How long does a migraine last? The four phases

The headache: 4 to 72 hours

The International Classification of Headache Disorders, the reference doctors use to diagnose migraine, defines migraine without aura as headache attacks lasting 4 to 72 hours when untreated or unsuccessfully treated. In children and teenagers under 18, it says attacks may last 2 to 72 hours. The NHS gives a similar range: attacks usually last between 4 hours and 3 days.

The NHS adds a point that explains much of the confusion. Early symptoms, such as feeling very tired, can start hours or up to 2 days before the head pain starts and finish after the headache stops. So how long a migraine lasts depends on whether you count only the pain or the whole attack.

The four phases and how long each lasts

The American Migraine Foundation (AMF) describes four phases. Not everyone has every phase, and the phases overlap, so treat the times as typical ranges.

• Prodrome, the warning phase. AMF says it can last from a few hours to several days and may bring mood changes, sensitivity to light and sound, trouble focusing and food cravings. MedlinePlus says it starts up to 24 hours before the migraine.
• Aura. Only about 25% to 30% of people with migraine get one, according to AMF. Symptoms such as zigzag lines, flashing lights, numbness or tingling build over at least five minutes and last up to an hour. The classification gives 5 to 60 minutes for each aura symptom, and the NHS says an aura should not last longer than 1 hour.
• Headache. AMF says this phase may last anywhere from a few hours up to three days, with moderate to severe pain on one or both sides of the head, nausea, and sensitivity to light and sound.
• Postdrome, sometimes called the migraine hangover. AMF says about 80% of people with migraine have it, and that it typically lasts one to two days, with fatigue, trouble concentrating, dizziness and body aches. MedlinePlus says up to a day.

Why the numbers differ from source to source

Sources count different things and use different ranges, which is why one page says a day and another says two. AMF notes that there is a lot of overlap between phases, and one of its experts says to be generous with yourself when sorting symptoms. Brain fog, for example, can show up in the prodrome, the headache and the postdrome.

AMF also says that, from first warning to full recovery, an attack can take days or even weeks to pass through all four phases. Practical advice from us: if you count a migraine from the first warning sign to the day you feel normal, expect a number well above the headache itself.

When a migraine lasts too long

The classification has a name for a migraine headache that goes beyond 72 hours: status migrainosus, a debilitating attack that is unremitting for more than 72 hours. It accepts breaks of up to 12 hours because of medication or sleep. It also notes that a headache like this is often caused by medication overuse.

The NHS says to ask for an urgent appointment, or get help from NHS 111 in the United Kingdom, if an attack has lasted longer than 72 hours, if aura symptoms last longer than 1 hour at a time, or if you are pregnant or just had a baby. It also advises seeing a GP if attacks are getting worse, lasting longer than usual, or happening more than once a week.

The NHS says to call 999, the UK emergency number, for a headache that came on suddenly and is extremely painful, problems speaking or remembering, loss of vision or double vision, drowsiness or confusion, a seizure, a very high temperature with signs of meningitis, weakness on one side of the body or face, or a recent head injury. In the United States, call 911 for these. This is general information and not a diagnosis.

What the sources say about length and treatment

The NHS says that migraine attacks around a period, called menstrual migraines, are often longer and more severe than other attacks. It also says that painkillers work best taken as soon as the headache starts, and that taking them more than two days a week can cause more headaches. MedlinePlus says that the sooner a migraine medicine is taken, the better it works, and suggests resting in a quiet, dark room, a cool cloth on the forehead and fluids.

Ask your doctor what to take and when. The right treatment depends on your history, your other medicines and how often you have attacks.

Log the start and end of each phase

A diary answers the question for your own attacks. Write down the time the first warning sign appeared, the time any aura started and ended, the time the pain began, the time you took each medicine, the time the pain eased and the day you felt normal again. Add what you did that day and what you ate, slept and drank.

After a few attacks, you can see your own pattern, and a doctor can tell whether your attacks are getting longer. A record of what you took and when also helps to spot medication overuse.