If you have ever experienced the pain of migraine, you’re familiar with the signs of an attack coming on: intense pain, sensitivity to light or sound, and maybe a little nausea is the cherry on top. These warning signs let you know it’s coming, but you wonder, how long can a migraine last? When will you be able to resume your normal life?
What is migraine?
Migraine is a type of headache that brings on moderate to severe pain. Migraine attacks unfold through a cascade of events. Migraines often cause episodic pain, located on one side of the head that feels like throbbing or pulsing pain.
Although migraine has a genetic cause (90% of people with migraine have a family history of migraine), some triggers can cause migraine attacks. Common triggers include:
- Stress or anxiety
- Fluctuation of hormones, menstrual period
- Bright lights, loud noises, powerful smells
- Certain medications
- Too little or too much sleep
- Sudden weather or environmental changes
- Excess physical activity
- Certain foods, such as alcohol, chocolate, aged cheeses, food additives like MSG (monosodium glutamate), fermented or pickled foods, yeast, cured or processed meats
- Skipped meals
- Aspartame, nitrites, alcohol, caffeine, or other substances that make your blood vessels contract then dilate
How common is migraine?
Migraine is the third most prevalent illness in the world, according to the Migraine Research Foundation. Almost 1 in 4 households in the U.S. includes someone with migraine.
Migraine is much more common in women, affecting three times as many adult women as men. Migraine is poorly understood and often undiagnosed and undertreated. The condition has a tremendous economic impact: People who live with migraine may have high medical costs, limited support, or poor access to quality care. In fact, migraines are a common cause of disability and ranked second (after low back pain) with respect to life lived with disability.
Migraine symptoms vary, but you may experience some of the following symptoms:
- Moderate to severe headache pain, usually unilateral, but not always—which can be either side of the head or in the front or back
- Head pain that can feel like throbbing, pounding, or pulsating and worsens with movement
- Nausea and vomiting
- Sensitivity to light, noise, smells
A migraine attack can be so severe as to lead to missed work or school days.
One way to remember migraine symptoms is with the acronym POUND.
P: Pulsating pain
O: One-day duration of severe untreated attacks
U: Unilateral pain (pain on one side)
D: Disabling intensity
How long do migraines last?
A typical migraine attack can last from four hours to 72 hours—but can vary widely. Migraine attacks occur in phases. It can be helpful to recognize the first stage—when migraine attack is coming on—so you can take medication as recommended by your healthcare provider.
Not every phase occurs during every attack. Keeping a migraine journal (on paper or with an app) and taking detailed notes of symptoms and times can help you and your physician find patterns and establish an effective treatment plan.
The phases of migraine are:
|Phases of migraine|
|Phase||Description||Symptoms||How long does it last?|
(occurs in up to 77% of migraineurs)
|The beginning of a migraine||Irritability; euphoria, sensitivity to light or sound; fatigue; nausea; difficulty with concentration, reading, or speaking; yawning; food cravings; frequent urination||24 to 48 hours|
|Aura (potentially)||A symptom for 25% to 30% of people with migraine that often involves changes in vision||Vision disturbance: seeing sparks, dots, or zig-zags or vision loss
Sensory disturbance: numbness or tingling
Motor disturbance: jerking
|5 minutes to 1 hour|
|Headache||Pain is the main symptom, can lead to absence from work or school||Throbbing pain; pain and stiffness in the neck; nausea; vomiting; sensitivity to light and sound||4 hours to 72 hours|
|Postdrome||Known as the “hangover,” the period when pain ends, but the migraine is still occurring||Mood changes; fatigue; difficulty concentrating, sudden head movements transiently cause pain in the location of the previous headache||24 to 48 hours|
RELATED: How to survive a migraine hangover
How can I make a migraine go away?
Prevention is one of the best tools for stopping migraine symptoms. “One of the most effective ways to treat migraine is simply not to have one,” says Alex Feoktistov, MD, the founder and the president of the Synergy Integrative Headache Center in Chicago, Illinois. Identifying and avoiding the things that trigger your migraine onset is key. “Trigger avoidance is a very important treatment strategy that allows us to reduce migraine attack frequency naturally,” Dr. Feoktistov says.
Migraine can be challenging to diagnose and treat, but there are many helpful medications and strategies. Seek advice from a headache specialist if you experience moderate or severe headaches that are difficult to control. A headache specialist can help to establish a treatment plan that includes preventive and acute treatment for migraine pain.
Preventive treatment aims to reduce the frequency of migraine attacks and may take several weeks to start working. Preventive treatment can be considered if you have at least three or four episodes per month, and/or experience significant disability from the attacks.
Preventive treatment options may include one or a combination of the following:
- Dietary supplements such as magnesium, riboflavin, and coenzyme Q10
- A beta blocker such as propranolol or metoprolol
- An anticonvulsant such as divalproex or topiramate
- An antidepressant such as amitriptyline or venlafaxine
- A CGRP (calcitonin gene-related peptide) inhibitor such as Aimovig, Ajovy, Emgality, or Vyepti
- Botox injections every 12 weeks
Lifestyle changes to avoid triggers can help decrease the number of attacks as well.
While the goal of preventive treatment is to reduce the frequency of attacks, the goal of acute or abortive treatment is to stop an ongoing migraine attack. It should work quickly, within one or two hours, Dr. Feoktistov explains. Abortive treatments work best when given early in the course of a headache and in a single large dose (instead of repeated small doses).
Acute treatment for migraine can include one or a combination of the following medicines:
- Over-the-counter medications (OTC) pain relief such as acetaminophen, ibuprofen, naproxen, or combination medications containing aspirin, acetaminophen, and caffeine
- Triptans such as Imitrex, Relpax, or Zomig, which come in a variety of formulations (a non-oral route of administration may be needed for patients with significant nausea or vomiting)
- Anti-nausea medications may be needed to be given intravenously: metoclopramide or prochlorperazine
- Medications such as Fioricet (butalbital, acetaminophen, and caffeine) and opioid pain relievers may be prescribed if all other treatments fail
With any acute treatment, there is a possibility of medication overuse headache or rebound headache. There is also the potential for side effects. For example, triptans come with a risk for serotonin syndrome, especially when combined with other medications that increase serotonin levels. Keep an open line of communication with your healthcare provider to ensure you are getting the proper treatment with minimal side effects and no drug interactions.
You can also talk with your headache specialist about noninvasive neuromodulation devices. Limited data from small randomized controlled trials suggest the use of electrical current or magnets to prevent or treat migraine: gammaCore, Nerivio, Cefaly, or Relivion. “These devices have demonstrated good efficacy and an excellent side effect profile,” Dr. Feoktistov says.
Everyone has a different medical history and takes different medications. Talk to your healthcare provider about all of the health conditions you have, all of the medications you take (including prescription, OTC, and vitamins), and your unique treatment needs.
How long is too long for a migraine?
Every 10 seconds, someone in the U.S. goes to the emergency room for head pain. So when should you go to the ER for migraine? According to the American Migraine Foundation, “the best reason for an ER visit is for unusual symptoms that are new to you.”
Not sure when you should go to an emergency department? You should go if you have:
- A severe headache that comes on within seconds
- A new or unusual symptom like fever, numbness, weakness, vision problems, or confusion
- A new unusual headache while pregnant
- A headache with an immunocompromised immune system
- A headache with other serious medical conditions
- A migraine attack that lasts longer than 72 hours (this is called status migrainosus)
- Taken headache medication and it is not working or your pain is debilitating
- Persistent aura with the aura symptoms lasting for one week or more, as this may require neuroimaging
- Neurologic changes, such as stiff neck, visual changes, personality change, or disorganized thinking
The American Migraine Foundation reminds patients that there is not one universal protocol for treating headache or migraine in the ER. Different ER doctors may approach treatment in different ways. For the long-run you should follow up with your headache specialist to establish or tweak your treatment plan.
Don’t give up
If one treatment hasn’t worked, there are always other options to try. “There are many effective ways to treat migraine headaches and that may include lifestyle changes, diet, and supplements, pharmacological therapy, noninvasive neuromodulation, as well as interventional treatment including a variety of nerve blocks and other interventions that might be very helpful,” says Dr. Feoktistov. When you find the combination that works for you, migraine should not stop you from living a normal, uncompromised life.