Phases of a Migraine
Published July 2021
Celebrities like Serena Williams and Khloe Kardashian suffer from them. They are common, affecting 35 million Americans. In fact, 43% of women and 18% of men will have migraines at some point in their lives. But, migraines are more than just headaches.
"For many people, the headache is a big part of a migraine, but migraines are not just headaches. They're more than that," says Katherine S. Carroll, MD, neurologist and director of the Comprehensive Headache Center at Northwestern Memorial Hospital. "Knowing the unusual symptoms of your migraine can help you get ahead of the actual attack, or the headache itself."
Mechanism of a Migraine
The leading theory of how migraines occur is called the cortical spreading depression theory.
It says that the beginning phase of a migraine involves improper signaling of the neurons, or nerve cells, in the cortex and deep structures of the brain, including the hypothalamus, which controls vital functions like breathing, sleep and body temperature. When the actual headache sets in, small proteins called neuropeptides are improperly released. This causes the blood vessels in the brain to swell, resulting in pain.
Four Phases of a Migraine
Stage 1: Prodromal phase
The prodromal phase can last a few hours to a few days. People may experience unusual symptoms like excessive yawning and strong food cravings, which are unique to each person.
- Excessive yawning
- Abnormal feelings of elation or sudden bursts of energy
- Strong food cravings
Stage 2: Aura
The aura phase involves changes in sensation, most commonly visual changes which can last five minutes to one hour. Auras occur in one in three people with migraines. The aura phase is directly related to the neurons in the cerebral cortex becoming excited and firing improperly, according to the cortical spreading depression theory.
Visual changes, such as:
- Sparks of light
- Geometric shapes that grow
- Kaleidoscopic vision
- Tunnel vision
- Temporary loss of vision
Sensory symptoms, such as:
- Numbness or tingling in the extremities or face
- Olfactory (smell) hallucinations, such as:
- A smell that is usually foul, like burned rubber or gasoline
Stage 3: Headache
The headache can last a few hours to a few days. Headache symptoms differ for each person and can range from a deep drilling or stabbing pain, to a throbbing sensation. You may feel the headache in different parts of your head.
"Typically, the pain of a migraine is one sided, and oftentimes makes it difficult for someone to function, or doing activity worsens the pain," says Dr. Carroll. "Also, migraine headaches come with light or sound sensitivity and can also cause nausea and sometimes vomiting."
Pain in the head that can feel like:
- Drilling or stabbing
- Difficulty sleeping
- Sinus congestion
- Sensitivity to light, smell and sound
- Neck pain or stiffness
Stage 4: Postdromal phase
The postdromal phase can last a few days, and it can sometimes feel like a hangover.
- Sensitivity to light, smell and sound
- Feeling "off"
- Allodynia, or pain in the scalp, which can cause trouble brushing, styling or shampooing hair
"While we don't know exactly what causes these unusual symptoms, we know that people should pay attention to them so that they are ready to treat the headache when the attack comes on," says Dr. Carroll. "Also, it's important for people to realize that even after the headache is gone, the lingering symptoms of a migraine can be debilitating and affect quality of life."
Get a Head Start
If you have migraines, note how you act and feel before your headache starts. This can help understand your prodromal and aura symptoms so you can get ahead of treatment. This may involve removing stressors that trigger your migraines, taking over-the-counter pain medications and getting enough sleep. It is good to rest and avoid triggers during the postdromal phase as well.
Remember: Time is often the only way to beat a migraine, but practicing good self-care and avoiding triggers are keys to avoiding migraines. Early treatment with appropriate, migraine-specific medication is important once the migraine sets in as well.
If your migraine symptoms become more severe than normal, or you experience symptoms such as confusion, fever, trouble speaking or arm weakness, call 911 or go to the nearest emergency department right away.