The Timeline of a Migraine Attack
Understanding migraine progression can help you better anticipate and manage your symptoms
Migraine attacks have distinct phases, and understanding them can help people manage their disease. Symptoms associated with the earliest stages of a migraine attack, like the fatigue and blurred vision that can accompany the prodrome and aura stages, can serve as warning signs and signal the need for abortive medication. Identifying and treating a migraine early can even help prevent the symptoms for some people. Additionally, identifying risk factors that can contribute to postdrome “hangovers” may help individuals anticipate the duration of their attack and its aftereffects.
The Phases of Migraine
Also known as “preheadache” or the premonitory phase, prodrome can mark the beginning of a migraine attack. This phase can last several hours or may even occur over several days.
Most people with migraine will experience prodrome, but not necessarily before every migraine attack. If a person with migraine is experiencing prodrome, his or her care team can study their symptoms and patterns to guide a treatment plan that may lessen the severity of the oncoming headache. During this phase, taking medication, minimizing/avoiding other trigger factors (e.g. foods, alcohol) and practicing mindfulness meditation, relaxation therapy or other biobehavioral techniques, can even prevent headache in some cases. Prodrome symptoms vary from person to person, but can include changes in mood, from feelings of depression or irritability to difficulty focusing. Other symptoms may include fatigue, sensitivity to light and sound, insomnia, nausea, constipation or diarrhea, and muscle stiffness, especially in the neck and shoulders. Symptoms that are especially unique to the prodrome phase of migraine include yawning, cravings for certain foods, and frequent urination.
Up to one-third of people with migraine experience aura as a distinct phase in the progression of their migraine attack. Like other phases, aura doesn’t necessarily occur during every migraine attack in those who experience them. People experiencing aura might endure periods of blurry vision or vision loss, or the appearance of geometric patterns, flashing or shimmering lights, or blind spots in one or both eyes. These symptoms usually gradually evolve over at least 5 minutes and can last for up to 60 minutes. Not all auras are followed by headaches, but since they typically precede the headache phase, they can serve as another warning of a potential headache. In about 20% of individuals, the aura may last longer than 60 minutes and in some, the aura may not precede the headache phase but occur after the headache has already started.
The headache phase of a migraine attack is characterized by pain on one or both sides of the head. This phase typically lasts from several hours to up to three days. Headache phase pain can vary from person to person and from incident to incident, with some migraine attacks causing mild pain, while others are debilitating. The pain can shift from one side of a person’s head to the other over the course of the headache, or more commonly, may begin on one side and then gradually involve the other side. Besides pain, headache phase symptoms can include nausea, inability to sleep, anxiety and sensitivity to sound, light and smell. Even everyday activities — like turning on the lights or participating in physical activity — can aggravate people with migraine during this phase.
Postdrome, also called the “migraine hangover,” typically occurs after the end of the headache phase. Like prodrome and aura, not every person with migraine suffers from postdrome, but it does occur in most (approximately 80%). For those that do, postdrome may not follow every migraine attack they experience, and the length of this phase can vary. Postdrome can be just as debilitating as headache, according to some people with migraine. Symptoms of postdrome include fatigue, body aches, trouble concentrating, dizziness and sensitivity to light. Even though the headache is over, people in postdrome are still experiencing a migraine attack and can benefit from avoiding triggers that aggravate headache, like bright lights and strong smells. Some people have reported finding relief during this phase by engaging in relaxing activities like meditation or yoga, drinking water and avoiding stress.
Understanding your individual phases of migraine can be an essential cornerstone in finding the right treatment option. Maintaining a headache diary can help people with migraine recognize their symptoms and the phases they experience before and after each headache. Identifying these symptoms, and using them to catch and treat a migraine attack early, is key to lessening the severity of headache—or in some cases, even stopping them.
More than 36 million Americans suffer from migraine, but only one of every three patients talk with their a doctor about their headaches. If you experience migraine attacks and haven’t yet partnered with a healthcare team, use the American Migraine Foundation search tool to find someone in your area who can help manage your pain today.