The Four Phases of Migraines

Migraines are a neurological disease, of which the most common symptom is an intense and disabling episodic headache. Migraines are usually characterized by severe pain on one or both sides of the head and are often accompanied by hypersensitivity to light, hypersensitivity to sound and nausea.

The signs and symptoms of migraine vary among persons. Therefore, what a person experiences before, during and after an attack cannot be defined exactly. The four "signs and symptoms" below are common among persons but are not necessarily experienced by all migraine sufferers:

1.The prodrome, which occurs hours or days before the headache.

2.The aura, which immediately precedes the headache.

3.The headache phase.

4.The postdrome.

The first phase or prodrome

Prodromal symptoms occur in 40% to 60% of migraineures. This phase consists of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g., chocolate), and other vegetative symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days and experience teaches the person or observant family that the migraine attack is near.

The second phase or the Aura

The migraine aura is comprised of focal neurological phenomena that precedes or accompany the attack. They appear gradually over 5 to 20 minutes and usually subside just before the headache begins. Symptoms of migraine aura are usually sensory in nature.

Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white or rarely of multicolored lights (photopsia) or formations of dazzling zigzag lines (arranged like the battlements of a castle, hence the term fortification spectra or teichopsia).

Some persons complain of blurred or shimmering or cloudy vision, as though they were looking through thick or smoked glass. The somatosensory aura of migraines consist of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the ipsilateral nose-mouth area. Paresthesia migrate up the arm and then extend to involve the face, lips and tongue.

The third phase: The Headache

The typical migraine headache is unilateral, throbbing, moderate to severe and can be aggravated by physical activity . Not all of these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, usually alternates sides from one attack to the next.

The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 to 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraineur experiences from one to three migraines a month.

The head pain varies greatly in intensity. The pain of migraines is invariably accompanied by other features. Anorexia is common, and nausea occurs in almost 90 percent of persons, while vomiting occurs in about one third of persons.

Many persons experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.

The fourth phase: postdrome phase

The person may feel tired, "washed out", irritable, listless and may have impaired concentration, scalp tenderness or mood changes. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise.

The information presented here should not be interpreted as medical advice. If you or someone you know suffers from migraines, please seek professional medical advice for the latest treatment options.

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