The 4 Stages of Migraine

Find out the different stages of migraine—prodromal, aura phase, attack phase, postdromal—and how to get relief.

Health Monitor Staff
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Sensitivity to light and sound. Flashing lights and patterns that make it hard to see. Nausea and vomiting.

If you have migraines, you’re familiar with these symptoms. But did you know they characterize the various stages of migraine—and that cuing into them can be the key to more effective treatment? Read on to learn more.

1. Prodromal (early warning)

When it happens: Several hours to up to two days in advance.
Frequency: About 60% of those with migraines will experience this phase. 
Possible symptoms: Anxiety, unexplained energy or feelings of euphoria, irritability, difficulty concentrating, food cravings, sensitivity to smells or noise, fatigue with frequent yawning
What to do: Take the pain reliever your doctor recommended or prescribed. Doing so right now can help you avoid a full-on migraine. This is also a good time to think about possible triggers—for example, ask yourself what you’ve eaten or had to drink, how stressed you are and how much sleep you’ve had.

2. Aura Phase (pre-migraine)

When it happens: About an hour before to right when the headache strikes.
Frequency: About 20% of those with migraines experience this phase, but not necessarily with each migraine.
Possible symptoms: Changes in vision, such as flickering, shimmering or flashing lights, tunnel vision, difficulty focusing, spots of vision loss or zigzag lines that cross your line of sight; skin sensations, such as numbness in your extremities or feelings of tingling or “pins and needles” in the face or hands; trouble speaking, writing or understanding words; muscle weakness 
What to do: Immediately take a pain reliever or the medication you’ve been prescribed for your migraine. Make sure you have your migraine tool kit handy and avoid any triggers.

3. Attack Phase (during headache)

When it happens: This is when the actual headache strikes; it can last for hours up to several days.
Frequency: 100% if the migraine is untreated.
Possible symptoms: Throbbing or pulsing pain ranging from mild to severe, often on one side but sometimes both sides of the head; sensitivity to light, sounds and sometimes smells; nausea and vomiting; blurred vision; light-headedness and/or fainting
What to do: Immediately take a pain reliever or medication you’ve been prescribed for your migraine. Relax in a cool, dark, quiet setting.

4. Postdromal (after headache)

When it happens: After the attack phase has subsided, and lasting for a few hours up to two days.
Frequency: Most people who experience the attack phase will experience some form of postdromal phase.
Possible symptoms: Extreme fatigue, sluggishness, confusion, irritability, head pain if you move too quickly or bend over
What to do: If you’ve been taking acute pain relievers, start to cut back so you avoid a rebound headache. Continue to rest and avoid stress or other common triggers.

January 2014