Which Stage of a Migraine Attack Are You In?

Which Stage of a Migraine Attack Are You In?

Migraine is not a headache; it’s a neurological disorder that produces discrete or overlapping attacks composed of pain and other symptoms, such as mood changes, nausea, and difficulty concentrating. 

It’s also different from the common tension-type headache in that it won’t go away with a simple over-the-counter pain reliever like aspirin or ibuprofen.

A migraine attack affects each person somewhat differently, but it’s always a bumpy ride. 

The Migraine Research Foundation indicates migraine is the sixth most disabling disease worldwide. One in four American families has someone living with chronic migraine, defined as 15 or more headache days per month.

Dr. Patrick Brennan and our team at Coastal Pain Medicine understand just how debilitating migraine attacks can be. That’s why we offer a number of treatments to help our patients in the Pompano Beach, Florida, area who live with the disorder. 

Here’s what you need to know about the various stages of a migraine attack, how we help prevent those attacks, and how we treat them.

All about migraine

The exact cause of migraine is unknown, but doctors believe there may be a genetic predisposition since migraine often runs in families. Environmental factors likely that spark the disorder.

Many patients who live with migraine find that certain things can trigger an attack: specific foods, caffeine, tobacco, lack of sleep, and hormonal changes, among other things. But other people seem to have no triggers.

Migraine pain is considered more severe than tension-type headaches, and instead of diffuse pain, it usually affects just one side of the head, most often as a pulsing sensation that gets worse with movement.

In addition, a migraine attack comes with a variety of neurological symptoms that includes:

Which stage of a migraine attack are you in?

A migraine attack contains four discrete stages, though you can get just one, a combination of two or three, or all of them. In order of presentation, the stages are:


This stage is the warning period, starting a day or two before the pain stage starts. The symptoms vary, but some of the most common include mood changes, uncontrollable yawning, food cravings, confusion, and a sense that something is wrong.


You can have a migraine attack with aura or without aura. Generally, a person experiences one type or the other with their attacks, but not both. 

If you experience the aura stage, you may see lightning bolts or zigzag lines across your vision (the most common), or have muscle weakness and/or garbled speech. Auras generally last about 20-30 minutes before the pain hits.

Interestingly, in women over 70, migraine attacks generally present as an aura without the subsequent pain phase.


This stage is what most people think of as the migraine attack. For some people, the pain starts gradually, while for others it hits all at once. It often comes up the back of your neck, then settles into a throbbing on one side of your head and in the eyeball. It can last anywhere from four to 72 hours. 

Common side effects of this stage are GI distress and sensitivities to light, sound, and smell.


Even once the pain diminishes, the attack isn’t over. Most people experience a postdrome stage, akin to a post-adrenaline crash. It’s common to feel weak, tired, and mentally disoriented for a couple more days.

Migraine treatment

Because migraine differs from other headache types, it requires different kinds of treatment. Some prevent attacks, and some abort the attacks when they occur. 

Preventive treatments include a variety of medications, including the newly available anti-CGRP monoclonal antibodies and gepants, which specifically target migraine pathways in the brain. Neuromodulation devices are also an option.

Pharmaceutical options for aborting an attack include the triptans, the ergotamines, and a number of gepants.

Dr. Brennan can advise you about which of these options may be appropriate for you.

Coastal Pain Medicine also offers longer-lasting options, like acupuncture therapy and Botox® injections. 

The active ingredient in Botox comes from the same bacterium that causes botulism (food poisoning). But when diluted and administered by a properly trained physician like Dr. Brennan, this FDA-approved migraine treatment is completely safe. It temporarily paralyzes selected nerve fibers, preventing pain signals from reaching your brain. 

The results last 3-4 months, after which you can get another treatment, and many people see lasting relief.

If you suffer from migraine, knowing how to deal with each stage of an attack allows you to escape many of the effects. To learn more and to find out which treatments might be right for you, call Coastal Pain Medicine at 954-284-0996, or book online with us today.

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