There are four potential stages of a migraine that a migraine sufferer may experience: prodrome, aura, attack, and postdrome.
The prodrome stage, also known as premonitory or warning phase, marks the beginning of a migraine. It is the “calm before the storm” and lasts anywhere from a few hours to several days. Individuals keeping a migraine diary and who have a great sense of self-awareness of the body may be able to take abortive medications and avoid additional triggers as well as utilize meditation, relaxation therapy, acupuncture or other behavioral techniques to lessen the severity and even prevent the full onset of a migraine. The majority of migraine sufferers will experience a prodrome, but it does not necessarily occur with every episode of a migraine. Migraine prodrome symptoms vary from person to person and may include:
- Changes in bowel habits—constipation or diarrhea
- Changes in mood—anxiety, depression or irritability
- Muscle stiffness and/or cramping, especially in the neck and shoulder areas
- Fatigue, confusion and/or difficulty concentrating
- Urinary frequency
- Food cravings, especially sweets
- Excessive yawning
- Sensitivity to light, which is referred to as photophobia
- Sensitivity to sound, which is referred to as phonophobia.
The aura stage serves as another warning of a potential migraine. It does not occur with every migraine, but anywhere from one-quarter to one-third of individuals experience migraine with aura. During this stage, a migraine sufferer usually experiences disturbances in one or more senses. These changes evolve gradually and can last for as little as 5 minutes and as long as 60 minutes or more. The most common type of aura results in visual disturbances, such as geometric patterns (i.e., zigzag lines), blurry vision, temporary vision loss or sparkling/flickering lights. Some people experience sensory disturbances, such as tingling or numbness in the face, arms and/or legs. A person’s language or comprehension may be temporarily affected. Less commonly migraineurs may experience disturbances of hearing (e.g., ringing in the ears), taste or smell. Interestingly, the migraine aura for each individual remains relatively consistent.
Migraine Attack Stage
The migraine attack stage, or headache phase, is characterized by pain that is unilateral (on one side) that can spread to the opposite side of the head to become bilateral. The headache may be described as stabbing, throbbing or pulsating and graded as mild to severe and debilitating. The pain can develop at any time, but it is not uncommon for individuals to be awakened by the pain. The headache generally lasts from 4 to 72 hours. Additionally, the pain increases with physical activity and may be accompanied by symptoms such as nausea and vomiting, problems sleeping and increased sensitivity to light, sound or smell. Many migraineurs just want to withdraw to a darkened, quiet room. Occasionally, the migraine can last longer than 72 hours, at which time it’s considered status migrainosus—a medical emergency.
The postdrome stage, also known as the post headache or recovery phase, occurs after the end of the headache phase. It is often described by sufferers as a hangover-like or zombie-like experience, which may take 24 to 48 hours or sometimes longer to resolve. Many migraineurs attribute the “hangover” to the migraine medications they have taken in an effort to end the agony. Postdrome migraine symptoms may include poor concentration, extreme fatigue, body aches, depressed mood and confusion. As a result, some individuals report the postdrome being as debilitating as the headache phase.
Each stage of a migraine may vary in length and severity. An individual may suffer from a single migraine stage, a combination of various migraine stages or all migraine stages.
Dr. Jonathan Cabin of The Migraine Institute is a board-certified head and neck surgeon with dual-subspecialty training in Facial Plastic and Reconstructive Surgery. Dr. Cabin helps migraine patients achieve lasting relief through customized, cutting-edge, interventional treatments.
Can You Predict When a Migraine Will Happen?
It is often impossible to predict when a migraine will strike. Fortunately, an individual who knows the pre-migraine stages may be better equipped to prepare for migraine headaches. Education plays a key role in successful migraine treatment.
Dr. Cabin works closely with migraine patients, not only in interventional treatment, but also to help educate them regarding migraine causes, symptoms and alternative treatments. Individuals get the support they need to make informed migraine treatment decisions.
Schedule a Migraine Consultation with The Migraine Institute
Set up a consultation with Dr. Cabin to learn more. Please schedule a consultation by calling us at 310.461.0303 or submit a request online.