The Phases and Anatomy of a Migraine Attack

Many people think only of a “bad Headache” when they think “Migraine” or “Migraine attack.” That’s one of the myths that still surround Migraine.

The Headache of a Migraine, when there is one, is only one symptom of a Migraine attack. A Migraine attack can also occur with no Headache. When that happens, it’s described as “silent” or “acephalgic.” For a diagnosis of any form of Migraine, there must be other symptoms. A Migraine attack consists of  three or four parts, referred to as phases or components.

Migraine attacks differ from one person to the next. One person’s Migraine attacks can differ from one to the next also. Thus, it’s important to note that not every Migraine patient experiences all four phases, and individuals may experience different phases from one attack to the next.

The four potential phases of a Migraine attack are:

• prodrome
• aura
• headache
• postdrome

The Prodrome Phase of a Migraine Attack:

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 patient’s “yellow light,” a warning that a Migraine is imminent. It’s estimated that 30 to 40% of Migraine patients experience prodrome, but it’s also thought that may be a low estimate. According to Dr. Peter Goadsby, the prodrome is “common if you ask about it, but patients often don’t think to tell about those symptoms.” For those who experience prodrome, it can actually be very helpful because, in some cases, it gives opportunity to abort the attack. For patients who experience prodrome, it makes a solid case for keeping a Migraine diary and being aware of our bodies.

Potential symptoms of the prodrome include:

• concentration problems,
• depression,
• aphasia (difficulty in using language),
• diarrhea,
• fatigue,
• food cravings,
• hyperactivity,
• hypoactivity,
• increased thirst
• increased urination,
• nausea,
• phonophobia,
• photophobia,
• repetitive yawning,
• sleep issues, and
• stiff neck or neck pain.

The Aura Phase of a Migraine Attack:

The aura is perhaps the most talked about of the possible phases of a Migraine attack. 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 Wonderland.”

While most people probably think of aura as being strictly visual, auras can have a wide range of symptoms, including:

• visual:
  • flashing lights,
  • wavy lines, spots,
  • partial loss of sight,
  • blurry vision, phosphenes -brief flashes of light that streak across the visual field,
  • monocular blindness (total blindness in one eye)
• other:
  • allodynia (hypersensitivity to feel and touch),
  • aphasia,
  • auditory hallucinations (hearing things that aren’t really there),
  • confusion,
  • decrease in or loss of hearing,
  • dizziness,
  • hemiplegia (one-sided paralysis) or motor weakness (only in hemiplegic migraine),
  • hiccups,
  • neck pain (Surprisingly, research has shown that neck pain occurs as a migraine symptom more frequently than nausea.),
  • olfactory hallucinations (smelling odors that aren’t there),
  • paresthesia (tingling or numbness of the face or extremities on the side where the headache develops.
  • reduced sensation

Approximately 25% of people living with Migraine experience aura. As with the prodrome, Migraine aura, when recognized, 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 patients will experience aura but no Headache. There are several terms used for this experience, including “silent migraine,” “acephalgic migraine.”

The Headache Phase Phase of a Migraine Attack:

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 include:

• Headache pain that is often unilateral (on one side). This pain can shift to the other side or become bilateral (on both sides).
• 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 Migraine patients to be awakened by the pain.
• Because trigeminal nerve becomes inflamed during a Migraine attack, Migraine pain can also occur in the areas of the eyes, sinuses, and jaw.
• This phase usually lasts from four to 72 hours. In less common cases where it lasts longer than 72 hours, it is termed Status Migrainosus, and medical attention should be sought.
• The pain is worsened by any physical activity.
• phonophobia (increased sensitivity to sound),
• photophobia (increased sensitivity to light),
• osmophobia (increased sensitivity to odors),
• neck pain,
• nausea and vomiting,
• diarrhea or constipation,
• nasal congestion and/or runny nose,
• depression, severe anxiety,
• hot flashes and chills,
• dizziness,
• vertigo (sensation of spinning or whirling – not to be confused with dizziness or light-headedness),
• confusion,
• dehydration or fluid retention, depending on the individual body’s reactions

The Postdrome Phase of a Migraine Attack:

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 Migraine patients 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 and fluctuations of neurotransmitters such as serotonin, norepinephrine, and dopamine. They can last 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:

• lowered mood levels, especially depression,
• or feelings of well-being and euphoria,
• fatigue,
• poor concentration and comprehension,
• lowered intellect levels

Summary

Migraine. As we’ve seen there’s far more to an attack than just the Headache phase. Not everyone will 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 attack 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 move.

Sources

1. Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia, Volume: 38 issue: 1, page(s): 1-211.