What are the Phases of Migraines? And Surviving Migraine Postdrome
As a migraineur, I didn’t realize that the migraines I was suffering from had phases – which was pretty eye-opening to me, and explained a lot!
According to the US National Library of Medicine – National Institutes of Health, migraines are divided into four phases – the premonitory (or prodrome) phase, the aura, the headache phase, and the postdrome.
Migraine Phases
Premonitory or Prodome
The premonitory or prodrome phase is the initial phase of a migraine – and occurs hours or even days before pain occurs. Migraine.com estimates that 30% to 40% of migraineurs exhibit the premonitory phase – helpful because it serves as warning that a migraine will occur.
Symptoms of the premonitory phase may include:
- Neck pain
- Sleepiness
- Food cravings
- Fatigue
- Difficulty concentrating
Aura
The aura is the next phase of a migraine, and it is estimated that only 25% of migraineurs suffer from auras. The aura is typically a visual symptom, but occasionally there are other symptoms associated with an aura, and they may include:
- Alice in Wonderland syndrome (a rare form of aura where there is a distortion of body image and perspective)
- Olfactory hallucinations
- Vertigo
- Visual disturbances, such as blurriness, wavy lines, blank or blind spots
- Auditory hallucinations
Headache
The headache phase is the classic migraine that we all know and are so familiar with.
We find migraines to be debilitating – but sometimes migraines don’t last as long as the other phases – the prodrome, aura, and postdrome – and in the grand scheme, are not quite as debilitating as the other phases.
However, the migraine can cause symptoms in other parts of the body as well:
- A headache, which can be unilateral or bilateral, and can have qualities such as pulsating or throbbing
- Headaches that may last anywhere from four to 72 hours in adults, and one to 72 hours in children
- Osmophobia (sensitivity to odors)
- Phonophobia (sensitivity to sound)
- Photophobia (sensitivity to light)
- Confusion
- Dehydration
- Nausea and/or vomiting
- Neck pain
- Vertigo
What is Migraine Postdrome?
The postdrome phase is the phase that occurs after a headache actually happens. It can occur for one to two days. The symptoms that occur are typically non-headache symptoms and may include:
- Tiredness
- Poor mood, concentration and/or comprehension
- Decreased intellect levels
Do these symptoms sound familiar? Many people describe this phase as a “migraine hangover” – because that is exactly what it feels like, a hangover!
The issue with migraine postdrome? As migraineurs, we all know it exists! However, it has been poorly studied and thus, poorly documented.
In fact, studies of migraines go back for years, but studies about migraine postdrome only go back to 2004. “The postdrome, while disabling for many patients, has not been prospectively documented, and is not defined in the International Classification of Headache Disorders (ICHD).”
The Research About Migraine Postdrome
In a research study, migraine patients from four headache centers were recruited.
The criteria were that they had to have non-headache symptoms, besides classic migraine symptoms such as auras, nausea and vomiting, phonophobia and photophobia. These people were recruited for a three-month electronic diary study, which aimed to document non-headache symptoms in all four phases of the migraine.
The diaries were programmed to alarm once daily, and the participants were asked to answers a series of questions about their current symptoms. They were also asked to make voluntary entries in their electronic diary as needed.
The results were quite interesting. Of the 120 participants, 23 participants were excluded because they had fewer than three migraines during the study period.
“Of the remaining 97, there were 9 protocol violators: 1 did not usually experience 2–8 migraines per month, 5 recorded diary entries on fewer than 80% of days, and 3 took excluded medications: flunarizine or valproate. Twelve patients withdrew before the end of the study with diary fatigue, though all had usable data with more than 3 migraine headaches in the study period and were included in the analysis.”
Ultimately, 85% of the participants suffered from non-headache-related symptoms after a headache dissipated. Of this 85% of participants, 66% had symptoms in 90% of their headaches, and the postdrome was lasted for at least one day in 49% of the participants.
