Phases of Migraine
By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD
Migraine can be divided into four distinct phases, known as the prodrome, aura, headache, and postdrome phases [1]. Understanding these phases can help people further define their migraine, and also manage their disease. It is important to mention that not everyone who has migraine experiences all four stages [2]. In today’s blog post, we dive deeper into each of these phases and discuss the duration and associated symptoms.
The prodrome phase lasts a few hours to days, and can mark the beginning of a migraine attack. The prodrome phase is also known as “preheadache” or the premonitory phase [1]. Taking medication, minimizing triggers, and practicing relaxation or meditation may lessen the severity of the oncoming headache. For patients experiencing the prodrome phase, their care team can study their symptoms and patterns, and use this information to better establish a treatment plan [1]. Thus, this information, which can also be tracked in a headache diary, may guide them to find ways to lessen the severity of an oncoming headache. Symptoms of the prodrome phase may include fatigue, sensitivity to light or sound, nausea, yawning, muscle stiffness, and cravings. Prodromal symptoms can vary from patient to patient. Some mood and cognitive symptoms of the prodrome phase may include irritability, depression, problems concentrating, and difficulty speaking and/or reading [1]. New science shows that using as needed migraine treatments during this phase may stop the pain of headache from occurring.
Approximately ⅓ of people living with migraine experience aura as a distinct phase as their migraine progresses [1]. For some patients, aura might occur before or during a migraine attack [2]. In addition, aura does not necessarily occur with every migraine attack for those who experience them. The aura phase begins gradually, and can last 20 minutes to one hour. Some examples of aura may include bright spots or flashes of light, tingling in the arm or leg, difficulty speaking, or weakness in the face or extremities. Further, some people may experience periods of vision loss, blurry vision, or blind spots in one or both eyes [1].
The headache phase lasts several hours to days [1]. This phase is characterized by pain on one or both sides of the head [2]. Pain can also gradually shift to the other side of the head. Pain caused by migraine can range from mild to debilitating. Symptoms experienced during the headache phase can include nausea, and sensitivity to light, sound, or smell. It can be difficult to function during the headache phase [1].
Lastly, the postdrome phase does not happen for everyone, and its length can vary. It is often referred to as a “migraine hangover” [1]. After progressing through the headache phase, people may feel drained or confused for up to 24 hours [2]. It is also possible that sudden head movement or changes in position may reignite the pain for a brief time [2]. Symptoms experienced during the postdrome phase can include fatigue, body aches, trouble concentrating, dizziness, and sensitivity to light.
In conclusion, if you regularly have signs and symptoms of migraine, it may help to start a headache diary so that you can keep track of the attacks and how you treated them. Understanding the individual phases of migraine can help determine the right treatment option for you.
We look forward to helping you at the Westport Headache Institute! – Dr. K
References:
- The Timeline of a Migraine Attack. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/. Accessed 17 May 2023
- What are the stages of a migraine? In: Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/what-are-the-stages-of-a-migraine. Accessed 17 May 2023