The 5 possible stages of a Migraine attack

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The 5 possible stages of a Migraine attack

At first it is often difficult to predict when a migraine attack is going to happen, however, over time you can learn to recognise a pattern of each attack – everyone is different and sadly not all attacks are the same – so keeping a diary may help you and sadly the more you have the more experience you will have of spotting the signs… thus giving you the clues to stop and rest or to take medication. Understanding your phases can also help your doctors to diagnosis and treat you.

In adults* a migraine attack actual comes in four or five phases –  that roll on from each other – however not everyone has all five phases:

  1. Warning phase (Known as the Prodrome)
  2. Aura (not always present)
  3. The headache (not always present – can be one sided or even both sides)
  4. Resolution  (Known as the Postdrome)
  5. Recovery

* In children the migraine attack is often shorter and it may therefore not be possible to fully make out the different phases.

1. Warning phase (Known as the Prodrome)

The Prodrome can occur hours or even days before the aura or headache begins – often overlooked these symptoms maybe mistake for migraine ‘triggers’.  it is however considered to be an integral component of the migraine process. It acts as a warning sign that a migraine is imminent. About 60% of people with migraine experience prodromal symptoms.

Typical symptoms can include:

  • Physical symptoms
  • Muscle stiffness, especially in the neck
  • Altered perception of heat and cold
  • Increased thirst
  • Increased urination
  • Food cravings
  • Loss of appetite
  • Yawning
  • Constipation
  • Diarrhoea
  • Fluid retention
  • Sensitivity to light and/or sound

Psychological symptoms

  • Depression
  • Euphoria
  • Irritability
  • Restlessness
  • Hyperactivity
  • Fatigue
  • Drowsiness
  • Difficulty in concentration

2 Aura

The aura of migraine includes a wide range of neurological symptoms – it is not only visual as many people think. This stage can statistically last for between 5 and 30 minutes, and usually happens before the headache. However, I have met many people whom experience this for much longer and a few whom have aura symptoms for days and days. Statistical only 15% of migraine sufferers have aura, and will only have a few of these listed. Auara can be broken down into 4 groups: (A full explanation of these can be found here)

  • Sensory disturbances
  • Motor disturbances
  • Verbal disturbances
  • Visual disturbances

Sensory

  • Somatosensory symptoms
  • Body image disturbances (Alice in Wonderland Syndrome),
  • Near-death experiences
  • Depersonalisation
  • Derealisation
  • Auditory symptoms
  • Gustatory symptoms
  • Olfactory symptoms
  • Paramnesias
  • Forced reminiscence
  • Dreaming disturbance
  • Synaesthesia
  • Time perception disturbances

Motor

  • Paralysis
  • Weakness
  • Numbness
  • Painless sensation [tactile hallucination] of coldness
  • Tactile hallucinations of movement
  • Impaired coordination
  • Involuntary movements

Verbal disturbances

  • Stuttering
  • Involuntary vocalisations
  • Paralysis of speech muscles
  • Global aphasia
  • Anomic aphasia
  • Reading disturbances
  • Writing disturbances

Visual disturbances

Visual aura is the most common of auras. A visual aura is like an electrical or chemical wave that moves across the visual cortex of your brain. It is possible to see this via a MRI. As the activation spreads during an aura, a person loses normal visual function.

  • Autokinesis
  • Cinematographic vision
  • Corona phenomenon
  • Diplopia
  • Dysmetropsia
  • Illusory visual splitting, tilted vision, inverted vision
  • Metamorphopsia
  • Mosaic illusion
  • Polyopia /Palinopsia
  • Visual loss
  • Visual hallucinations
  • Random form dimension
  • Line form dimension
  • Curve form dimension
  • Web form dimension
  • Lattice form dimension
  • Tunnel form dimension
  • Spiral form dimension
  • Kaleidoscope form dimension
  • Floaters
  • Soft focus
  • Snow

3.The headache
This stage involves head pain which can be severe, even unbearable – I would often describe this as a horse kicking my head from the inside out.

The headache is typically throbbing, and made worse by movement, it is usually on one side of the head, but some sufferers get the pain on both sides of the head, or over the forehead, but not usually at the back of the head.

But YOU CAN have a migraine attack with no headache and these are not to be underestaimated sometimes the auara stage can be worse than the headache stage.

The headache phase is often accompanied by:

  • Nausea (sickness)
  • Vomiting (being sick)
  • Sensitive to light
  • Sensitive to sound
  • Stiffness or tenderness of the neck

4 Resolution (Known as the Postdrome)

The postdromal or resolution phase follows the headache and may last for up to 48 hours. Most attacks slowly fade away, but some stop suddenly after the sufferer is sick, or cries a lot. Sleep seems to be the best ‘cure’ for many sufferers, who find that even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.

Typical symptoms include:

  • Fatigue
  • Sore muscles
  • Food intolerance
  • Malaise
  • Alteration in mood
  • Impaired concentration
  • Scalp tenderness
  • Decreased energy requiring a period of rest.

A few sufferers immediately after an attack can feel energised, euphoric and can return to normal activities at once.

5 Recovery 

Often known as the hungover or run over phase  – This is the final stage of an attack, and it can take hours or even days for this ‘hangover’ type feeling to disappear.

Symptoms can be similar to those of the first stage, and often they are mirrored symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, now you might feel full of energy. Most people just feel warn out and weak and in need of rest.

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