Migraine Symptoms: A Guide to What You Might Feel

The Five Phases of a Migraine

When people talk about migraine generally, they often are referring to the period when they experience head pain during an episode (commonly referred to as “attack”). However, a migraine episode develops in 4 phases: prodrome or premonitory phase, headache or main phase, resolution, and postdrome or recovery phase (also commonly referred to as “the hangover”), with some people also experiencing aura at times.

The period of time in between episodes is called the “interictal phase”. 

Below is a breakdown of the progression of each phase and the common symptoms accompanying each phase.

Understanding how migraine shows up for you is an important part of managing it well. Migraine looks different for everyone—and even from one episode to the next. By learning to recognise your personal signs and symptoms, you may be able to catch an episode earlier and treat it more effectively.

Prodrome (Early Warning Signs)

The prodrome, or premonitory phase serves as an early warning signal that a migraine episode is developing. Around 75% of people experience prodrome symptoms.

During this first stage people can feel a variety of physical and mental changes such as:

• • • brain fog, trouble concentrating, or difficulty processing information
    • fatigue or tiredness
    • food cravings (such as for sweet or salty food)
    • frequent urination
    • frequent yawning
    • mood changes, such as depression, irritability, or elation/euphoria
    • nausea
    • neck stiffness or pain
    • sensitivity to light (photophobia)
    • sensitivity to noise (phonophobia)
    • sensitivity to smells (osmophobia)
    • sleeping difficulties

These feelings can last from 1 to 24 hours.

Most people would still be working or getting through their usual day at this point in the episode.

This early phase is the point at which acute medication can be the most effective as it is what’s known as the onset of the episode.  Research shows it may double your chances of being pain-free within two hours  – but be careful of how often you take your acute medication, and discuss this with your doctor. (1)

Many people think the symptoms during this stage are triggers when in fact the migraine episode has already started.

Learning to distinguish between triggers and what symptoms are part of your prodrome can help identify them as warning signs and can help you implement your strategies and take your medication early on to try to prevent an episode from developing past this first stage.

Aura (If Present)

Aura occurs due to a spontaneous, wave of electrical and chemical activity called cortical spreading depression, that moves slowly across the cortex (the outer layer of the brain), temporarily affecting the functioning of the parts it travels over.  

The associated symptoms (link to migraine with aura below) are reversible and depend on which parts of the brain are affected.

This stage can last from 5 to 60 minutes, and usually happens around 30-60 minutes before the headache. Migraine without aura does not include this stage.

Many people find aura symptoms very debilitating and wouldn’t be able to function properly during this stage.

Not everyone with migraine experiences aura, and even in those who do, it may not occur with every episode. While aura can be unsettling, recognising it as part of migraine can help you act early with treatment and self-care.

Headache (Main Phase)

This is the main phase of an episode. This stage involves head pain which can be severe, even unbearable. People often describe it as somebody sticking an ice-pick in your eye or drilling your head.

The headache is typically throbbing, and made worse by movement. Some people describe a pressing or tightening pain.

Migraine is traditionally viewed as a headache that is worse or only present on one side. However, some people do experience the pain equally on both sides, or even spread all over the head.

Nausea and vomiting can happen at this stage, and the person with migraine may feel sensitive to light, sound, smells or all three.

This stage can last anywhere from 4-72 hours if left untreated. People may need to retreat to a dark room and lie motionless. 

This is typically when working people would take a day of sick leave if it is possible.

Resolution

Most episodes slowly fade away, but some stop suddenly. Sleep seems to help many people. Even an hour or two of sleep can be enough to end an episode.

Postdrome (Recovery Phase)

Recovery may give the impression of rest, however in reality this final stage of an episode is often described as a ‘hangover’ type feeling and it can take hours or days to disappear.

Symptoms can be similar to those of the first stage, and often they are mirrored symptoms.  For example, if a person lost their appetite at the beginning of the episode, they might be very hungry now. If they were tired, now they might feel full of energy.

Although migraine typically follows the five phases, the length and intensity of each phase can vary greatly. Some people may experience a short episode that resolves within hours, while others may endure symptoms over several days. The timelines below illustrate how migraine can look in short, medium, and long episodes—showing just how unpredictable this condition can be. In addition to these examples, some attacks may last more than 72 hours. Called ‘status migrainosus’, these protracted attacks often will need medical care and specific therapies to end them.

Interictal (in between episodes)

Even when the headache itself isn’t present, people with migraine often experience ongoing symptoms and challenges. These can include:

• • • hypersensitivity to light, sound, or motion
    • difficulty concentrating or thinking
    • fatigue
    • emotional distress
    • anxiety about when the next episode will happen

Such interictal symptoms significantly impair quality of life, reducing mobility, cognitive function, and overall wellbeing even between episodes. (2)

Common Migraine Symptoms

Migraine is a complex neurological condition that can affect the whole body. While head pain is the most commonly recognised symptom, it is only one part of the picture. Because the brain and nervous system regulates so many body functions, migraine symptoms can affect or be associated with issues relating to the digestive, musculoskeletal, and cardiovascular systems.

This is why migraine is so complex, with symptoms that reach far beyond head pain.

Nervous System (Central & Peripheral)

• • • Confusion, difficulty concentrating, lack of mental clarity, memory lapses, brain fog
    • Numbness, tingling, temporary paralysis, depersonalisation
    • Dizziness, difficulty balancing, vertigo
    • Sensitivity to light, sound, and smell (photophobia, phonophobia, osmophobia)
    • Visual disturbances, olfactory hallucinations  (i.e., experiencing a smell that is not from the external environment)
    • Anxiety, irritability, mood changes

Musculoskeletal System

• • • Jaw pain
    • Neck pain
    • Muscle fatigue

Digestive System (Gastrointestinal)

• • • Abdominal pain, colic (in infants/children)
    • Nausea, vomiting
    • Diarrhoea, constipation

Cardiovascular System

• • • Cold extremities (due to changes in blood flow and autonomic regulation)
    • Flushing, hot flashes, chills (autonomic dysfunction affecting vascular tone)

Respiratory / ENT System

• • • Sinus pain and pressure (often from trigeminal nerve activation rather than sinus disease itself)
    • Nasal congestion
    • Tinnitus (ringing in the ears)

General / Systemic

• • • Fatigue, headache, yawning

Below we delve into more detail but it is important to remember that migraine can look very different from person to person, and these are only some of the many symptoms that people with migraine can experience.

Head Pain

Migraine pain is often described as throbbing or pulsating, but it can vary in intensity and location. Although many people associate migraine with one-sided pain, it can also be bilateral (on both sides of the head) or felt all over the head. (3)

Sensitivity to Light, Sound, and Smells

People with migraine commonly experience heightened sensitivity to sensory stimuli, such as light (photophobia), sound (phonophobia), and sometimes smells (osmophobia). These sensitivities can be so severe during an episode that people need to retreat to a dark, quiet environment.
In one study of over 6,000 people with migraine, photophobia was reported as the top Most Bothersome Symptom (MBS) for 49.1% of respondents. And phonophobia was the third MBS for 22.8% of respondents. (4)

Nausea and vomiting

Nausea is one of the most disabling symptoms of migraine, often accompanied by vomiting. These gastrointestinal symptoms can be more distressing than the pain itself, and they can make oral medications difficult to keep down. It is worth considering adding anti-nausea medications and non-oral treatment options (for example, nasal sprays or subcutaneous injections) for those who experience significant nausea during migraine episodes.
In the MAST study nausea was the second Most Bothersome Symptom for 28.1% of respondents. (4)

Visual Disturbances

About a quarter to a third of people with migraine experience aura, which most often involves visual disturbances such as flashing lights, zigzag lines, or blind spots. These symptoms typically precede the headache phase but may also occur during it. (5, 6)

Less Common but Recognised Symptoms

Migraine is more than just a headache and there are over 30 different symptoms that can be just as debilitating as head pain which can and do manifest before, during and after an episode in many people.

Neck pain and stiffness

Many people with migraine experience neck pain or stiffness, which may occur before, during, or after a migraine attack. For some, neck pain is part of the migraine itself, while for others it may be a separate condition or a trigger. Migraine pain processing pathways in the brain include inputs from the neck, which can result in referred pain. (7)

Mood changes

Mood changes are common in the hours or days before a migraine attack, and can include irritability, depression, or even elation. These changes are considered premonitory (prodromal) symptoms and may provide a warning that a migraine episode is coming. (8)

Food cravings or appetite changes

Some people with migraine experience cravings for certain foods (such as chocolate or sweets), loss of appetite, or increased hunger before a migraine episode. These changes are now thought to be early symptoms of the brain changes that precede migraine pain, rather than triggers themselves. (8)

Frequent urination

Needing to urinate more often than usual can be a premonitory symptom of migraine, occurring in the hours before headache pain begins.(9)

Yawning

Excessive yawning is a classic early warning sign of migraine. While everyone yawns at times, repetitive yawning (often many times in a row) may signal the start of a migraine episode for some individuals. (9)

Neurological Symptoms

Difficulty Speaking or Thinking Clearly

Many people with migraine experience cognitive symptoms such as trouble finding words, slowed thinking, confusion, or a sense of “brain fog.” This can occur before, during, or after a migraine attack and may be accompanied by fatigue. (10)

Tingling or Numbness

Tingling (paresthesia) or numbness can occur as part of sensory aura in migraine, most commonly affecting the face, hands, or arms. These symptoms are typically temporary and reversible. (3)

Vertigo and Dizziness

Some migraine episodes are accompanied by vertigo (a spinning sensation), dizziness, or balance problems. These symptoms may occur with or without headache and are especially common in vestibular migraine. (11)

Weakness or Paralysis (Rare)

Rarely, migraine episodes can cause temporary weakness or even paralysis on one side of the body, a condition known as hemiplegic migraine. These neurological symptoms can mimic those of a stroke but are fully reversible. Remember that any sudden loss of function (e.g., sensory change, weakness) should be brought to urgent medical attention, as it may be a stroke that requires emergency care. (12)

Symptoms by Migraine Type

Migraine With Aura (5, 6, 9)

• • • Main features: Temporary neurological symptoms before or during headache, most commonly visual changes such as flashing lights, zig-zag lines, blind spots, or colourful patterns.
    • Duration: Aura typically lasts 5–60 minutes and often occurs 30–60 minutes before head pain.
    • Other symptoms: Tingling or numbness, difficulty speaking, dizziness, confusion, or rarely, temporary paralysis.
    • Distinctive point: Aura symptoms are reversible and vary depending on which area of the brain is affected by the slow-moving wave of electrical activity.
    • Other useful information: Around 30% of people with migraine experience aura at least once, but only about 15% have aura with every episode. When aura lasts longer than an hour, it is called “prolonged aura,” which is less common.

Vestibular Migraine (13)

• • • Main features: Dizziness, vertigo (spinning, rocking, floating, swaying), and balance problems.
    • Duration: Episodes may last minutes to several days.
    • Other symptoms: Nausea, sensitivity to light and sound, visual aura, hearing changes, confusion, and distorted perception (sometimes described as Alice in Wonderland Syndrome).
    • Distinctive point: Dizziness can occur with or without head pain, which makes it different from most other migraine types.
    • Other useful information: Vestibular migraine shares many triggers with other migraine types (stress, hormonal changes, lack of sleep, dehydration, certain foods), but dizziness can also be triggered by head movement or intense visual stimulation.

Hemiplegic Migraine (12)

• • • Main features: Temporary weakness or paralysis on one side of the body, often with other migraine symptoms.
    • Duration: Symptoms can last from several hours to a few days before resolving.
    • Other symptoms: Visual changes, tingling, dizziness, and speech difficulties. Head pain may or may not occur.
    • Distinctive point: Can mimic a stroke, so urgent medical assessment is essential the first time it occurs.
    • Other useful information: Hemiplegic migraine often begins in childhood and may run in families.

Chronic Migraine

• • • Main features: Headache on 15 or more days per month for at least 3 months, with at least 8 days having features of migraine.
    • Duration: Ongoing, frequent, or daily episodes.
    • Other symptoms: Sensory sensitivities, nausea, fatigue, brain fog, mood changes, and anxiety about future episodes.
    • Distinctive point: Greatly affects quality of life due to frequency and unpredictability, often impacting work, study, and relationships.
    • Other useful information: People with chronic migraine often benefit from a holistic management plan, including medical treatment, lifestyle strategies, and psychological support.

Hormonal or Menstrual Migraine  (14, 15)

• • • Main features: Hormonal migraine episodes occur around menstruation, often are more severe, longer-lasting, and harder to treat than attacks at other times.
    • Duration: Typically from two days before through to day three of bleeding.
    • Other symptoms: Usually occur without aura, even in people who have aura at other times of the cycle.
    • Distinctive point: Triggered by hormonal fluctuations, particularly the drop in estrogen  level that occurs just before the onset of bleeding.
    • Other useful information: Around half of women with migraine notice a menstrual connection. Very high estrogen levels (during pregnancy, while taking the combined pill, or with HRT) can increase the likelihood of migraine with aura.

Migraine Without Aura  (14, 16)

• • • Main features: Recurrent moderate to severe head pain, often one-sided (but may be both sides, especially in children). Pain is throbbing or pulsating and worsens with routine activity.
    • Duration: 4–72 hours if untreated or unsuccessfully treated.
    • Other symptoms: Nausea, vomiting, sensitivity to light and sound.
    • Distinctive point: Does not include reversible neurological symptoms such as visual changes or tingling.
    • Other useful information: This is the most common type of migraine and is diagnosed based on symptom history, as there are no biomarkers or specific tests.

Migraine in Children and Adolescents 

Main Features (17, 18, 19)

• • • Headache in children may present differently than in adults.
    • Head pain is common, but not always present or may not be the main symptom.
    • Can also appear as abdominal pain, repeated vomiting, nausea, or pallor.
    • Behavioural clues are important: covering eyes, withdrawing to dark/quiet spaces, avoiding noise.

Duration

• • • Attacks are often shorter than in adults.
    • In young children, they may last as little as 2 hours (compared to a minimum of 4 hours in adults).

Other Symptoms

• • • Sensitivity to light and sound (sometimes shown through behaviour rather than words).
    • Visual disturbances, dizziness, brain fog.
    • Colic in infants.
    • Pain can be bilateral (both sides of the head) and more diffuse.

Other Useful Information

• • • Before puberty, migraine affects boys and girls equally; after puberty, it becomes more common in girls.
    • Migraine in children is often misdiagnosed, particularly as gastrointestinal issues (abdominal pain, cyclic vomiting, colic), tension-type headache, or sinus headache.
    • Symptoms may initially be mistaken for repeated stomach bugs, intestinal problems, or even avoidance of school activities. Recognising the pattern early can reduce delays in diagnosis and treatment.

When Migraine Symptoms Can Mimic Other Conditions

As we have seen, migraine symptoms are varied and wide-ranging and can be quite debilitating, sometimes they can mimic other serious conditions.

In a national research study carried out this year of the experience of women with migraine in Australia, (20) respondents reported that because migraine has many overlapping symptoms with other chronic conditions, consequently many were misdiagnosed, most commonly with: 

• • • tension headaches, 
    • sinus issues, 
    • chronic fatigue syndrome (CFS), 
    • anxiety, 
    • depression, 
    • TIA/mini-stroke, 
    • tinnitus (ringing sound in the ears), 
    • ataxia (unsteadiness when moving),
    • multiple sclerosis (MS). 

Eventually they were correctly diagnosed with migraine.

Interestingly, because of this overlap in symptoms, migraine was also diagnosed in cases where the person didn’t have it. Conditions misdiagnosed as migraine included: Occipital Neuralgia, Stroke, CerebroSpinal Fluid (CSF) leak, Benign Paroxysmal Positional Vertigo (BPPV). (20)

Because of these overlapping symptoms, it is important for healthcare providers to systematically rule out other potential causes when diagnosing migraine, especially when symptoms are atypical or alarming. Because there are currently no biomarkers or definitive laboratory tests to diagnose migraine, brain imaging (such as MRI or CT scans) is used not to confirm migraine, but to exclude other serious conditions—such as brain tumours, stroke, or structural abnormalities—that could explain the headache symptoms.

When migraine symptoms are typical and there are no warning signs, imaging is rarely necessary. Imaging may be done when migraine occurs with certain ‘red flags’ – please see the section below.

Stroke or TIA (21)

Migraine with aura, especially with sensory, visual, or motor symptoms, can closely resemble a stroke or TIA. Symptoms such as sudden weakness, numbness, difficulty speaking, or vision changes may be mistaken for a cerebrovascular event. However, migraine aura typically develops gradually (over minutes), is fully reversible, and often includes positive neurological symptoms (like flashing lights or tingling), whereas stroke/TIA symptoms tend to be negative (loss of function) and abrupt.

Sinus Headache (22)

Migraine is frequently mistaken for a sinus headache because it often causes pain in the forehead, around the eyes, or in the face, and can be associated with nasal symptoms such as congestion or runny nose. However, true sinus headaches are rare and usually occur with signs of sinus infection (fever, thick nasal discharge). Most so-called “sinus headaches” in the general population are actually migraine.

Tension-Type Headache  (16)

Tension-type headache is the most common primary headache disorder and is characterized by mild to moderate, pressing or tightening pain, often on both sides of the head. Migraine can sometimes present with similar features—especially when mild or without nausea—and may be misdiagnosed as tension-type headache. Conversely, people with tension-type headache may also experience light or sound sensitivity, which are features of migraine.

Cluster Headache (23)

Cluster headache is often misdiagnosed as migraine because both can cause severe, one-sided pain and associated symptoms (such as teary eyes or runny nose), they are sometimes confused. However, cluster headache is a distinct and severe headache disorder, often described as one of the most excruciating types of pain known to medicine. Key differences include:

• • • Cluster headache attacks are strictly one-sided, “uniformly severe” (they start and end with the same level of intensity), and much shorter in duration (usually less than two hours) than migraine attacks.
    • Autonomic symptoms (tearing, runny or blocked nostril) are almost always present and occur on the same side as the pain in cluster headache.
    • Cluster attacks often wake people from sleep, typically in the early night hours.
    • Cluster headache attacks are highly stereotyped and occur with clock-like regularity during a cluster period.

Red Flag Symptoms: When to Seek Immediate Medical Help (24)

While most headaches can be managed at home, certain warning signs—or red flags—mean it’s important to get medical attention quickly.

Key situations that warrant urgent help can be:

• • • A sudden, severe headache that comes out of nowhere—often called a “thunderclap” headache—could be a sign of something serious, such as bleeding in the brain.
    • Headache with neurological symptoms, like sudden weakness, numbness, confusion, trouble speaking, or vision changes, may indicate conditions like stroke or brain tumour.
    • Headache following a head injury, especially if it worsens or comes with confusion, vomiting, or drowsiness, may suggest brain injury or bleeding.
    • Fever plus stiff neck and headache could be signs of an infection like meningitis—this combination needs urgent evaluation.
    • A rapidly worsening or persistent headache, different from what you’d usually experience, should prompt medical review—especially if it doesn’t improve or gets progressively worse.
    • Mood, memory, or behaviour changes alongside headache may point to underlying neurological concerns and should not be ignored.
    • New or severe headaches accompanied by vision changes, or positional headaches that worsen when upright and improve when lying down, can signal high or low pressure headaches, which may lead to permanent vision loss, bleeding on the brain, or even coma if not treated urgently.

These warning signs align with the clinical SNNOOP tool used by healthcare professionals to help distinguish between unmanaged migraines and potentially serious conditions. (25)

Tracking and Communicating Your Symptoms

Keeping track of your migraine symptoms can help you understand your condition and make conversations with your healthcare provider more effective. A migraine diary is one useful tool. You can record details such as triggers, symptoms, medications, timing, duration, and other factors like stress, hormones, or weather. This can highlight patterns and show how migraine is affecting your daily life. Use whatever format works best for you—paper, calendar, or an app. If daily tracking feels overwhelming, it’s fine to scale back; the goal is to make it useful, not stressful.

Another simple approach is keeping track of migraine impact on you by using the “Traffic Light System,” which uses colour codes to describe how much migraine is affecting you:

• • • Green light (“I can GO”) – you can keep up with daily activities despite your headache.
    • Yellow light (“I need to SLOW down”) – you can continue, but only with caution and rest.
    • Red light (“I must STOP”) – migraine forces you to stop, lie down, or withdraw.

Using these tools can make it easier to explain your symptoms, track changes over time, and work with your healthcare provider on the best plan for you.

What to Tell Your Doctor

When speaking with your doctor, it helps to share as much detail as possible about your migraine symptoms and their impact on your daily life. Be ready to explain:

• • • The type of symptoms you experience (head pain, nausea, sensory changes, fatigue, etc.).
    • How long your symptoms usually last and how often they occur.
    • How severe the symptoms are and whether they interfere with work, school, or daily activities.
    • Any medications or strategies you’ve tried and whether they helped.
    • Family history of migraine or other neurological conditions.

Clear and honest communication gives your doctor the best chance of identifying the right diagnosis and treatment options for you.

Symptom Patterns to Note

Tracking patterns in your symptoms can provide valuable insights. Some things to pay attention to include:

• • • Timing – when symptoms occur (for example, around menstruation, after changes in sleep, or with stress).
    • Progression – how your symptoms develop during each phase of an episode, from prodrome through to recovery.
    • Triggers – possible factors that seem to bring on your migraine (foods, hormones, weather changes, sensory overload, etc.).
    • Recovery – how long it takes to feel back to normal after an episode.

Recognising these patterns can help you and your healthcare team tailor a more effective management plan.

Conclusion

Migraine is a complex, whole-body neurological condition with symptoms that extend far beyond head pain. It affects or can be associated with other issues relating to the nervous, digestive, musculoskeletal, cardiovascular, and autonomic systems, and can vary not only from person to person but also from one episode to the next. Understanding this wide range of symptoms is key to recognising migraine as the disabling condition it can be, and to managing it more effectively.

Because migraine symptoms can overlap with other serious health conditions, it is important to seek medical advice to rule out other causes and to confirm the diagnosis. Imaging is not used to diagnose migraine itself, but rather to exclude other conditions. When symptoms are typical and there are no warning signs, imaging is rarely necessary.

Living well with migraine means taking a proactive approach. Recognising and tracking your own migraine symptoms and patterns can be a powerful step in taking back some control. This knowledge helps you act early, communicate clearly with your doctor, and find treatments and strategies that work for you. 

For people with episodic migraine, early care and attention to risk factors can help reduce the chance of progressing to chronic migraine. Working in partnership with a healthcare provider who takes a whole-person approach—considering lifestyle, mental health, and personal needs—can make a meaningful difference to long-term health and quality of life.

By building awareness that migraine is more than “just a headache”, we can help reduce stigma and highlight the significant physical, emotional, and psychological toll it has on those who live with it. With early diagnosis, timely management, and the right support, people with migraine can improve their quality of life, feel empowered in their care, and know they are not alone in their journey.

Further Resources and Information

If you would like to learn more about migraine, mental health support available in Australia and other tools and resources which may support your migraine management, you may find the following useful:

• • • Migraine – a comprehensive article about migraine symptoms, causes, treatments, and more.
    • Acute Migraine Medication – article summarising other types of acute migraine medication, including a general overview of other triptans. 
    • Treatment directory – overview article including a brief explanation of the medications available to treat migraine and different classes of treatment.
    • Gepants – overview of all gepants in the market and available in Australia
    • Understanding and Managing the Psychological Impact– article exploring the less visible impacts of living with migraine, offers practical, evidence-informed strategies to help people living with migraine not just cope, but live well
    • Strategies to Help Prevent the Progression from Episodic to Chronic Migraine – article exploring the factors that play a role in migraine chronification and strategies for prevention.
  • • Migraine tracking apps: Migraine Buddy, N1-Headache
    • The Traffic Light of Headache diary-keeping method: https://americanheadachesociety.org/news/the-traffic-light-of-headache
    • The Social Model of Disability – https://afdo.org.au/social-model-of-disability/

Share this article – and the below resources – with someone you think could benefit from it

Downloadable Resources

Migraine & Headache Australia Migraine Management Plan
MHA Migraine Management Plan

Key Principles for Preventing Progression from Episodic to Chronic Migraine
MHA Key Principles of Preventing Progression to Chronic Migraine

References 

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