How Long Will My Migraine Attack Last?

Migraine attacks vary from person to person — not everyone has the same migraine symptoms or triggers.

How long a migraine attack lasts can vary, too. The National Headache Foundation says that most migraine attacks last 4 to 72 hours. “But some people have migraines for a shorter time and some people have them for longer — it’s very individual,” says Alexander Mauskop, MD, a neurologist and the founder and director of the New York Headache Center in Manhattan and White Plains, New York.

Several factors can play a role in how long your migraine attack lasts, from how many triggers occur before the attack to how you respond once an attack begins. Here’s what you should know about the duration and phases of migraine attacks, and how certain self-care interventions and drugs may shorten an attack.

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Phases of a Migraine Attack

A migraine attack often involves distinct phases, though people may experience them differently, says Roderick Spears, MD, a neurologist and headache specialist at Brown University in Providence, Rhode Island.

Prodrome phase This first phase of migraine can occur hours to days before the attack, says Dr. Spears. “It typically involves a change in mood and energy. Certain cravings or excessive yawning can be a sign of prodrome,” he says.

People sometimes confuse these prodrome or “premonitory” symptoms with migraine triggers. That’s to say, a person who craves chocolate as a prodrome symptom may mistakenly believe that consuming chocolate triggered the migraine attack, notes Migraine Again.

Aura About 25 to 35 percent of people with migraine experience aura, says Spears. “The most common aura is a visual change with a kaleidoscope-like phenomenon that can last anywhere from five minutes to an hour, but usually much less than an hour,” he says. Other aura symptoms may include tingling sensations, numbness, garbled speech, and clumsiness or weakness.

Headache phase “This stage can last 4 to 72 hours, and in most patients, it’s marked by a headache on one side of the head that’s throbbing and pulsating in quality. Typically, the pain is described as moderate to severe,” says Spears.

The headache phase is also associated with sensitivity to your environment, he adds. “Light, sound, and odor sensitivity are common, as are nausea and vomiting,” he says.

In a survey of 1,100 U.S. adults with migraine, 44 percent of participants reported that their headache or attack phase of migraine lasted for up to 24 hours, while 33 percent said it could persist for more than 24 hours.

Postdrome or recovery phase This phase — in which there’s no pain or very mild pain, but people don’t feel normal — can last 24 to 48 hours, says Spears. “They’re not as sharp cognitively, and they can feel ‘hungover,’” he says of people in this phase.

“There are also some people who feel elated — almost euphoric — because they don’t have the pain anymore, and they’re full of energy, even verging on hyper,” Spears adds.

Self-Care Tips to Shorten Your Migraine Attack

If you recognize the signs that a migraine attack may be coming on, you may be able to reduce the amount of time it lasts, according to Spears. “Often the person with migraine doesn’t always recognize the prodrome phase, but someone close to them — a spouse or family member — may pick up on it,” he says.

Spears offers a few tips to potentially reduce the length of your migraine attack:

• Aggressively hydrate. Drinking a lot of water is usually helpful.
• Limit your physical activity. If possible, sit or lie down somewhere.
• Avoid stimulating environments. Go to a dark, quiet place.

Some people find that relaxation techniques, such as meditation or massage, help reduce the tension they feel in their face, jaw, or neck. If you can release tension with these techniques, your migraine attack may not be as severe or last as long.

Other people find that putting a cold compress on their temples relieves migraine symptoms and reduces the length of an attack, Mauskop says.

Acute Drug Treatment to Stop a Migraine Attack

There are several different medication options for treating a migraine attack once it has begun. The type of migraine you have as well as the frequency and severity of your attacks is something you should discuss with your doctor when developing a treatment plan.

For people with mild to moderate symptoms, over-the-counter medications are often sufficient to relieve them, according to the American Migraine Foundation. These drugs include:

• Aspirin
• Acetaminophen (Tylenol)
• Acetaminophen, aspirin, and caffeine combination (Excedrin Migraine)
• Ibuprofen (Advil or Motrin)
• Naproxen (Aleve)

Your doctor may also prescribe any of a number of drugs for acute treatment of migraine. Generally speaking, acute migraine treatments work better the earlier in the attack you take them, before your pain has gotten severe. Triptans are the most commonly used acute migraine medications, and gepants and ditans are two new classes of migraine drugs that may be helpful if you can’t take triptans or are not helped by them.

Triptans

There are seven different triptan drugs, of which sumatriptan (sold as Alsuma, Imitrex, Onzetra, Zembrace, and Treximet, which is a combination of sumatriptan and naproxen) is probably the best known. All the triptans are available as pills, two come as nasal sprays or powders, and one is sold as a self-administered injection.

Most triptans taken as pills start relieving pain in 30 to 60 minutes, although two longer-acting triptans, Amerge (naratriptan) and Frova (frovatriptan), take one to three hours and about two hours, respectively, to start working. Triptan injections start relieving pain in about 10 minutes, and nasal sprays start working in 10 to 15 minutes.

If migraine pain recurs within 24 hours after you take a triptan, a second dose may be needed. But migraine recurrence may be an indication that a different triptan or a different dose of the one you’re taking may work better for you, according to Eric Baron, DO, a neurologist at the Cleveland Clinic in Ohio, writing for Virtual Headache Specialist.

Because one of the effects of triptans is to narrow blood vessels in the brain, these medications should not be taken by people with coronary artery disease, a history of stroke, peripheral vascular disease, or uncontrolled high blood pressure. Women who are pregnant or planning to become pregnant should discuss the relative risks and benefits of using triptans during pregnancy.

Gepants

A newer class of migraine drugs called calcitonin gene-related peptide (CGRP) receptor antagonists, or “gepants,” may be an alternative for people who can’t use triptans because of vascular disease, since they don’t narrow your blood vessels. CGRP receptor antagonists include:

• Rimegepant (Nurtec ODT)
• Ubrogepant (Ubrelvy)
• Zavegepant (Zavzpret)

According to Spears, “These medications target a different neurotransmitter pathway than triptans.”

Both rimegepant and ubrogepant are taken as pills, both begin reducing migraine pain within 60 minutes, and both can cause nausea or sleepiness as a side effect.

Zavegepant is taken as a nasal spray and can relieve pain in as little as 15 minutes.

Ditans

Lasmiditan (Reyvow) belongs to a newer class of migraine medication called selective 5-HT(1F) receptor agonists, or ditans for short. It does not constrict blood vessels and may therefore be another alternative for people who can’t use triptans because of vascular disease.

Lasmiditan is available as a tablet in three dose sizes. No more than one dose of lasmiditan should be taken within 24 hours, and people should not drive or operate machinery for eight hours after taking the drug. Common side effects include dizziness, fatigue, drowsiness, and abnormal skin sensations such as tingling or numbness.

Other Acute Migraine Treatment Options

In addition to the drugs mentioned above, other options for acute migraine relief include the prescription NSAID diclofenac (Cambia); a class of drugs called ergots, which are sometimes used in people who don’t respond to triptans; and a variety of neurostimulation devices that deliver magnetic or electric pulses to specific nerves involved in migraine.

If the combination of drugs and home remedies you’re using to stop migraine attacks isn’t working, talk to your doctor about other treatment possibilities.

Medication-Overuse Headaches

When people with migraine take acute medications too often, they can develop what are known as medication-overuse headaches, also known as rebound headaches.

The risk of medication-overuse headaches can put people with migraine in a difficult position, says Spears. “Migraine is a condition where the sooner you treat it with medication, the more likely it is that you’ll be successful in stopping it. At the same time, if you take your rescue medication too frequently, it will lead to rebound,” he says.

Most of the medications commonly used to treat migraine attacks — such as aspirin, NSAIDs, acetaminophen, triptans, and others — have been associated with rebound headaches. It’s recommended that people don’t take these medications for acute treatment of migraine on more than two days a week.

The one class of drugs that hasn’t been shown to cause medication-overuse headache is gepants, according to Spears. “We still try to limit patients to using them two days a week,” though, he says.

Status Migrainosus

A debilitating migraine attack that lasts longer than 72 hours (3 days) and doesn’t respond to normal treatment is called status migrainosus, or intractable migraine.

It can be more medically serious than a normal migraine attack, especially if symptoms such as vomiting are prolonged, because of the risk for severe dehydration, according to the National Headache Foundation.

Status migrainosus is what brings many people to the hospital emergency department, where a variety of IV drugs may be administered to break the pain cycle.

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Preventing Future Migraine Attacks

In addition to medications that can stop a migraine attack in progress, there are also drugs that can be taken for migraine prophylaxis, or preventive therapy, as a way to reduce the frequency and severity of migraine attacks.

Preventive migraine treatments include prescription medications that were originally developed for epilepsy, depression, or high blood pressure, Mauskop says. They also include a newer class of drugs called CGRP antibodies, which include:

• Eptinezumab (Vyepti)
• Erenumab (Aimovig)
• Fremanezumab (Ajovy)
• Galcanezumab (Emgality) 

Two drugs in gepant class can also be used to prevent migraine:

• Atogepant (Qulipta)
• Rimegepant (Nurtec ODT)

Women whose migraine attacks are associated with their menstrual cycles may find relief by taking certain types of hormonal birth control or hormone replacement therapy. In some cases, though, these options can make migraine worse, according to the American Migraine Foundation.

Many people do get effective migraine relief from various treatments. “However, if your headaches persist or they last a long time, you should seek medical help from a neurologist or headache specialist,” says Mauskop. “You shouldn’t self-treat migraines if they are unusually long or you’re having them for the first time.”