What is the typical duration of a migraine and tension headache episode in a general adult patient with no specific medical history?

Duration of Migraine and Tension Headache Episodes

Migraine attacks last 4-72 hours in adults when untreated or unsuccessfully treated, while tension-type headache episodes can extend beyond 72 hours, with duration >72 hours being a characteristic feature associated with chronic tension-type headache. 1, 2, 3

Migraine Duration

Standard Duration Parameters

• Migraine without aura lasts 4-72 hours in adults according to International Classification of Headache Disorders (ICHD-3) criteria, which represents the typical untreated or unsuccessfully treated attack duration 1, 3, 4
• In children and adolescents (aged <18 years), migraine attacks may be shorter, lasting 2-72 hours, requiring age-adjusted diagnostic criteria 1, 2, 3
• When a patient falls asleep during a migraine attack and wakes without headache, the duration is counted only until the time of awakening—a critical nuance often overlooked in clinical assessment 1, 3

Real-World Duration Variability

• Approximately 20-24% of migraine patients experience attacks lasting beyond 72 hours in real-world clinical settings, which exceeds the standard ICHD-3 criteria but represents actual clinical experience 5
• Disability from pain, nausea, or malaise can persist for over 3 days in 24.3% of patients with migraine with aura and 16.7% of those without aura, even when the headache itself may have resolved 5
• The buildup time from no pain to moderate/severe pain is typically rapid: less than 2 hours in 97% of patients with aura and 86% of those without aura 5

Aura Duration

• Visual aura symptoms last 5-60 minutes and typically develop gradually over 5-20 minutes before resolving completely 1, 2, 3
• Each individual aura symptom lasts 5-60 minutes, and when multiple aura symptoms occur in succession, the acceptable maximal duration is calculated as the sum (e.g., 3 symptoms = up to 180 minutes total) 1
• Motor symptoms represent an exception and may last up to 72 hours 1

Tension-Type Headache Duration

Duration Characteristics

• Tension-type headache episodes lasting >72 hours are a defining characteristic that distinguishes chronic tension-type headache from episodic forms and is associated with poor long-term outcomes 6
• Duration >72 hours at baseline was significantly associated with chronic tension-type headache (p = .002) in population-based studies 6
• Individual tension-type headache attack duration greater than 72 hours was a significant predictor of poor outcome and chronification 6

Vestibular Migraine Duration

• Vestibular migraine episodes last 5 minutes to 72 hours, with highly variable duration patterns: approximately 30% of patients have episodes lasting minutes, 30% have attacks lasting hours, and 30% have attacks over several days 1, 4
• About 10% of vestibular migraine patients experience attacks lasting only seconds that recur repeatedly during head motion or visual stimulation, with episode duration defined as the total period during which short attacks recur 1
• While some patients may take four weeks to fully recover from a vestibular migraine episode, the core episode rarely exceeds 72 hours 1

Clinical Pitfalls and Practical Considerations

Common Diagnostic Errors

• Clinicians often fail to account for attacks exceeding 72 hours, which occur in approximately one-fifth of migraine patients but fall outside strict ICHD-3 criteria 5
• Nausea occurs in over 90% of migraine cases and can interfere with oral medication absorption in about 25% of patients, potentially prolonging attack duration due to inadequate treatment 5
• The presence of nausea, daily use of acute medications, and coexistent headaches are significant predictors of chronic headache development 6

Duration-Related Risk Factors

• Longer individual headache attack duration is associated with poor outcomes and increased risk of chronification for both migraine and tension-type headache 6
• For migraine patients, attacks with pulsating quality, severe intensity, photophobia, phonophobia, and longer duration tend to predict progression to chronic migraine 6
• For tension-type headache, unilateral location, nausea, and duration >72 hours predict chronification 6

Monitoring Recommendations

• Prospective headache diaries are essential for accurately documenting attack frequency, duration, associated symptoms, and medication use, as retrospective recall consistently underestimates these parameters 2, 4
• Patients should be monitored for progression from episodic to chronic forms, defined as headache on ≥15 days per month for >3 months 3, 4, 7