Last week, I provided an overall definition of migraine, based upon current research. Today we’ll be talking about the phases of a migraine attack. A migraine attack is the entire episodic event known as a migraine event.
There are four phases of a migraine attack: prodrome, aura, headache, and postdrome. Not everyone experiences all four of these phases. Likewise, you may experience some phases only occasionally. Knowing the symptoms and characteristics of each phase, especially those preceding the actual head pain, can be beneficial. If you know a migraine is coming, you can take steps to mitigate the pain.
The Phases of a Migraine Attack
Prodrome refers to early symptoms that signal the onset of the migraine attack. Think of it like that little scratch or tickle in your throat that tells you a cold is coming on. For a migraine attack, the prodrome is the warning signs of what is to come. The prodrome can occur a few hours up to a day or two ahead of the headache phase and is experienced by between forty and sixty percent of migraineurs. The prodrome symptoms are a result of changes in the levels of neurotransmitters and endorphins in the blood.
Prodrome symptoms are widely variable and include agitation, difficulty concentrating, change in appetite, diarrhea or constipation, thirst, drowsiness, food cravings, and more.
Not everyone experiences the prodrome and it’s possible that we don’t always equate it to a migraine phase. I haven’t really made the connection for myself. Have you?
The aura is the phase that most of us have heard of, even though it is only present in about 20% of migraineurs. When present, it can develop between 5 minutes to one hour before the headache. It’s also something we may not experience every time. For myself, I know of one instance of experiencing an aura. And, quite frankly, it freaked me out. I was shopping and suddenly began seeing black, squiggly lines across my field of vision.
We most often think of aura as changes in the way we see, including zig-zag lines, flashing lights, and bright colors, among other changes. But the aura can also result in unusual sensations – such as a pins-and-needles feeling in the hands and arms, changes in hearing, smell, taste or speech.
An interesting side note is that there are people who experience the aura and not the actually pain of the headache. My husband has occasional ‘ocular migraines’ where his vision will get, as he calls it, “swimmy” but there is never a headache. (He once told me he never gets headaches but has since admitted to getting them. BUT, I do know that he once had an abscessed tooth without pain.)
The headache phase of a migraine attack is the most familiar phase. It consists of the head pain that all migraineurs know. The pain can be intense, although it doesn’t have to be. Nor is it always throbbing or one-sided. The pain can be aggravated by noise, light, and smells. Which explains why we seek dark, quiet rooms. For some the pain is accompanied by nausea, chills, hot flashes, sensitivity to touch, confusion, and more. The headache phase can last from four hours all the way up to seventy two hours!
The postdrome phase, which follows the headache phase, can be considered the hangover phase of a migraine attack. If you experience migraines, then you’re likely familiar with this phase. It’s that groggy, tired, irritable, achy period of time once the headache pain has stopped. It can last for hours to days following the headache. The symptoms could be attributed to the medications taken for the migraine pain or to the fluctuations in neurotransmitters within our body. OR, a combination.
For the chronic migraineur, the lines here likely blur. That was certainly true for me when I was experiencing chronic migraines. My head pain would start on the way to work on Monday mornings. It would get a bit better in the evenings but would be back the next day – Monday through Friday. Each day it was a little worse. I had a co-worker back then who made that observation because he could see it in my face as the week progressed. Weekends were a bit better than weekdays. All-in-all, I think that the various phases blurred into a continuous migraine attack.
What are your thoughts? If you experience migraines, leave a comment below telling which phases you experience.
This post is part of a series of posts on migraines and headaches. My goal is to raise everyone’s awareness (even my own) on what migraines are and how they impact the lives of migraineurs and those close to them. If you have specific questions you would like to see covered, please leave a comment below.
If you’re ready to begin your journey to better migraine control, then contact me to set up your initial session.