While I write this article, I have a migraine and associated vertigo symptoms – it’s challenging to write, but I want people to understand migraine disease. If my words are strange, I can chalk it up to my ‘migraine brain,’ which I will explain below. However, my pain has become my purpose and inspires me to be a very vocal migraine advocate.
For this issue, let’s talk about the phases of a migraine attack and some of the more common types of migraine. Migraine is divided into four phases: prodrome, aura, head pain, and postdrome. Migraine and its symptoms come in many forms and are different from person to person and from attack to attack, becoming confusing and challenging to deal with.
Phases of a Migraine
1st Phase - Prodrome
More than 60% of those who have migraine will experience this first phase, sometimes called the “premonitory phase.” Symptoms begin to occur and can slowly creep up on us. This phase can last for hours or days before the second or third stages of the migraine begin. If noticeable, these symptoms can be used as a warning, alerting you to take measures to help prevent a full-blown migraine from happening.
Common symptoms can include cognitive dysfunction (confusion, forgetfulness, inability to concentrate, AKA ‘migraine brain’), blurred vision, nausea, mood changes (depression and irritability), fatigue, food cravings, yawning, sensitivity to light or sound, and neck stiffness and/or pain.
2nd Phase - Aura
Only 25-30% of people who have migraine experience a temporary but distinct aura phase which usually only lasts 30-60 minutes. Visual aura is the most common, but aura can also affect other senses.
Common symptoms can include visual disturbances such as flashing, jagged, sharp-edged, colorful lines and temporary darkening or loss of vision. You can also experience numbness or tingling in your face, arms or legs, have difficulty speaking, or smell things that aren’t there (smoke).
3rd Phase – Head Pain
During this phase, most people experience severe head pain that typically worsens with physical activity. Lasting hours or even days, this phase is usually characterized by moderate to severe pain on one side of the head, generally pulsating or throbbing. It can vary from person to person and from one attack to another.
Along with head pain, common symptoms can include nausea, vomiting, extreme sensitivity to light, sound or smells, hot flashes or chills, and dizziness or vertigo.
4th Phase – Postdrome
Almost 80% of people describe the postdrome, or ‘hangover’ phase, to be just as debilitating as the head pain phase. It has been described as feeling as bad as the flu. It is the recovery time and can last for hours or days.
Common symptoms can include heavy fatigue, body aches, difficulty concentrating and comprehension, dizziness, lowered mood levels, especially depression, or feelings of well-being and euphoria.
Common Types of Migraines
Migraine Without Aura
The most common type of migraine is Migraine Without Aura that can last 4–72 hours. Typical elements are one-sided pulsating or throbbing moderate to severe pain. It is aggravated by routine physical activity and can be accompanied by nausea and/or vomiting, sensitivity to light, sound and smell.
Migraine With Aura
An “aura phase” accompanies a migraine with aura. These attacks can last several minutes to an hour and are usually one-sided, fully reversible visual, sensory or other central nervous system symptoms. They tend to develop gradually and may be followed by head pain and associated migraine symptoms.
Medication Overuse Headache (MOH)
When people use too many over-the-counter NSAIDS or abortive prescription medications for head pain, a medication overuse headache (MOH) or “rebound headache” can occur. The brain gets used to these medications and starts to think they are part of the normal brain chemistry. The medicines become less effective, which causes people to take even more.
Also known as “intractable migraine,” this is when the head pain phase goes on for so long it causes ‘central sensitization’ where our brains get trapped in the cycle of chronic pain. Our brain learns that being in pain is our new normal. The longer we stay in pain, the harder that cycle is to break.
For those that have migraines, you are not alone. Don’t give up! Between old treatments and new treatments, there are more options than ever before. Life with migraine can be isolating, but you don’t have to do it alone.
Stay tuned for more in the next issue.
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