Time is an important factor when it comes to migraine management. Find out how to recognize a migraine attack and when to take action.
When a migraine attack starts, you might have a lot of questions about what is happening, how long it will last and how you can treat your symptoms. Understanding the timing involved in a migraine attack—specifically the headache phase—will go a long way in helping you manage your migraine and knowing when to take action.
What is a migraine attack?
Migraine is not just a bad headache. It is a neurological disease with different symptoms and treatment options than other headache disorders. A migraine attack includes debilitating head pain that interferes with your ability to function normally. Other symptoms include nausea, vomiting and sensitivity to light, noise and smells.
How do you know if you’re having a migraine attack?
People with migraine often have different symptoms, as the presentation of migraine can vary from person to person. But if your head pain is moderate to severe, lasts several hours, causes a throbbing or pounding sensation, gets worse with physical movement and interferes with your life, work or school activities, you may be experiencing migraine. The head pain can be on one or both sides of your head, in the front or back. It can also be in or around your eyes or behind your cheeks.
Migraine can also cause nausea and/or vomiting and increase your sensitivity to light, smells and noise. Some people experience migraine with aura, a visual disturbance that typically occurs before the headache pain begins and resolves within an hour or less.
How long is a migraine attack?
There are four phases of a migraine attack: prodrome, aura, headache and postdrome. Not everyone experiences every phase during a migraine attack, and each attack may be different, even within the same person.
The headache portion of an attack can last from four hours to three days. An entire migraine attack—including prodrome, aura, headache and postdrome—may last anywhere from a bit more than one day to slightly more than a week at its very longest, though this is not typical. Most typically, a migraine attack will last for one to two days.
How to prevent migraine attacks
The causes of migraine aren’t clear, but it may have a hereditary link. Environmental factors can also play a role, and some people have identifiable triggers that can cause migraine attacks. Some common triggers include stress, certain foods, alcohol, dehydration, changes in sleep, changes in weather, hormone fluctuations (such as the menstrual cycle), light or smell.
While trigger avoidance may seem like a way for people to take matters into their own hands, many experience spontaneous attacks, which means there is nothing specific that caused them. Lifestyle changes that eliminate or reduce these triggers, such as consistent and adequate nutrition, hydration, exercise, sleep and stress management, can help decrease the frequency and severity of migraine attacks.
How to reduce the effects and treat a migraine attack
Identifying your individual symptoms of a migraine attack can help you treat them early and more effectively. As a headache progresses, treatment is often much less likely to be effective and may have more side effects.
Start by maintaining a headache diary that notes what happens before, during and after the headache part of an attack. Symptoms during the prodromal stage can be non-specific, such as fatigue, irritability, anxiety, yawning, frequent urination, difficulty concentrating and food cravings. So they may be hard to recognize as part of an attack at first.
By noticing these early symptoms, you can quickly treat your migraine to reduce the effects and possibly stop the attack. Acute treatments include over-the-counter or prescription medications, devices or other therapies.
What do I do if my migraine lasts for more than 72 hours or won’t go away?
You should talk to your provider about a plan should your migraine extend past the 72-hour mark. You may need treatment for a condition called status migrainosus. We define this as a migraine that lasts more than 72 hours without a pain-free interval. Status migrainosus is often treated differently than shorter migraine attacks and may require you to receive different treatments.
If your pain is different, much more severe than usual and includes any “red flag” symptoms, get emergency treatment. If you’re unsure, call your doctor or a health information line.
How do I know if I have chronic migraine?
Chronic migraine is currently defined as having 15 or more headache days per month for three months, and at least 8 of those headache days include migraine symptoms or are treated like migraine. About 3 to 5% of people in the U.S. experience chronic migraine. Episodic migraine is defined as 14 or fewer headache days per month. It can become chronic in some people if it’s not recognized or treated.
A primary care physician or headache specialist can provide a diagnosis and help you manage your migraine. If you think you may have episodic or chronic migraine, keep track of all of your headache days—both migraine and other types of headache—and speak to your doctor.
Timing can play a role in diagnosis of other headache disorders, such as new daily persistent headache (NDPH) and hemicrania continua. Both disorders involve constant head pain that continues for over three months without relief. NDPH commonly has a distinct, sudden onset, while hemicrania continua is marked by pain only on one side of the head.
It’s important to share your symptoms and duration of pain with your doctor so they can diagnose and treat your condition appropriately. Factors like time, as well as location of pain and your specific symptoms, can help with getting a correct diagnosis and working on a treatment plan tailored to your lifestyle and headache.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.