Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Migraine Symptoms UK: A Complete Guide to All Four Phases
From the earliest prodrome warning signs through aura, the headache phase, and postdrome recovery — a clinically reviewed breakdown of every stage of a migraine attack.
▶ Migraine symptoms at a glance
Migraine has four phases: prodrome (warning signs hours to days before), aura (neurological symptoms in 25–30% of attacks), the headache phase (4–72 hours of moderate to severe throbbing pain), and postdrome (recovery, often described as a “migraine hangover”). Each phase has distinct features that can guide recognition, treatment timing, and management.
Phase 1: Prodrome (Warning Phase)
The prodrome occurs hours to days before the headache. It affects approximately 60% of people with migraine — though some estimates range from 30% to 80% depending on how symptoms are defined and reported.1 Recognising prodrome symptoms allows earlier treatment, potentially aborting the attack.
- Mood changes — depression, irritability, or unexplained euphoria
- Food cravings (chocolate, carbohydrates) or loss of appetite
- Excessive yawning — one of the most consistent prodrome symptoms
- Neck stiffness or tenderness
- Fatigue, difficulty concentrating
- Increased urination
- Sensitivity to light or sound starting to build
Prodrome as early warning: Keeping a migraine diary can help identify your personal prodrome pattern. Recognising it consistently may allow you to take acute treatment early, when it is most effective.
Phase 2: Aura
Aura occurs in 25–30% of people with migraine and consists of focal neurological symptoms that develop gradually over 5 minutes or more, typically lasting 5–60 minutes.2 Each symptom builds, peaks, and resolves before or during the headache phase.
- Visual aura (most common — over 90% of aura cases) — zigzag flickering lines, flashing lights, or partial vision loss, expanding slowly across the visual field
- Sensory aura — tingling or numbness spreading typically from fingers up the arm to the face, over 10–20 minutes
- Speech aura — difficulty finding words or slurred speech
For a complete guide to all aura types, subtypes, how to distinguish aura from a TIA, and the important contraceptive pill safety point, see: Migraine with aura: full guide →
Aura symptoms vs stroke symptoms: New neurological symptoms — especially sudden severe vision loss, weakness affecting one side of the body, or speech difficulty — that do not follow the gradual build-up pattern of aura should be treated as a possible stroke. Call 999. Migraine aura builds gradually; stroke symptoms are typically sudden.
Phase 3: Headache Phase
The headache phase is the most disabling part of the migraine attack, typically lasting 4–72 hours untreated.
| Feature | Typical presentation |
|---|---|
| Pain quality | Throbbing or pulsating, worsening with physical activity |
| Location | Usually unilateral (one side of the head), but can be bilateral |
| Severity | Moderate to severe — often prevents normal activities |
| Duration | 4–72 hours untreated |
| Nausea / vomiting | Common — affects absorption of oral medications |
| Photophobia | Severe sensitivity to light — rest in darkened room often necessary |
| Phonophobia | Severe sensitivity to sound |
| Osmophobia | Sensitivity to smells — present in many attacks |
Nausea and vomiting during the headache phase can significantly reduce the effectiveness of oral tablets. Anti-emetics (prochlorperazine, metoclopramide) taken alongside acute treatment improve both nausea control and analgesic absorption.
Phase 4: Postdrome (Recovery Phase)
The postdrome follows headache resolution and can last hours to 2 days. Often described as a ‘migraine hangover’, it can significantly affect productivity and quality of life even after the headache itself has cleared.
- Profound fatigue and exhaustion
- Cognitive impairment — difficulty concentrating, “brain fog”
- Mood changes — depression or euphoria
- Neck stiffness or scalp tenderness
- Residual mild head pain
When Migraine Doesn't Follow the Rules
Acephalgic (silent) migraine
Acephalgic migraine — also called silent migraine or migraine aura without headache — involves all the neurological symptoms of a migraine attack (aura, and sometimes prodrome and postdrome) but without the characteristic head pain. It affects approximately 5% of people with migraine.3 Because the headache is absent, silent migraine can be mistaken for a transient ischaemic attack (TIA) or other neurological event, particularly in older adults.
Status migrainosus
Status migrainosus is defined as a debilitating migraine attack lasting longer than 72 hours despite treatment. It is a medical emergency requiring urgent assessment. If your headache phase persists beyond 72 hours, seek same-day medical advice.
Medication overuse headache (MOH)
Medication overuse headache occurs when acute headache medications are taken too frequently. As a rule of thumb, triptans or opioids should be used on fewer than 10 days per month, and simple analgesics on fewer than 15 days per month. Exceeding these thresholds can paradoxically worsen headache frequency and intensity. If you suspect MOH, do not stop medications abruptly without medical guidance — withdrawal requires supervision.
When to suspect MOH: If you are needing acute migraine treatment on 10 or more days per month, or if your headaches are becoming more frequent despite treatment, medication overuse may be contributing. Discuss with your prescriber.
When to Seek Help
Seek emergency care immediately if you experience: sudden onset ‘thunderclap’ headache (worst headache of your life) · headache with fever, stiff neck, rash · new weakness affecting one side of the body · vision loss that is sudden, not gradual · headache following head injury · headache with confusion or reduced consciousness.
These symptoms require urgent assessment to exclude serious causes including subarachnoid haemorrhage, meningitis, and stroke.
Get Prescription Migraine Treatment Online
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View Migraine Treatments →Frequently Asked Questions
What are the main symptoms of a migraine?
The main headache-phase symptoms are moderate to severe throbbing pain (usually one-sided), nausea and vomiting, severe sensitivity to light (photophobia) and sound (phonophobia), and significant worsening with physical activity. Many attacks are preceded by prodrome symptoms and, in 25–30% of cases, neurological aura.
What does migraine aura look like?
The most common aura is visual — a scintillating scotoma, which appears as a flickering, crescent-shaped blind spot with a zigzag shimmering border. Flashing lights, blurred vision, and temporary partial vision loss also occur. Sensory aura (tingling spreading from fingers to face) and speech aura are less common.
How long does a migraine last?
The headache phase lasts 4–72 hours untreated. The full migraine attack including prodrome and postdrome can span several days. With effective early treatment, the headache phase can often be significantly shortened.
What is the postdrome and how long does it last?
The postdrome is the recovery phase following headache resolution. It causes profound fatigue, difficulty concentrating, mood changes, and neck stiffness. It can last hours to 2 days and is often as disabling as the headache phase for some people.
How can I tell if my symptoms are a migraine or something more serious?
New neurological symptoms that develop suddenly (rather than gradually over minutes), weakness affecting one side of the body, sudden vision loss, or headache described as the worst of your life are warning signs requiring emergency assessment. Call 999.
Can you have a migraine without a headache?
Yes. This is called acephalgic migraine, or silent migraine. It involves the aura phase — visual disturbances, tingling, or speech difficulty — without the characteristic headache pain. It affects about 5% of people with migraine.
What is status migrainosus?
Status migrainosus is a debilitating migraine attack that lasts longer than 72 hours despite treatment. It requires urgent medical assessment. If your headache phase persists beyond 72 hours, seek same-day medical advice.
What is medication overuse headache?
Medication overuse headache (MOH) occurs when acute painkillers or triptans are taken too frequently — typically triptans or opioids on 10 or more days per month, or simple analgesics on 15 or more days per month. It paradoxically worsens headache frequency. Treatment involves abruptly stopping the overused medication, which requires medical supervision.
References
- Kelman L. The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache. 2004;44(9):865-72. (Prevalence of prodrome reported at ~60%; wider estimates 30–80% in subsequent literature.)
- Joppeková Ľ et al. What does a migraine aura look like? A systematic review. J Headache Pain. 2025;26:149. (Aura affects up to 30% of people with migraine; visual aura in >90% of cases.)
- Cleveland Clinic. Silent Migraine (Typical Aura Without Headache). 2024. (Silent migraine affects ~5% of people with migraine.)
- NICE. Headaches in over 12s: diagnosis and management. CG150. 2012 (updated 2025).
- NHS. Migraine. nhs.uk/conditions/migraine
- Goadsby PJ et al. Pathophysiology of migraine. N Engl J Med. 2017.
Medical disclaimer: This article is for informational purposes only. Prescription migraine treatments require a clinical consultation. Always consult a qualified healthcare professional. In a medical emergency, call 999.