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Migraine Attacks: Phases Of Pain & Types Of Migraine

Although the exact symptoms, severity, and duration of migraine attacks differ between people, most attacks have four distinct phases. Each phase has different types of symptoms that help identify which phase you are experiencing. Understanding migraine phases can help you recognize early warning signs of an attack, and guide you to treat it before the worst symptoms begin.  

The four migraine attack phases are prodrome, aura, headache, and postdrome. While the first two phases have non-headache symptoms, the headache phase is where individuals experience pain and throbbing sensation in their head and neck [1]. 

Not all patients experience severe headache attacks, and for some, a migraine attack might come without a headache at all. There are medications as well as drug-free treatment options that your provider can prescribe you. Ask them about these options.

What Exactly is a Migraine Headache Attack?

The headache phase is the third stage of a migraine. It comes after the early warning signs of the prodrome and aura phases, however, both of these earlier phases may not appear in every patient or in every attack. 

In this phase, patients may experience migraine attack symptoms like sharp head pain that shifts from one side of the head to the other, sensitivity to light, sensitivity to sound, nausea, vomiting, neck pain or neck stiffness, insomnia, anxiety, nasal congestion, giddiness, depression, or sensitivity to smell [2]. 

The headache phase can last several hours to a few days when not treated or without effective treatment. During this phase, individuals may find physical activity difficult or aggravating [3].

What are the Types of Migraine?

There are several different types of migraine: vestibular migraine, hemiplegic migraine, menstrual migraine, with or without aura, brainstem aura, chronic migraine, episodic migraine, ocular migraine, and retinal migraine [4]. 

Chronic and Episodic Migraine 

Episodic migraine attacks are more common than chronic migraine attacks and can be experienced for up to seven days each month. If you experience a migraine for more than seven days each month, you may have chronic migraine attack and should consult your healthcare provider [5].  

Chronic migraine is defined as having headache on at least 15 days per month, with eight of these having migraine symptoms, for at least three months [6]. 

Vestibular Migraine 

The symptoms and stages of vestibular migraine are similar to other types, except for the additional experience of vertigo or a spinning sensation. Vestibular migraine attacks can last up to an hour in some cases [7].

Hemiplegic Migraine 

Hemiplegic migraine symptoms are rare but include weakness on one side of the body, blurry vision, nausea, fever, visual distortion, and other aura symptoms. These symptoms can mimic a stroke or other neurological conditions like seizures. A proper diagnosis is needed in case of such symptoms or weakness on one side of the body [8].  

Menstrual Migraine 

Menstrual migraine symptoms are often the result of changes in hormonal levels during menstrual cycles. They appear in the time window of between three days prior to menstruation till two days into menstruation. Symptoms can include dull throbbing in the head, dizziness, nausea, and sensitivity to light. On the Women’s Health section of our site, we talk more in-depth about menstrual migraine attacks [9].

Ocular and Retinal Migraine 

Ocular migraine includes visual disturbances like flashes of light, geometric shapes, or zig-zags. Ocular migraine involve both eyes, while in retinal migraine the visual symptoms occur in only one eye. It is also possible to experience temporary blindness during an ocular or retinal migraine. There are other conditions that can also cause vision loss. Contact a doctor immediately if you experience changes in your eyesight [10] [11]. 

Brainstem Aura Migraine 

Brainstem aura migraine includes symptoms like vertigo, ataxia (impaired coordination), or pain in the back of your head. Patients may also experience double vision, impaired hearing, or ringing in the ears. To ensure proper diagnosis and to rule out seizures as the cause of these symptoms, patients must be checked by a doctor as soon as possible [12].  

Migraine is a neurological disease and can result from genetic factors as well as a variety of environmental factors. Drug-free treatments with Nerivio can help manage the symptoms effectively [13].

What Does Severe Migraine Feel Like?

Migraine has four different stages, each with its unique symptoms. Some symptoms are non-headache-related and may include sensitivity to light, sensitivity to sound, nausea, vomiting, neck pain, depression, muscle stiffness, fatigue, or mood changes.

During the headache phase of a migraine attack, an individual experiences severe headache that worsens during physical activity. Along with a headache, increased sensitivity to light or sound, nausea or vomiting are likely. These symptoms can last several hours to a couple of days.

Nerivio’s Quick Q&A Guide on Navigating A Migraine

“Am I Getting a Migraine?”

Migraine is a complex neurological disease. You may have a migraine if you experience headache for longer than four hours, if you have increased sensitivity to light, smell, or noise, if your headache pain is only on one side, or if it worsens while engaging in physical activity.

If you are experiencing migraine symptoms, you should speak with your doctor for a proper health diagnosis.

“Can I Treat Migraine in the Headache Phase?”

It is best to treat migraine attacks as early as possible, even before the appearance of the migraine headache. There are over-the-counter medications and your healthcare provider may prescribe abortive migraine medication, pain medications, or a migraine device such as Nerivio as part of a long-term plan toward pain freedom [3]. 

Your healthcare provider might also educate you about the importance of keeping a migraine diary, to help you catch attacks in the early stages. Contact your provider for short-term relief and a long-term treatment plan for pain management. 

“How do I Prevent Migraine Attacks?”  

Keeping a migraine diary helps each person track their symptoms. By understanding how your symptoms develop in each migraine phase, you will be able to recognize attacks by their early warning signs. When you treat your migraine in the prodrome and aura phases, you are more likely to avoid the painful throbbing sensations of the attack phase [14]. 

If you’re currently experiencing the headache phase, here’s what you can do.

  • Relax in a dark room without bright flashing lights or sensory stimulation. 
  • Do not engage in physical activity during a migraine attack. For most people, activity will aggravate the pain [2]
  • Get plenty of sleep. 
  • Avoid eating trigger foods like chocolate, wine, and alcohol which commonly induce migraine attack [15].
  • Avoid any other triggers you may associate with your migraine attack, such as stressful situations.  


  1. American Migraine Foundation. (n.d.). Migraine Signs & Symptoms. https://americanmigrainefoundation.org/migraine-signs-symptoms/ 
  2. Cleveland Clinic. (n.d.). Migraine headaches. https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches 
  3. Mayo Clinic. (2021, July 02). Migraine. https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207 
  4. National Institute of Neurological Disorders and Stroke. (n.d.). Migraine. https://www.ninds.nih.gov/health-information/disorders/migraine 
  5. Katsarava, Z., Buse, D. C., Manack, A. N., & Lipton, R. B. (2012). Defining the differences between episodic migraine and chronic migraine. Current pain and headache reports, 16(1), 86–92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258393/
  6. Migraine Trust. (2021, Apr 20). Chronic migraine. https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/ 
  7. John Hopkins Medicine. (2021, Dec 13).  Vestibular Migraine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/vestibular-migraine
  8. Migraine Trust. (2021, Apr 20). Hemiplegic migraine. https://migrainetrust.org/understand-migraine/types-of-migraine/hemiplegic-migraine/
  9. Migraine Trust. (2021, Apr 20). Menstrual migraine. https://migrainetrust.org/understand-migraine/types-of-migraine/menstrual-migraine/ 
  10. American Migraine Foundation. (2017, October 19). Understanding Ocular Migraine. https://americanmigrainefoundation.org/resource-library/understanding-ocular-migraine/ 
  11. American Migraine Foundation. (2022, May 12). Retinal Migraine: Symptoms, Causes and Treatment. https://americanmigrainefoundation.org/resource-library/retinal-migraine/
  12. American Migraine Foundation. (2016, October 8). Migraine with Brainstem Aura (Basilar Type Migraine) https://americanmigrainefoundation.org/resource-library/migraine-with-brainstem-aura/   
  13. Migraine Trust. (2021, Apr 20) Genetics and migraine. https://migrainetrust.org/understand-migraine/genetics-and-migraine/ 
  14. Migraine Trust. (2021, Apr 20) Migraine attack triggers.  https://migrainetrust.org/live-with-migraine/self-management/common-triggers/ 
  15. American Migraine Foundation. (2016, January 1). Migraine and Diet. https://americanmigrainefoundation.org/resource-library/migraine-and-diet/
  16. merican Migraine Foundation. (2017, July 27). Top 10 Migraine Triggers And How to Deal With Them. https://americanmigrainefoundation.org/resource-library/top-10-migraine-triggers/

Safety Information

It is highly recommended that you consult your doctor before taking any action based on the information above. This content does not constitute medical advice or a recommendation.

Nerivio is an FDA-cleared, drug-free therapy for acute and preventive treatment of migraine with or without aura in patients 12 years and up. It is a prescription use, a self-administered device for use in the home environment at the onset of migraine headache or aura for acute treatment, or every other day for preventive treatment.

Nerivio should not be used by people with uncontrolled epilepsy, an active implantable medical device, such as a pacemaker, hearing aid implant, or any implanted electronic device. Such use could cause electric shock, electrical interference or serious injuries or medical conditions.”

For full user instructions and safety information, please see the Nerivio User Manual.
Talk to your doctor to see if Nerivio is right for you.