4 Stages of Migraine: A Migraine Starts Before the Head Pain Begins

A migraine attack is so much more than just head pain.  Did you know that a migraine has 4 distinct phases?  Head pain is just ONE of the FOUR phases of a migraine attack.  A migraine even starts before the head pain even begins.  

Let’s take a closer look at the phases of migraine and how there may even be some “warning signs” that a migraine head pain is about to start!

The Phases of Migraine

1. Prodrome

The Prodrome marks the beginning of a migraine attack.  This phase is also known as  the “preheadache” or premonitory phase and is often described as the warning stage.  This stage can occur a few hours to a few days before the head pain even begins.  It is subtle physical and mental changes that can help to warn you that a migraine attack is coming.

Prodrome symptoms include:

• Depression

• Difficulty sleeping

• Nausea

• Fatigue

• Muscle stiffness in the neck and shoulders

• Sensitivity to light 

• Sensitivity to sound

• Food cravings

• Irritability/Mood changes

• Yawning

• Frequent urination

• Difficulty speaking

• Difficulty reading

• Constipation or diarrhea

The prodrome symptoms can serve as a very helpful warning sign that a migraine attack is starting.  These symptoms may not occur before every migraine attack, but it is important to be listening to your body.  If you notice these symptoms occur, you can take this warning sign and avoid and minimize other migraine triggers (like get 8 hours of sleep, limit caffeine, avoid food triggers, practice mindfulness techniques etc).  This may be enough to prevent the migraine head pain from even starting or to lessen the severity of the symptoms. 

Before a migraine head pain starts, sometimes I have food cravings for pizza.  Being gluten free and sticking to a mostly all natural diet, I hardly ever eat pizza (but of course I keep a stack of GF pizza’s in the freezer for this). So, when I have the food craving for pizza, I know that this is a sign that I am in the Prodrome phase of a migraine attack.  So, this is the time when I make sure that I minimize my migraine triggers and I promote things that increase my migraine threshold. This can hopefully decrease or completely take away the head pain during the attack phase from even starting.

2. Aura

The next phase in a migraine attack is Aura.  This phase only occurs in about ⅓ of people with migraine.  So, people with the diagnosis of migraine with aura will have this phase whereas those with migraine without aura will not have this phase. The symptoms in this phase can last anywhere from 5 minutes to 60 minutes and occur before the attack phase starts.  It is also important to note that those with silent migraine will have aura symptoms and not move onto the head pain of the attack. 

Aura is the result of cortical spreading depression which is a wave of nerve activity that spreads over the brain.  As this wave of nerve activity spreads, the nerves fire off and create a wide range of neurological symptoms. 

This phase of a migraine attack can also serve as a warning sign that a migraine head pain is coming.  Some doctors will recommend taking an abortive medication during this phase.  This is because this phase lasts about 1 hour and medications typically take about 30 minutes to 1 hour to start working. So, if you take an abortive medication at the first sign of an aura (if you experience this phase) then you can potentially help the migraine headache phase from even starting. 

The symptoms of Aura include:

• Visual disturbances → visual loss, seeing dark spots, zigzag lines, colored spots, stars or sparkles, flashes of light (this is different from retinal migraine)

• Numbness or pin and needles in arms and/or legs

• Dizziness or vertigo (this is different than vestibular migraine)

• Difficulty speaking

• Changes in hearing or hearing noises or music

**If vision loss, difficulty speaking, changes in hearing, or numbness and tingling are new symptoms for you, please seek medical attention immediately.  This could be a sign of a life threatening disorder. 

3. Attack

The next phase of a migraine attack is the Attack phase.  During this phase, the head pain is present and can last from several hours to 3 days/72 hours. Head pain is often described as throbbing and interrupts daily tasks.  It is normally located on one side of the head, but it can be on both sides, back of head, or not present at all. The head pain normally gets worse with physical activity, lights, sounds, and smells. With the head pain, there are accompanying symptoms. The accompanying symptoms include nausea, sensitivity to light and sound, dizziness, blurred vision, fatigue, nasal congestion, irritability, and more.  

These accompanying symptoms, along with the severity of pain, is what distinguishes a migraine from a headache.

During the attack phase, I like to ensure that I am making myself comfortable. If I haven't already, I take an abortive medication.  I know that this can take up to an hour to kick in. So, while I wait for the pain to calm down, I like to try to make myself comfortable. I will lie down in a dark room (because during a migraine I am very sensitive to light and sound) and I like to apply cold therapy.  This can be in the form of an ice pack or a migraine product such as The Soothie Hoodie or ReLeaf pack. Cold therapy is great to use during a migraine because it can help to distract from the pain and help to alleviate some of it when applied.

You can read my full review of Soothie Hoodie here. (there is even a promo code)

4. Postdrome

The final phase of a migraine attack is the Postdrome, also known, as the migraine hangover.  During this phase, the head pain has ended and now you feel exhausted, withdrawn, depressed, and have difficulty concentrating. The reason this happens is because before and during a migraine, your brain and body go through hyperactivity and chemical changes. Your body needs time to reset itself and get back to normal. This causes a surge in tiredness. 

But how can we combat this fatigue? By drinking plenty of fluids and staying adequately hydrated. During the attack phase, you may have been throwing up or felt so nauseous that you did not drink any fluids for hours. Next, you are going to want to eat a well balanced meal that includes protein and a variety of fruits and vegetables. These foods are perfect for helping to boost energy. Also, performing gentle movement is essential. This can be as simple as a small walk around the neighborhood or house or performing a light mindfulness yoga routine. Exercise has been proven to increase endorphins, which are the happy hormones. Moreover, listen to your body when it wants to rest. Take some of these steps and give your body the chance to REST, RESET, and RECOVER. So you can get back to doing the things you love and enjoy.