The four hidden phases of a migraine—and why timing matters

Migraine remains one of the most widespread neurological disorders, affecting over 1 billion people globally. Rising rates of chronic illnesses, allergens, and uneven healthcare access contribute to its growing impact. Yet despite its prevalence, many remain unaware of how the condition develops and how best to manage it.

A migraine attack unfolds in four distinct phases, each with its own set of symptoms. The process often begins with the Premonitory phase, which starts 24 to 48 hours before the headache itself. During this time, people may notice poor concentration, unusual food cravings, irritability, or trouble sleeping.

For about 30% of sufferers, the Aura phase follows, bringing temporary disturbances in vision, speech, or sensation. This stage can include flashing lights, tingling, or difficulty speaking.

The Headache phase then sets in, lasting anywhere from four to 72 hours if untreated. Symptoms typically include a throbbing or pulsating headache, nausea, vomiting, and extreme sensitivity to light and sound.

Finally, the Postdrome phase—often called a 'migraine hangover'—leaves people feeling exhausted and struggling to focus as their brain recovers. Recognising these stages early can help in managing symptoms and preventing attacks from overlapping.

Health experts advise that those experiencing more than four migraines a month explore preventive treatments, including medications or injectables. Women with migraine who also have aura symptoms are urged to speak with a doctor before using hormone-based contraception.

In Australia alone, around five million people live with migraine, yet awareness of its phases remains low. Early identification of symptoms and appropriate medical advice can reduce the severity of attacks. Better understanding of the condition may also improve long-term management for those affected.