The Four Phases of Migraine Attacks

Written by Lizzie Propati | April 15, 2022

Did you know there are 4 phases to migraine attacks? Did you know that each “phase” comes with its own sweet set of symptoms? It’s not just nausea, vomiting and head pain… as if that isn’t enough by itself! We’re going to look at vision distortion, cravings, emotional changes, energy levels, and much more! And, we’re going to look at when each of these MIGHT occur during a migraine attack. Then of course, there’s the sweet “interictal period.” That time in between attacks when theoretically you are symptom-free, but in reality… that is often far from the truth! That’s a topic for another blog, but in short —migraine attacks are complex, unpredictable and debilitating, but being armed with information can help!

The Prodrome Phase

This is your early warning sign that a full blown migraine attack is coming! Sometimes the warning is feelings of depression, excitability or even… more energy! Ever wondered why you have tons of energy one day and then the next are completely laid up with a migraine? It’s not necessarily that you did too much. It could simply be that the energy was part of your prodrome. Other possible symptoms are sleepiness, frequent urination, irritability, frequent yawning, being extra thirsty, or craving certain foods. While we’re on the topic of “food cravings”… one of the reasons it can be challenging to figure out food triggers is for this exact reason. Often an “attack” starts and is in the prodrome phase without pain, and we crave foods like chocolate! Then the next thing you know, wham! The pain hits and we blame the chocolate or anything else that we had been eating. But the food wasn’t necessarily the trigger; rather, it was part of the initial phase of the migraine and the trigger actually came WAY BEFORE that. The good thing about the prodrome is that once you are able to figure out your symptoms, that information can help you to prepare for what is coming next.

The Aura Phase

This phase is interesting because not everyone who has migraine has these symptoms—in fact, only about 1 in 4 people who have migraine experience aura. Read on to learn more! Symptoms can include feelings of tingling or pins and needles, flickering of lights, or a blind spot in vision. Some people even experience what is known as Alice in Wonderland syndrome with distorted perception where things appear bigger, smaller, closer, or further away that they really are, or sometimes just warped. Often doctors don’t ask patients about this type of aura, so if you experience anything like this, it’s important to let your doctor know! Other symptoms experienced by some during the aura phase are language dysfunction with trouble speaking or understanding oral or written language, confusion, brain fog, or just a feeling of being overwhelmingly unfocused. Remember, if you DON’T have one or more of these symptoms it doesn’t mean you do NOT have migraine attacks, because they happen in only 1 in 4 people with migraine.

The Acute or “Headache” Phase

This is when you are truly in the full blown “migraine zone”!! You know the PAIN that you experience here! Most healthcare providers will ask, “What’s your pain level from one to ten?” Are they kidding? Do they even understand what we are dealing with? Aside from pain being either on one side of your head, or stabbing behind your eye, it can also feel like someone is swinging a hammer at your head over and over again, a band strangling your brain, or continuous explosive throbbing. But wait… there’s more! As if the pain itself isn’t enough, there are many other symptoms that can occur! Symptoms such as visual impairment, confusion/brain fog, unstable motor skills, vertigo, dizziness, nausea, vomiting, slurred or muddled speech, IBS, extreme sensitivity to light, sound and smells, exhaustion, neck or body pains, sinus congestion, teary eyes, and the list goes on and on.

The Postdrome Phase

This is the last phase of a migraine attack. Unbelievably, while the pain, nausea, and other debilitating symptoms may be over, the attack is not yet through. You may not feel well for a day or more and there could be lingering symptoms. You may experience sluggishness, exhaustion, brain fog, muscle soreness, neck ache, low grade ongoing headache, and more.

Let Us Know

It can be frustrating because some of these symptoms overlap from one phase to the next or they could be all different. Did you realize that your migraine attacks could have FOUR PHASES? Did you realize that before you know you’re even having an attack the symptoms have started? Perhaps you thought that for instance, your stomach issues were disconnected from your invisible disease, or your visual distortion was a totally separate issue! Make sure to notate what’s happening to your whole body and to inform your headache specialist. We would love to hear from you in the comments so that we can learn together and help raise awareness!

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