A migraine attack can be divided into four phases: the premonitory phase (before head pain), the aura phase (immediately before or during head pain), the head pain phase, and the postdrome phase (after the head pain subsides). While this is a general outline of a migraine attack, there is immense variability as phases of an attack can be overlapping or completely absent.
PREMONITORY PHASE (Hours – days)
The premonitory phase dishes out a whole host of symptoms. Patients may experience yawning, cravings, increased urination, light sensitivity, neck pain, brain fog, irritability, and more. Brain imaging studies have revealed that the hypothalamus, a small structure in your brain that is the master coordinator of your entire hormone system, is likely involved in the production of premonitory symptoms.
AURA PHASE (minutEs – hours)
Researchers are still investigating what aura is and why it happens, but aura symptoms can be visual, sensory, lingual or olfactory. Visual aura symptoms are the most common, with the majority of patients with migraine with aura reporting tunnel vision, the appearance of zig-zag lines, or blind spots in one / both eyes. *Population studies suggest that migraine with aura increases an individual’s risk of ischemic stroke, restless leg syndrome, panic disorder, and more.
THE HEAD PAIN PHASE (4-72 hours)
The head pain phase is commonly characterized by severe throbbing / pulsing pain on one side of the head that is accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Additional symptoms can include insomnia, gastrointestinal issues, congestion, anxiety, depression, and neck pain.
POSTDROME phase (24-48 HOURS)
The postdrome phase has been dubbed the ‘migraine hangover’. This phase is highly variable, but it can be just as debilitating as the head pain phase with symptoms ranging from intense fatigue, body aches, brain fog, dizziness, and sensory sensitivity.
Did you know all the phases of a migraine attack? Being able to identify the phases of a migraine attack will enable you to better manage your symptoms. The earlier you are able to treat a migraine attack the less severe the attack is likely to be.
Resources:
- Charles, Andrew. “The pathophysiology of migraine: implications for clinical management.” The Lancet Neurology 17.2 (2018): 174-182.
- The Timeline of a Migraine Attack. (n.d.). Retrieved August 19, 2020, from https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/
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