Stages of a Migraine

For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine is caused by inherited abnormalities in genes that control the activities of certain cell populations in the brain."

Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems. Many things can affect the level of serotonin in your body, including your level of blood sugar, certain foods and changes in your estrogen level if you're a woman.

The classic migraine develops in four stages

Prodrome
Aura
Headache
Postheadache

The Prodrome (sometimes called preheadache) may be experienced hours or even days before a Migraine episode. The prodrome may be considered to be the Migraineur's "yellow light," a warning that a Migraine is imminent. For the 30 to 40% of Migraineurs that experience prodrome, it can actually be very helpful because, in some cases, it gives opportunity to abort the episode. For Migraineurs who experience prodrome, it makes a solid case for keeping a Migraine diary and being aware of one's body. Symptoms typical of the prodrome are:

food cravings
constipation or diarrhea
mood changes - depression, irritability, etc.
muscle stiffness, especially in the neck
fatigue
increased frequency of urination

The Aura is the most familiar of the phases. Aura follows the prodrome and usually lasts less than an hour. The symptoms and effects of the aura vary widely. Some can be quite terrifying, especially when experienced for the first time. Some of the visual distortions can be exotic and bizarre. It's interesting to note that Migraine aura symptoms are thought to have influenced some famous pieces of art and literary works. One of the better know is Lewis Carroll's Alice in Wonderland. While most people probably think of aura as being strictly visual, auras can have a wide range of symptoms, including:

visual: flashing lights, wavy lines, spots, partial loss of sight, blurry vision
olfactory hallucinations - smelling odors that aren't there
tingling or numbness of the face or extremities on the side where the headache develops.
difficult finding words and/or speaking
confusion
vertigo
partial paralysis
auditory hallucinations
decrease in or loss of hearing
reduced sensation
hypersensitivity to feel and touch

Approximately 20% of Migraineurs experience aura. As with the prodrome, Migraine aura, when the Migraineur is aware of it, can serve as a warning, and sometimes allows the use of medications to abort the episode before the headache itself begins. As noted earlier, not all Migraine episodes include all phases. Although not the majority of episodes, there are some Migraine episodes in which Migraineurs experience aura but no headache. There are several terms used for this experience, including "silent Migraine," "sans-Migraine," and "Migraine equivalent."

The Headache phase is generally the most debilitating part of a Migraine episode. It's effects are not limited to the head only, but affect the entire body. The pain of the headache is so intense that it is difficult to comprehend by those who have not experienced it. Characteristics of the headache phase include:

headache pain that is often hemicranial - on one side.
This pain can shift to the other side or become bilateral.
Although Migraine pain can occur at any time of day, statistics have shown the most common time to be 6 a.m. It is not uncommon for Migraineurs to be awakened by the pain.
This phase usually lasts from one to 72 hours. In less common cases where it lasts longer than 72 hours, it is termed status migrainosus, and medical attention should be sought.
The pain is worsened by any physical activity.
phonophobia - sensitivity to sound
photophobia - sensitivity to light
nausea and vomiting
diarrhea or constipation
nasal congestion and/or runny nose
depression, severe anxiety
hot flashes and chills
dizziness
confusion
dehydration or fluid retention, depending on the individual body's reactions

The Postdrome Once the headache is over, the Migraine episode is still not over.
The postdrome (sometimes called postheadache) follows immediately afterward. The majority of Migraineurs take hours to fully recover; some take days. Many people describe postdrome as feeling "like a zombie" or "hungover." These feelings are often attributed to medications taken to treat the Migraine, but may well be caused by the Migraine itself. Postdromal symptoms have been shown to be accompanied and possibly caused by abnormal cerebral blood flow and EEG readings for up to 24 hours after the end of the headache stage. In cases where prodrome and/or aura are experienced without the headache phase, the postdrome may still occur. The symptoms of prodrome include:

lowered mood levels, especially depression
or feelings of well-being and euphoria
fatigue
poor concentration and comprehension
lowered intellect levels

Not all Migraineurs experience all phases, and those who do don't experience them with each episode. If it all sounds unpredictable - it is. For those who suffer from Migraine, there can be great advantage to learning about these components of Migraine and how to recognize them. Once we know about them, and learn to listen to our bodies, if we experience prodrome or aura symptoms, we have a better chance of avoiding the headache phase. In addition, there's always an emotional comfort factor to knowing what is causing us to feel depressed or have other symptoms. Add in a bit of control - once we learn to recognize these symptoms and use them in our Migraine management, we gain a bit more control over Migraine. Any time we can do that, it's a positive move.

If you experience the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision, see your doctor immediately to rule out more serious conditions, such as stroke or retinal tear. Once these conditions have been ruled out, future migraines with aura can be considered not to be a sign of a more serious condition and won't require a visit to your doctor, unless you notice unusual or worsening symptoms.

The psychological effects of pain amplify the trauma, contributing to depression, anxiety, sleeplessness and suicide. "Many people in severe pain from terminal illness fear their pain more than they fear death," says Scott Fishman, chief of pain medicine at the University of California-Davis.

(c) 2007-2008, Theda Foster, CEEMP, All rights reserved.
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It is not intended to diagnose, treat, or cure any illness, disease, or disorder.