Migraine Attack: The Four Phases & Their Symptoms


Predicting the occurrence of a migraine could be difficult but you surely can identify its stages. Read on to know about the symptoms of each phase and what you can do about it.

Severe throbbing pain on one side of the head is identified to be a migraine attack. It involves extreme sensitivity towards light and sound. It is accompanied by vomiting and nausea. The pain due to a migraine can last from several hours to several days. There are four stages that a migraine progresses through.

The pattern of each migraine attack can be predicted as they are divided into stages. The symptoms of these stages also help one in distinguishing between a headache and a migraine attack. A migraine attack can be divided into four stages: prodrome, aura, headache and postdrome.

Let's look at each phase in detail along with the accompanying symptoms.

This stage occurs hours before the actual migraine attack sets in. Sometimes, this stage can also begin days before the migraine attack. This stage marks the beginning of the attack and is also referred to as preheadache or as just the premonitory phase. However, it is not necessary that every migraine attack is preceded by a prodrome.

Symptoms of this phase are:

• Excessive irritability
• Thirst
• Unusually energetic or depressed
• Specific food cravings
• Extreme sleepiness
• The feeling of having to urinate more often

This is the phase when strange feelings begin to occur. Usually, the aura stage accompanies the headache or just begins before the headache sets in. Every one in four people with the migraine issue does come across the aura phase.

The symptoms of this phase are:

• Vision changes - A blind spot in your field of vision, flickering lights of complicated shape usually on either the left or the right side of your vision's focus. It lasts for a few minutes and keeps getting bigger. Hallucinations could also be a part of visionary changes during the aura stage of a migraine attack.

• Skin sensitivity - A tingling sensation is observed such as pins or needles being mildly poked on your body. There could be episodes of numbness. It lasts for several minutes and usually occurs on the face and hands.

• Communicating difficulty - You could find it difficult to express what you wish to say while speaking or writing. There could be trouble in concentrating and also bouts of confusion.

This is the main attack stage. There is a pain on one or both sides of your head. It can last up to a maximum of say about 3 days, sometimes more in rare cases. The course of the headache can involve shifting of the headache from one side of the head to the other. The intensity of the pain varies from person to person.

The following are the symptoms of this phase.

• Begins above the eyes
• Feels like throbbing
• Usually begins with the headache on one side of the head
• Gets worse when you move around
• Worsens during strenuous activity or when you lean forward
• Increased sensitivity towards smell, sound and light
• Nausea accompanied by vomiting
• Fainting and lightheadedness

This stage is also referred to as the "migraine hangover" or the post-migraine phase. It occurs almost among 80 per cent of the people who suffer from migraine attacks. Although the headache phase is over, the postdrome phase can still continue to show some of the symptoms. It is, therefore, essential to continue avoiding the migraine triggers during this phase as well.

The symptoms of this phase are:

• Sluggishness
• Confusion
• Head pain worsening when you lean or move around too quickly
• Extreme tiredness

Doctors are able to easily differentiate between a migraine and a general headache by listening to the symptoms that occur. Medical history along with a general physical and neurological examination helps a doctor assess the condition of the migraine attack that you are facing. Some tests could be prescribed to rule out other medical complications. These include:

• MRI scans to diagnose the presence of tumours, bleeding in the brain, infection or stroke.
• CT scans to identify medical reasons other than a migraine that could be causing headaches.
• Blood tests to determine problems in the spinal cord or brain, the presence of toxins and blood vessel-related ailments.
• Spinal tap in case doctor suspects an infection or bleeding in the brain.

Treatment strategies followed by your doctor would depend on your condition and the frequency of the migraine attacks. Treatments can help in reducing symptoms and also in preventing future attacks. The two broad categories of migraine-treating medications are:

Taken during a migraine attack. These help in addressing and reducing the symptoms. The usual ones are aspirin or ibuprofen. Triptans such as naratriptan, sumatriptan, almotriptan, etc., can also be used to treat migraines. These work by constricting blood vessels and blocking pain pathways in the brain.

These drugs are taken daily to reduce the frequency and severity of such attacks. These include cardiovascular drugs such as beta blockers, tricyclic antidepressants such as amitriptyline, anti-seizure drugs such as valproate and topiramate, etc.

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