache resolves Duration: Up to 48 hours

The postdrome is one of the most underrecognized phases. Many people feel significantly impaired even after the pain is gone.

Common Postdrome Symptoms​

  • Fatigue and exhaustion — profound tiredness even after sleep
  • Cognitive fog — difficulty thinking clearly, poor concentration, slow processing
  • Mood changes — depression, emotional fragility, or conversely, a sense of relief or mild euphoria ("postdrome glow")
  • Mild head sensitivity — bending over or moving quickly may cause a dull ache
  • Muscle weakness — generalized body fatigue

The postdrome can last anywhere from a few hours to two days. Pushing through it — especially with demanding cognitive work — often extends recovery. Rest, hydration, and gentle movement tend to help.

Symptoms That Vary by Migraine Type​

Vestibular Migraine​

Instead of (or alongside) head pain, vestibular migraines produce:

  • Vertigo (spinning sensation)
  • Balance problems and unsteadiness
  • Dizziness and motion sensitivity
  • Sometimes little or no head pain

Menstrual Migraine​

Attacks linked to menstruation tend to be:

  • Longer in duration
  • More resistant to treatment
  • More likely to cause nausea and vomiting

Ocular/Silent Migraine (Migraine Without Headache)​

  • Visual aura symptoms (often a shimmering arc of light)
  • Occurs without significant head pain
  • Can be alarming if unexpected; usually benign and resolves within 30 minutes

Warning Symptoms That Need Immediate Attention​

See a doctor immediately or call emergency services if a headache:

  • Comes on suddenly and is the worst headache of your life ("thunderclap headache")
  • Is accompanied by fever, stiff neck, confusion, or rash
  • Follows a head injury
  • Is accompanied by new weakness, vision loss, speech difficulty, or numbness (especially if these are new symptoms for you)
  • Is significantly different from your usual migraine pattern

Tracking Your Symptoms Over Time​

Every person's migraine pattern is unique. The best way to understand your own symptom profile — and identify your triggers — is to track consistently.

Pressure Pal lets you log symptoms at each phase of an attack alongside barometric pressure data, helping you connect environmental triggers (especially weather) to your specific symptom pattern. Over weeks and months, your personal migraine signature becomes visible — which phase hits hardest, which triggers matter most, and which treatments work best for you.

Sharing this data with your neurologist or GP significantly improves the quality of your care.

Key Takeaways​

  • Migraine has four phases: prodrome, aura, headache, and postdrome — each with distinct symptoms.
  • Prodrome (1–48h before pain) is the best window for early intervention.
  • Aura (in ~30% of sufferers) involves reversible neurological symptoms, most commonly visual.
  • The headache phase involves throbbing unilateral pain, nausea, and severe sensory sensitivity.
  • Postdrome causes lingering fatigue and cognitive fog — often underestimated.
  • New or unusually severe symptoms warrant prompt medical evaluation.
  • Systematic tracking reveals your personal migraine pattern and helps guide effective treatment.