Sorry to be blunt, but migraines are the absolute worst. And those who get it, get it. They come out of nowhere, last an undetermined amount of time, and can be incredibly debilitating. After all, studies show that migraines are the second most disabling condition worldwide.
According to the American Migraine Foundation, migraines are three times more common in women than men and affect over 30 percent of women over a lifetime. From there, only 5 percent have been seen by a healthcare provider to receive an accurate diagnosis and proper care.
And while many migraines go undiagnosed or untreated, it’s critical to see your doc if they become your norm. The longer a migraine goes on, the more severe and debilitating it gets, says Damita Bryant, MD, a headache specialist and head physician at Nashville Neuroscience Group. “We want to prevent someone who has occasional migraines from turning into more chronic debilitating migraines, and that usually happens if you don’t treat them quickly enough,” she says.
Plus, the more frequent the attacks, the less time your brain has to recover, and the more likely you are to have another migraine, adds Merle Diamond, MD, a headache specialist, president and medical director of Diamond Headache Clinic. So, don’t be afraid to talk with your doctor if you experience multiple migraines a month, because TBH, migraines are way more complex than you may realize.
Okay, but how long is too long of a migraine and when should you seek treatment? The good news is migraines are methodical and there are ways to stop them in their tracks or prevent another from happening. Here’s everything you need to know, according to experts.
Meet the experts: Damita Bryant, MD, a headache specialist and head physician at Nashville Neuroscience Group; Merle Diamond, MD, a headache specialist, president and medical director of Diamond Headache Clinic.
What is a migraine, exactly?
A migraine is way more than just a headache, says Dr. Diamond. “The three most important pieces of migraine are severe to moderate head pain, the associated symptoms such as nausea, vomiting, light and noise sensitivity, and the high level of disability,” she says. “The vast majority of patients that have a migraine attack cannot function in a normal fashion.”
The cause of a migraine varies on the individual, but the most common cause is genetics, notes Dr. Diamond. “If you have a first degree relative who has migraine, like your mom or dad, you have about a 50 percent chance of carrying it.” Aside from genetics, head trauma, lack of sleep, skipping meals, dehydration, excessive caffeine, menstrual cycles or changing hormone levels, and even the weather can trigger migraines.
How long does a migraine typically last?
Migraines have a mind of their own (literally) and can unfortunately last for hours or even days if left untreated, says Dr. Bryant.
There are often four phases of a migraine, but not everyone experiences every phase each time they have an attack. If you experience any of the stages, take medication immediately, says Dr. Bryant. “The sooner you start treatment, the sooner it can go away.”
Prodrome: The first stage of a migraine can start hours, or even days, before the actual attack, and it may not happen every time, says Dr. Diamond. Prodrome consists of the early symptoms you may have before the migraine comes on, such as extreme tiredness, hunger pains, neck pain, lightheadedness, excessive yawning, mood changes, or irritability. “Prodrome tends to be a repetitive symptom or group of symptoms,” says Dr. Diamond. “It lets you know that an attack is coming.”
Aura: Only 20 percent of people experience an aura, but they consist of visual or neurological symptoms that come on about 30 minutes to an hour before a migraine, explains Dr. Bryant. You may see vision changes like flashes of light, blind spots, and floaters, and in some extreme cases you might feel tingling loss of movement on one side of the body.
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Attack: The attack is the main event and consists of moderate to severe headache pain that’s throbbing or stabbing, says Dr. Bryant. Pain typically starts on one side before spreading to the other, and symptoms such as nausea, vomiting, and light and/or noise sensitivity often follow. The length of the attack varies but can last four to 48 hours.
Postdrome: Also known as the “migraine hangover,” postdrome is when symptoms occur after the pain subsides, says Dr. Diamond. This phase can last up to 24 hours, and people often experience fatigue, grogginess, irritability, and extreme tiredness. “The biggest sign is that people just feel wiped out,” adds Dr. Bryant.
Can a migraine last for days?
Unfortunately, yes. A migraine starts when an area in the brainstem gets activated and pro-inflammatory neuropeptides send pain signals, says Dr. Diamond. There is then an electrical or chemical spread of irritation across the surface of the brain, and symptoms occur for various periods of time depending which part(s) of the brain is irritated. Because of this variability, a migraine can sometimes last two to three days, if not treated, to get through all the stages.
“If a person is sure what they are feeling is a migraine, they should start treatment quickly.”
In 2018, there was also a major breakthrough linked to migraines with the discovery of calcitonin gene-related peptide (CGRP), a protein in the brain that causes inflammation. “Migraine is an inflammatory disease and people who have migraine have more CGRP being secreted in their brain,” says Dr. Bryant. In other words, the more CGRP in your brain, the more severe and longer migraines you get.
How can you get rid of a migraine?
“If a person is sure what they are feeling is a migraine, they should start treatment quickly,” says Dr. Bryant. So, if you experience an early phase (prodrome or aura) or feel a migraine coming, you should treat it ASAP.
For non-medicated treatment, you should go into a dark and quiet environment if light or sound is a trigger, says Dr. Bryant. An ice pack can also help relieve head pain and gentle stretching may dissolve muscle tension.
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But for moderate to severe head pain, medications work the best, and the earlier you take them, the better. For over-the-counter treatments, Dr. Diamond suggests pain relievers such as ibuprofen (Advil or Motrin IB), and aspirin and acetaminophen (Excedrin Migraine). However, it’s important to note that these medications are not long-term solutions. If taken two to three times a week, check-in with your doctor, because multiple days in a row can actually cause medication-overuse headaches and bleeding in the gastrointestinal tract.
If OTC meds aren’t working for you, or you find yourself needing to take them every day, it’s time to check-in with your doctor. “Prescription medicines work to prevent and get rid of an attack once we know it’s coming,” says Dr. Diamond. Triptan medications were usually the first line of defense, but newer CGRP blockers are especially successful in reducing migraine headaches with few side effects, adds Dr. Bryant. “Most of my patients tell me that it has been a life changer for them.”
When should you go to the doctor for a migraine?
There is no cure for migraine, but resources, specialists, and medications can seriously relieve symptoms and provide effective care. If you have sporadic migraine attacks and can manage with a dose or two of OTC medicine, then you don’t need to see a doctor, says Dr. Diamond. But if a migraine lingers more than a day using your own treatments, becomes recurrent or more severe, or if you miss work, school, or significant days due to pain, then you need to visit a physician for treatment. Remember, the longer a migraine goes on, the more it can turn into a chronic condition, says Dr. Bryant.
And in extreme cases, if migraine pain has become so severe that you have trouble speaking, vision changes, confusion, or numbness in the body, then you should go to the emergency room.
The bottom line: Migraines can be treated, and you should visit your primary care doctor or headache specialist if you are suffering. There have been remarkable strides in care over the last five year, says Dr. Bryant. “I don’t want people to give up.”
Andi Breitowich is a Chicago-based writer and graduate student at Northwestern Medill. She’s a mass consumer of social media and cares about women’s rights, holistic wellness, and non-stigmatizing reproductive care. As a former collegiate pole vaulter, she has a love for all things fitness and is currently obsessed with Peloton Tread workouts and hot yoga.