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.
Is It Necessary to Go to a Doctor After a Migraine Attack?
Migraines are frequently undiagnosed and untreated, and they can cause severe problems over time. For people who experience ongoing migraine attacks, it helps to consult with a doctor. At this time, a doctor evaluates a patient and performs different tests. If a doctor determines that a patient is coping with migraines, he or she may prescribe migraine medications.
Although migraine medications often help patients alleviate migraine pain, they sometimes cause intolerable side effects. Or, in other instances, migraine medications are ineffective. If a person continues to experience migraine pain despite using migraine medications, he or she may receive a chronic migraine diagnosis. At this point, additional medications or therapies may be used to help treat migraine pain.
For patients who continue to experience migraine pain in spite of using migraine medications, Dr. Cabin can help. As a head and neck surgeon with dual subspecialty training in facial plastic and reconstructive surgery, Dr. Cabin performs a comprehensive assessment to help a patient treat his or her chronic migraines.
How Does Dr. Cabin Address Migraine Pain at Different Migraine Stages?
Dr. Cabin understands the 4 stages of migraine attacks, and he works closely with a patient to understand how this individual copes with migraine pain during each of these stages. For patients who are dealing with migraine aura, prodrome migraine or other migraine stages, Dr. Cabin conducts various tests to analyze migraine symptoms. He then develops a personalized migraine treatment plan to help a patient treat migraine attack symptoms and prevent them from recurring.
Dr. Cabin offers two treatment options for chronic migraine patients: minimally invasive migraine surgery and Botox for migraines. Migraine surgery is a procedure designed to help a patient permanently address his or her migraine pain. For most patients, migraine surgery results in a dramatic reduction in migraine duration, frequency or intensity. Migraine surgery has also been shown to eliminate migraines in approximately half of all patients. Comparatively, Botox for migraines involves the use of a neurotoxin derived from Clostridium botulinum bacteria. Botox is injected into a patient’s skin, and it temporarily stops nerve cell signals from reaching the muscles. This helps reduce abnormal muscle contractions that otherwise lead to migraine pain.
When it comes to treating migraine pain at different migraine stages, no two treatment plans are exactly the same. Dr. Cabin tailors a migraine treatment plan to a patient; therefore, a treatment plan may include migraine surgery, Botox or both. Regardless of treatment plan, Dr. Cabin strives to help his patient alleviate his or her migraine pain.
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.
There are four migraine stages: prodrome, aura, migraine and postdrome. A migraine sufferer may experience one or more of the aforementioned stages during a migraine attack. Additionally, each migraine stage may vary in terms of duration and severity. If a person suffers frequent migraines, he or she should try to plan ahead for the stages of a migraine attack. By doing so, this individual may be better equipped than ever before to address his or her migraine symptoms before they get out of hand.
Research indicates approximately two-thirds of migraine patients experience aura, aka the second potential stage of a migraine. Aura takes place before a migraine attack, and it rarely occurs without an associated headache. Meanwhile, aura typically lasts between 10 and 30 minutes, and common aura symptoms include muscle spasms or weakness, vision changes or speech difficulties. For those who experience aura or other migraine stages, it is important to consult with a doctor right away. Then, a patient can work with a doctor to identify his or her migraine triggers and implement a treatment plan to achieve long-term migraine relief.
There is no telling when a migraine will occur, and the symptoms associated with a migraine attack may range from mild to severe. Fortunately, short-term fixes are available to help migraine sufferers quickly address nausea, dizziness, fatigue and other migraine symptoms. Drinking a caffeinated beverage, applying a hot or cold compress to the neck or forehead and practicing deep breathing and other relaxation exercises are some of the things that a person can do to help alleviate his or her migraine symptoms. On the other hand, if a person experiences frequent migraines, he or she should consult with a doctor. That way, an individual can determine the best way to relieve his or her migraine symptoms.
A migraine “trigger point” refers to a spot on a person’s face, neck or scalp associated with migraine pain. Each migraine trigger point is related to a sensory nerve. Some migraine sufferers deal with a single migraine trigger point, while others experience migraines associated with multiple trigger points. A doctor uses a patient’s migraine history and various diagnostic methods to verify a migraine trigger point. After a doctor confirms a migraine trigger point, he or she may recommend surgery to create space around the sensory nerve associated with the migraine trigger point, thereby limiting the risk of irritation that otherwise causes migraines.
Migraine sufferers may receive preventative, abortive and rescue medications to treat their migraine symptoms. Yet in some instances, migraine medications fail to relieve migraine symptoms or cause unwanted side effects. For those who receive a chronic migraine diagnosis from a neurologist and find that their current migraine medications are ineffective, minimally invasive migraine surgery may be a viable treatment option. Migraine surgery is used to address a patient’s anatomical migraine trigger points, which send faulty signals to the brain that cause migraine pain. Each migraine surgery is customized to a patient, and as a result, helps this individual permanently treat his or her anatomical migraine trigger points.