When many people think “Migraine,” they think
only of the pain of Migraine. In reality, a Migraine (often called a "Migraine
attack") consists of far
more. The typical Migraine attack actually consists of four parts, referred to
as phases or
components. It's important to note that not every Migraineur (a person with
experiences all four phases. Also, attacks can vary with different
phases experienced during different attacks.
The four potential phases of a Migraine
The prodrome (sometimes called preheadache or premonitory phase) may be experienced hours or even
days before a Migraine attack. The prodrome may be considered to be the Migraineur's “yellow light,” a warning that a Migraine is imminent. For the
30 to 40% of Migraineurs who experience prodrome, it can
actually be very helpful because, in some cases, it gives opportunity to abort
the attack. For Migraineurs who experience prodrome, it makes a solid case for
keeping a Migraine diary and being aware of one's
Potential symptoms of the prodrome are:
- food cravings
- constipation or diarrhea
- mood changes —
depression, irritability, etc.
- muscle stiffness,
especially in the neck
- increased frequency of
The aura is perhaps the most talked about of the possible phases. The symptoms and effects of the aura vary widely. Some can be
quite terrifying, especially when experienced for the first time. Some of the
visual distortions can be exotic and bizarre. It's interesting to note that
Migraine aura symptoms are thought to have influenced some famous pieces of art
and literary works. One of the better know is Lewis Carroll's "Alice in
people probably think of aura as being strictly visual, auras can have a wide
range of symptoms, including:
flashing lights, wavy lines, spots, partial loss of sight, blurry vision
— smelling odors that aren't there
paresthesia - tingling or numbness of
the face or extremities on the side where the headache develops.
aphasia - difficult finding words
partial paralysis (only
in hemiplegic Migraine)
— hearing things that aren't really there
decrease in or loss of
- hypersensitivity to feel
brief flashes of light
that streak across the visual field (phosphenes)
Approximately 25% of
Migraineurs experience aura. As with the prodrome, Migraine aura, when the
Migraineur is aware of it, can serve as a warning, and sometimes allows the use
of medications to abort the attack before the headache phase begins. As noted
earlier, not all Migraine attacks include all phases.
Although not the majority of attacks, there are some Migraine attacks in which
Migraineurs experience aura but no headache. There are several terms used for
this experience, including "silent Migraine," "acephalgic
The headache phase is generally the most debilitating part of a Migraine attack.
It's effects are not limited to the head only, but affect the entire body. The
pain of the headache can range from mild to severe. It can be so intense that it is difficult to comprehend
by those who have not experienced it. Characteristics of the headache phase may
- headache pain that is
often unilateral — on one side.
This pain can shift to the other side or become bilateral.
- Although Migraine pain
can occur at any time of day, statistics have shown the most common time to
be 6 a.m. It is not uncommon for Migraineurs to be awakened by the pain.
- Because trigeminal
nerve becomes inflamed during a Migraine, Migraine pain can also occur in
the areas of the eyes, sinuses, and jaw.
- This phase usually lasts
from one to 72 hours. In less common cases where it lasts longer than 72
hours, it is termed
Migrainous, and medical attention should be
- The pain is worsened by
any physical activity.
increased sensitivity to sound
increased sensitivity to light
osmophobia — increased sensitivity to
- nausea and vomiting
- diarrhea or constipation
- nasal congestion and/or
- depression, severe
- hot flashes and chills
vertigo - sensation of spinning or whirling (not to be confused with
dizziness or light-headedness)
- dehydration or fluid
retention, depending on the individual body's reactions
Once the headache is over, the Migraine attack may or may not be over. The
postdrome (sometimes called postheadache) follows immediately afterward. The
majority of Migraineurs take hours to fully recover; some take days. Many people
describe postdrome as feeling “like a zombie” or “hung-over.” These
feelings are often attributed to medications taken to treat the Migraine, but
may well be caused by the Migraine itself. Postdromal symptoms have been shown
to be accompanied and possibly caused by abnormal cerebral blood flow for up to 24 hours after the end of the headache stage. In cases where
prodrome and/or aura are experienced without the headache phase, the postdrome
may still occur. The symptoms of prodrome may include:
mood levels, especially depression
- or feelings of
well-being and euphoria
- poor concentration and
- lowered intellect levels
Migraine. As we've seen there's far more to an attack than just the headache
phase. Not all Migraineurs experience all phases, and those who do don't
experience them with each attack. If it all sounds unpredictable — it is. For
those who suffer from Migraine, there can be great advantage to learning about
these phases of a Migraine and how to recognize them. Once we know about them
and learn to listen to our bodies, if we experience prodrome or aura symptoms,
we have a better chance of avoiding the headache phase. In addition, there's
always an emotional comfort factor to knowing what is causing us to feel
depressed or have other symptoms. Add in a bit of control — once we learn to
recognize these symptoms and use them in our Migraine management, we gain a bit
more control over Migraine. Any time we can do that, it's a positive mo
Young, William B., MD; Silberstein, Stephen D.,
MD. "Migraine and Other Headaches." AAN Press. St. Paul. 2004.
Robert, Teri. "Living Well with Migraine
Disease and Headaches." HarperCollins. New York. 2005.
Teri Robert, 2005 - 2010.
Last updated November February 3, 2010.