Symptoms and stages of migraine

Not everyone will have a ‘typical’ migraine. There are different types of migraine that involve different symptoms.

The most common symptoms of a migraine attack include throbbing headache, sensitivity to light and noise, nausea (feeling sick), vomiting (being sick) and lethargy (lack of energy).

Migraine attack stages or phases

It is often difficult to predict when a migraine attack is going to happen. However, you can often predict the pattern of each attack as there are well-defined stages.  It is these stages and their symptoms which distinguish a migraine from a headache.

In adults, we can divide a migraine attack into four or five stages that lead on from each other:

• Premonitory or warning phase
• Aura (not always present)
• The headache or main attack stage
• Resolution
• Recovery or postdrome stage

Learning to recognise the different phases of a migraine attack can be useful. You might get one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Each phase can vary in length and severity.

Recognising different symptoms at different times during your headache attack can give a doctor information which may help diagnosis. Also, taking medication before the symptoms have fully developed may reduce the effect of an attack. A child’s migraine attack is often much shorter than an adult’s attack, and it may therefore not be possible to fully make out the different headache phases.

Premonitory stage

This describes certain physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and a stiff neck. These feelings can last from 1 to 24 hours.

Aura

The aura of migraine includes a wide range of neurological symptoms. This stage can last from 5 to 60 minutes and usually happens before the headache. Migraine without aura does not include this stage.

In some people, changes in the cortex area of the brain cause changes in their sight, such as dark spots, coloured spots, sparkles or ‘stars’, and zigzag lines. Numbness or tingling, weakness, and dizziness or vertigo (the feeling of everything spinning) can also happen. Speech and hearing can also be disturbed, and people with migraine have reported memory changes, feelings of fear and confusion, and more rarely, partial paralysis or fainting. These neurological symptoms are called the ‘aura’ of migraine. In adults, they usually happen before the headache itself, but in children, they may happen at the same time as the headache. It is possible to have the aura symptoms without a headache.

The headache or main attack stage

This stage involves head pain which can be severe, even unbearable. The headache is typically throbbing, and made worse by movement. Some people describe a pressing or tightening pain. The headache is usually on one side of the head, especially at the start of an attack. However, it is not uncommon to get pain on both sides, or all over the head. Nausea (sickness) and vomiting (being sick) can happen at this stage, and the person with migraine may feel sensitive to light or sound, or both.

Resolution

Most attacks slowly fade away, but some stop suddenly after the person with migraine is sick, or cries a lot. Sleep seems to help many people, who find that even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.

Recovery or postdrome stage

This is the final stage of an attack, and it can take hours or days for a ‘hangover’ type feeling to disappear. Symptoms can be similar to those of the first stage, and often they are mirrored symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, now you might feel full of energy.

source: https://www.migrainetrust.org/