Phases of a Migraine

There are 4 distinct phases in classic migraine:

1)  Prodrome
The symptoms of the prodrome phase typically occurs hours or days prior to the actual onset of headache pain. Prodrome symptoms can include:

• Fatigue or excessive sleepiness
• Frequent yawning
• Altered mood
• Irritability
• Depression or euphoria
• Muscle stiffness (especially in the neck, back and face)
• Food cravings
• Difficulty concentrating

2)  Aura
Not all migraineurs experience an aura preceding or accompanying the actual headache pain. The aura phase typically begins minutes or hours prior to the onset of headache pain. Aura can be visual, sensory, or motor in nature. Visual symptoms include:

• Blurred vision
• Appearance of floaters (tiny specks that float before the eyes)
• Flashes of light or color
• A blind spot or even complete blindness in one eye
• Double vision

Sensory and motor symptoms include:

• Numbness or tingling of the hands, feet, and/or face
• Stiff neck
• Weakness
• Vertigo or Dizziness
• Loss of balance
• Ringing in the ears
• Difficulty talking
• Slow thinking or confusion
• Problems with concentration
• Changes in mood and activity level
• Hypersensitivity to touch

3)  Headache
This phase is the experience of the headache pain. For some, the pain is a one-sided,  throbbing or pounding pain. For others, the pain is all over the head. The migraine pain typically lasts between 4 to 72 hours. "Status migrainosus" are headaches that last longer than 72 hours, and require immediate medical attention. This is the most disruptive of the phases, and migraineurs often stop all activity and remove themselves from certain triggers (light, sound, odors). The headache phase often includes the pulsing / throbbing head pain, as well as some other symptoms, including:

• Extreme sensitivity to light, sound, and smell (photophobia, phonophobia, osmosphobia)
• Nausea
• Vomiting
• Increased pain with physical activity (such as walking or going up or down stairs)
• Blurred vision
• Scalp tenderness
• Stiffness and tenderness of the neck
• Problems with concentration
• Mood changes
• Vertigo, hotheadedness, and/or faintness
• Extremities feel cold and moist

4)  Postdrome
Some migraineurs experience symptoms after the headache pain has subsided. The postdrome symptoms may continue for several hours or even days. Symptoms of this phase can include:

• Fatigue
• Weakness
• Irritability
• Anxiety
• Depression
• Scalp tenderness
• Cognitive difficulties (difficulty concentrating)
• Mood changes
• Feeling "hungover"
• Head pain