How long do migraine symptoms typically last?

A typical migraine attack lasts between 4 and 72 hours if not treated. However, the entire process including the prodrome and postdrome phases can last for several days. Early warning signs may appear two days before the pain, and the recovery phase can last for 24 hours after the headache is gone.

What does a migraine aura feel like?

An aura often feels like a visual disturbance, such as seeing flashing lights, blind spots, or zigzag lines. It can also cause physical sensations like tingling in the hands or face. Most auras develop slowly over a few minutes and last about 20 to 60 minutes before the headache pain starts.

Can migraines cause symptoms besides head pain?

Yes, migraines are whole-body events. Many people experience nausea, vomiting, and extreme sensitivity to light, sound, and smells. During the early stages, you might notice mood swings, neck stiffness, or frequent yawning. After the headache, it is common to feel very tired or mentally foggy for about a day.

Are migraines always on one side of the head?

While one-sided pain is a classic sign of a migraine, it is not always the case. The pain can shift from one side to the other, or it can affect both sides of the head at once. Regardless of the location, the pain is usually described as throbbing or pulsing rather than a steady ache.

What is the difference between a migraine and a sinus headache?

Migraines are often misdiagnosed as sinus headaches because both can cause facial pain and a stuffy nose. However, a true sinus headache is caused by an infection and usually involves fever and thick mucus. If your "sinus" headache includes nausea or sensitivity to light, it is most likely a migraine.

When should I be worried about my migraine symptoms?

You should seek medical help if your symptoms change suddenly or become more severe. Warning signs include a "thunderclap" headache that starts instantly, a headache with a high fever and stiff neck, or new symptoms like confusion, fainting, or weakness in your limbs. These may indicate a more serious underlying condition.

🧠 Neurological

Migraine

Recurrent, often disabling headaches with sensory sensitivity and nausea.

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Overview

Migraine is a primary headache disorder. Attacks last hours to days and respond to specific acute and preventive treatments.

Symptoms

• Throbbing, unilateral headache
• Nausea or vomiting
• Light and sound sensitivity
• Aura (visual or sensory) in 25%

Risk factors

• Female sex
• Family history
• Hormonal cycling
• Sleep disruption
• Stress

Causes

• Neurovascular dysregulation with trigeminal activation

🚨 Red flags — seek urgent care

• Sudden 'thunderclap' headache (peak within 1 minute)
• New headache after 50
• Fever, stiff neck
• Focal weakness or speech change persisting beyond aura

When to seek care

• More than 4 attacks per month
• Aura without headache that is new
• Medication overuse risk

Diagnosis

• Clinical diagnosis using ICHD-3 criteria — recurrent moderate–severe unilateral throbbing headache, 4–72 h, with nausea or photophobia/phonophobia
• With aura: visual, sensory or speech disturbance lasting 5–60 min
• Imaging only if red flags (SNOOP4: Systemic features, Neurological signs, Onset sudden, Older, Pattern change, etc.)

Treatment

• Acute: simple analgesia (paracetamol/NSAID) ± triptan ± antiemetic
• Avoid opioids and overuse of acute medication (>10 days/month = medication-overuse risk)
• Preventive (≥4 attacks/month or significant disability): propranolol, topiramate, amitriptyline, candesartan
• Specialist: CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab), botulinum toxin for chronic migraine
• Lifestyle: sleep regularity, hydration, trigger diary, manage stress

Prevention

• Identify and manage personal triggers (sleep loss, dehydration, dietary)
• Regular meal pattern and adequate sleep
• Limit caffeine and alcohol; manage stress
• Treat coexisting depression, anxiety and sleep disorders

Complications

• Chronic migraine (≥15 headache days/month)
• Medication-overuse headache
• Migrainous infarction (rare)
• Status migrainosus (attack >72 h)
• Significant disability, mood disorder

Education & self-care

A headache diary helps identify triggers (sleep, dehydration, alcohol, specific foods) and confirms diagnosis.

Frequently asked questions

Is migraine dangerous?

The attacks themselves are not — but red-flag headaches need urgent assessment to exclude other causes.

Can it be prevented?

Yes — preventive medication, CGRP antagonists, and behavioral strategies all reduce attack frequency.

What is the difference between acute and preventive treatment?

Acute treatment (triptans, NSAIDs, paracetamol) is taken during an attack. Preventive medication (propranolol, topiramate, amitriptyline, CGRP antibodies) is taken daily to reduce frequency when attacks are frequent or disabling.

Are triptans safe?

Yes for most adults. They should be avoided in people with established coronary, peripheral or cerebrovascular disease, uncontrolled hypertension, or hemiplegic migraine.

Can painkillers cause migraine?

Yes. Regular use of acute medication on 10+ days per month (15+ for paracetamol or NSAIDs) can drive medication-overuse headache. Reducing intake — sometimes with bridging therapy — is the cure.

Evidence-based sources

Medically reviewed by Dr. Handel Emery, MD, FRCP (UK) · Last reviewed 2026-06-08