Migraine Symptoms and Aura: How an Attack Unfolds and What to Write Down for Your Doctor
Migraine symptoms, aura and phases explained simply: how long they last, what to note for your doctor, and when to get medical help.
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A migraine attack often runs in phases, and not everyone goes through all of them. Typical signs are a throbbing headache on one side, nausea, and sensitivity to light and sound, sometimes with an aura first. You can record how it looks for you on paper or in Sam, where you enter the length, strength and aura of every attack. This post describes the phases, shows what belongs in your diary and says when to contact a doctor.
What does a migraine look like, and what are the phases?
IQWiG describes migraine as moderate to severe headaches, often on one side of the head. The pain pulses. Many people feel sick or are sensitive to light and sound. Untreated, an attack lasts between four hours and three days.
According to the NHS, an attack can announce itself hours to two days before the pain starts. Some people then get an aura, followed by the headache phase. Write such early signs down, even when they seem minor. They help later when you ask what came before an attack.
Some attacks come without an aura. Whether you have migraine is for your doctor to decide. How it differs from tension headache is covered in migraine or tension headache.
What is an aura, and how long does it last?
An aura is a set of temporary symptoms of the nervous system. The Migraine Trust says it affects up to a third of people with migraine. Visual symptoms are the most common: flickering, zigzag lines, blind spots or flashes of light.
Other forms exist too. They include tingling or numbness in part of the body, difficulty speaking and dizziness. Symptoms usually build up gradually over about five minutes and last from five minutes up to an hour. IQWiG says the aura normally fades within an hour without lasting effects.
In everyday talk, an aura with visual symptoms is often called "ocular migraine". The same rule applies: have the first one checked. The Migraine Trust advises prompt medical advice for visual symptoms that appear for the first time.
Which symptoms belong to the headache phase?
The headache phase is dominated by the throbbing, often one-sided pain and the symptoms that come with it. gesund.bund.de names nausea and vomiting here.
Write down what applies to you and what does not. The combination matters for your doctor. When you see several attacks side by side, you often notice for yourself how a migraine day differs from an ordinary headache day. More on triggers: migraine triggers: sleep, stress and patterns.
What should you write down for your doctor?
According to gesund.bund.de, diagnosis starts with a detailed conversation. Your doctor asks what the symptoms are like, where they sit, when they began, which conditions you have and which medicines you take. A physical examination follows. With notes from several weeks, you answer these questions better than from memory.
IQWiG recommends noting the strength and length of attacks, the events before, food and drink, and the medicines you took. gesund.bund.de suggests the same to find personal triggers. To begin with, these points per attack are enough:
- Date and time it began.
- How strong: mild, moderate or severe.
- How long it lasted.
- Whether an aura came first and what it looked like.
- What came with it: nausea, sensitivity to light or sound, pain on one side.
- Which medicines you took, and when.
- What came before: sleep, stress, food, weather.
An invented example: "Thu, 12 Nov, 7:30. Flickering in the left eye, 20 minutes. Then severe headache until evening. Nausea. One tablet at 8:15. Three short nights before." An entry may be that short.
In the migraine program in Sam, these are the fields: start, strength, length, aura before, accompanying symptoms and a note. Other complaints between attacks go into the symptom diary. For entries made today, sleep and heart rate variability from Apple Health are added when data is available. How a watch fits into your migraine diary: Apple Watch and Sam for migraine.
When should you see a doctor, and when call the emergency number?
IQWiG stresses that headaches should be medically checked before you treat them yourself as migraine. A first aura, or a pattern that changes, belongs with your doctor. The NHS lists an attack longer than 72 hours and an aura longer than an hour as reasons to seek prompt medical advice. Muscle weakness during an aura should also be discussed, according to the Migraine Trust.
Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) if a sudden, very severe headache comes with loss of vision, confusion, trouble speaking or weakness on one side. These are the signs for which the NHS advises calling the emergency number. This is general information, not a diagnosis.
Log attacks in Sam and take them to your appointment as a report
You arrive with a record in which every attack has its length, strength and aura, instead of telling it from memory.
- Instead of paper slips: you enter start, strength, length, aura and accompanying symptoms in seconds, and for entries made today, sleep and heart rate variability from Apple Health sit beside them.
- Instead of recollection: the doctor report as a PDF shows your migraine days for the period you choose.
Sam records what you enter and is not meant for the moment of an attack. The program starts after a diagnosis confirmed by a doctor. More in the migraine program.
Try Sam HealthSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any disease or health condition. Always consult qualified professionals for medical decisions.
Related reading
Sources
Updated: October 2026
- IQWiG, Gesundheitsinformation.de: Migräne (updated 13 July 2022, German)
- IQWiG, Gesundheitsinformation.de: Kopfschmerzen (updated 13 July 2022, German)
- Bundesministerium für Gesundheit, gesund.bund.de: Migräne (as of 21 December 2022, German)
- NHS: Migraine (reviewed 10 March 2026)
- The Migraine Trust: Migraine with aura
More on Migraine
Frequently Asked Questions
What are the symptoms of a migraine?+
Typical signs are moderate to severe headaches, often on one side, that throb or pulse. Nausea is common, sometimes with vomiting, and so is sensitivity to light and sound. Left untreated, an attack lasts between four hours and three days, according to the NHS and IQWiG.
How long does a migraine aura last?+
The Migraine Trust says an aura usually builds up over about five minutes and lasts from five minutes up to an hour. The NHS says aura symptoms should not last longer than an hour. If yours does, get it checked promptly.
What is an ocular migraine?+
People use the term for an aura with visual symptoms such as flickering, zigzag lines or flashes of light. As with any aura, a first episode should be seen by a doctor, and sudden loss of vision is an emergency.
Does every migraine have an aura?+
No. According to the Migraine Trust, up to one in three people with migraine has aura. Many only have the headache phase.
What should I write in a migraine diary?+
When the attack started, how strong it was, how long it lasted and whether an aura came first. Add the other symptoms, what you ate, drank or went through beforehand, and the medicines you took. IQWiG and gesund.bund.de recommend these points.
When is a headache an emergency?+
When a sudden, very severe headache comes with loss of vision, confusion, trouble speaking or weakness on one side of the body. The NHS lists these as reasons to call the emergency number right away.
Can an app predict a migraine?+
No. An app can record attacks and the circumstances around them, nothing more. With time you may spot patterns in your own diary yourself, and you can discuss them with your doctor.