Migraine attacks consist of four phases, the prodrome, aura, headache, and postdrome. You may experience all of them or only one or two of them and they may vary from attack to attack.
The prodrome is the period before the migraine attack begins. It warns that a migraine is impending and may occur anywhere from hours to days before the aura or the pain begins. Between 30 to 40 percent of migraine sufferers say that they experience the prodrome; however, this estimate may be on the low side because people only mention it when directly asked about it.
Learning to recognize the prodrome is important because it can give you an advance warning — sometimes days before the migraine begins. Since most migraine medicines work best if taken early during an attack, knowing that a migraine is coming can give you the best opportunity to stop the attack before it starts.
The symptoms of the prodrome are hard to recognize unless you know what to look for, as they are quite generalized. They include trouble concentrating, depression, aphasia, diarrhea, fatigue, food cravings, hyperactivity, hypoactivity, increased thirst, increased urination, irritability, nausea, phonophobia, photophobia, repetitive yawning, sleep problems, and stiff neck.
The aura usually begins about an hour or so before the headache starts or just as the headache begins. About twenty percent of migraine sufferers experience the aura phase; however, not all migraines will have auras, even in people who usually get them.
The most common aura symptoms are visual in nature, such as flashing lights, wavy lines, spots, blurry vision, partial loss of sight, scotomas (blind spots), and phosphenes (flashes of light that streak across the eyes). However, auras can affect the other senses as well. For example, some people experience auras that include oversensitivity to touch, aphasia, dizziness, neck pain, and even partial paralysis.
The pain of a migraine headache is well known to all its sufferers. It may start as a dull throb above the eyes and spread across one side of the head. From there, it may migrate to the other side or engulf the entire head. It may sit at the back of the head and encompass the neck as well, but in all cases, it will throb or pulsate, almost in time with your heartbeat. It worsens with physical activity and makes you seek the comfort of a dark and quiet room. The headache phase lasts anywhere from two hours to three days — sometimes even a week.
As if the headache weren’t enough, other distressing symptoms may be part of the package as well. Among these are nausea and vomiting, sensitivity to light and sound, dizziness, vertigo, neck pain (more common than nausea), nasal congestion or runny nose, hot flashes and chills, dizziness, and confusion.
The headache can start at any time of the day, but most commonly begins at 6 AM. Many migraine sufferers are awakened by the pain.
The postdrome is the final phase of a migraine attack: it begins when the headache ends and lasts from a few hours to a few days. People describe “feeling like a zombie or hung over” during this phase. Studies indicate that there is a correlation between postdromal symptoms and abnormal blood flow in the cerebrum up to 24 hours following the headache phase. Postdromal symptoms include depression or euphoria, tiredness, and concentration and comprehension troubles.