Migraines can be debilitating, painful, and make it difficult to carry on with daily activities and responsibilities.
But not every person with migraine will experience the same symptoms or stages of the disorder.
Understanding the four stages of migraine—and which phase or phases you may experience—can help inform your treatment.
In this article, I’ll outline the four different stages of migraine and their respective symptoms, timelines, and treatment options.
If you’re experiencing symptoms of migraine for the first time or are unsure about which treatment is best for you, reach out to your healthcare provider to discuss your options.
What is Migraine?
Migraine is a headache disorder that affects an estimated 44.5 million adults in the United States.
Many people with migraine experience recurrent attacks of headaches that can cause moderate to severe pain.
But not everyone will experience the same migraine symptoms or stages.
Though experts still aren’t exactly sure what causes the disorder, many believe that the causes of migraine are related to genetic factors.
There are other factors that can put you at higher risk for migraine, including:
Sex: People with vaginas are three times more likely to have migraine.
Medical conditions: Certain conditions can increase your risk of migraine, including depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.
There are four phases of migraine, though not every person will go through each phase during a migraine attack.
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Prodrome Stage
Also called the premonitory stage, the prodrome stage of migraine describes the period leading up to a headache attack.
During this stage, several uncomfortable symptoms can occur.
Symptoms
Symptoms that can appear during the prodrome stage include:
Food cravings
Increased thirst
Mood changes
Fluid retention
Neck stiffness
Uncontrollable yawning
Timeline
Symptoms of the prodrome stage generally occur 1-2 days before an attack.
Treatment
Treatment of the prodrome stage will focus on symptom management.
Depending on the symptoms you experience, treatment options may include:
Drinking plenty of fluids
Sticking to a consistent bedtime routine
Engaging in some type of stress management or relaxation technique
Exercise and/or gentle stretching
Aura Stage
Around 25% of people with migraine experience aura, a neurological disturbance which can cause unique symptoms.
Symptoms
Temporary symptoms of migraine with aura can include:
Visual hallucination, like seeing flashing or bright lights, or zig-zag lines
Loss of vision
Muscle weakness
Changes in speech
Ringing in the ears (tinnitus)
Changes in smell or taste
Feeling of pins and needles on the skin
Numbness
Headache
Timeline
The duration of aura symptoms can vary, but they generally last from 10-60 minutes.
Treatment
To treat pain associated with headache or other symptoms, there are medications that can help—especially when taken at the onset aura symptoms.
Attack Stage
The most commonly experienced phase of migraine is the attack stage, when a headache can come on gradually and become more severe with time.
Symptoms
Sometimes referred to as the headache stage, the primary symptom is a moderate to severe headache that can cause severe pain, throbbing, or pulsing.
The headache is often experienced on one side of the head.
Additional symptoms can include:
Sensitivity to light and sound
Stomach pain, loss of appetite, and pale appearance (experienced with abdominal migraine)
Timeline
The attack stage can last from 4 hours to 3 days.
Treatment
There are several treatment options that can help during the attack stage:
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a first-line treatment for mild to moderate migraine headaches. But FDA-approved prescription medications like triptans and ditans can also help. Evidence suggests that triptans are most effective when taken early in an attack. For people with migraine with aura, it’s recommended to take triptans at the start of an attack rather than at the start of aura.
Cold compress: A cold compress or ice pack can provide relief for many people with migraine.
Mindfulness-based stress reduction (MSBR): MSBR or other stress management techniques may help you to cope with migraine attack symptoms.
Ginger: One meta-analysis of randomized controlled studies suggests that ginger may reduce migraine headache pain and other symptoms, including nausea and vomiting.
Postdrome Stage
Sometimes referred to as a migraine hangover, the postdrome stage refers to the stage after a headache attack.
Symptoms
People who experience this stage can exhibit symptoms including:
Fatigue or exhaustion
Inability to concentrate
Weakness
Depression or euphoria
Lack of comprehension
Stiffness in the neck and shoulders
Tenderness in the scalp
Timeline
The postdrome stage usually lasts 24-48 hours.
Treatment
Prevention is key when it comes to reducing the severity of your symptoms during the postdrome stage.
Keeping a headache diary can help you to keep track of your symptoms, as well as identify any possible triggers you may experience.
Reach out to your healthcare provider to discuss other preventive methods, including medication, acupuncture, and massage.
Suffering from a migraine? Chat with a doctor today to discuss treatment options.
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When to See a Doctor for Migraine
When managing migraine disorder, early treatment is key to limiting the severity of your symptoms.
Reaching out to a provider or neurologist to discuss treatment is the best way to learn more about which options may work best for you.
In the meantime, consider keeping a migraine diary.
Keep track of when you experience symptoms and which factors, if any, may be triggering them.
Not all severe headaches are a sign of migraine.
In rare but serious cases, a severe headache can be a sign of something else.
If you experience any of the below symptoms, seek immediate medical attention:
Nausea
Weakness in the body
Confusion
Double vision
The “worst” headache of your life
A headache prompted by a head injury
A severe and sudden headache
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