Migraine is a common neurological disorder, whose attacks contains four distinct phases, one of which is a ghastly headache. Interestingly, though, it’s possible to have migraine attacks without the pain phase, a state called a silent migraine.
In children, it’s more common to see abdominal migraine, where they develop pain in their stomach and abdomen that lasts 1-72 hours and is usually not accompanied by head pain. Adults can have abdominal migraine, too, but it’s much less common.
Researchers estimate some 12% of the population live with some form of migraine, though the experience varies from one person to the next.
Unlike tension-type headaches, migraine attacks come with a bevy of neurological symptoms in addition to the pain.
Types of migraine
There are several types of migraine. The most common migraine categories are:
- Migraine with aura (classic migraine)
Migraine without aura (common migraine)
Other types of migraine include:
- Abdominal migraine
Chronic migraine (more than 15 headache days a month)
Hemiplegic migraine (muscle weakness on one side)
Menstrual migraine (hormonally induced attack)
Migraine without headache (silent migraine)
Retinal migraine (ocular migraine)
Status migrainosus (aka a transformed migraine; lasts longer than a week)
You can have more than one type of migraine attack at the same time or different types at different periods in your life.
The four phases of a migraine attack
A “typical” migraine attack includes four phases, though the specific symptoms in each phase may differ between people. It’s also possible to have only two or three phases.
1. Prodrome
The first phase begins anywhere up to 24-36 hours before you experience the headache, and it’s a “warning” that an attack is coming. Symptoms include:
- Mood changes
Excessive yawning
Difficulty concentrating
Difficulty sleeping
Fatigue
Nausea
Increased hunger and thirst
Frequent urination
You may also experience symptoms that are unique to you, as well as have specific triggers (e.g., processed meats, chocolate, caffeine) that set off an attack.
2. Aura
An aura is a collection of sensory, motor, and/or speech symptoms that usually precedes the headache but may appear at the same time. It lasts anywhere up to 60 minutes. You may see zigzag lines or starbursts across your vision, experience muscle weakness, tinnitus, numbness and/or tingling, and/or have difficulty speaking or understanding others.
Aura is a warning that the migraine attack is progressing and the pain phase is imminent.
Most people either have migraine with aura or migraine without aura; it’s relatively rare to have a mix of the two.
3. The pain phase
This is the phase that most people think of when you say “migraine.” It consists of a blinding, one-sided, throbbing headache that may come up from the neck region and stab you through the eyeball. It worsens with any type of activity, and you may be extremely sensitive to light, sounds, and smells.
The headache is often accompanied by a slowing of gut motility, nausea, and repeated bouts of vomiting, as well as a great deal of brain fog and difficulty concentrating on anything other than the pain, which can last from 4-72 hours. You may have difficulty falling asleep or staying asleep because of the pain.
4. Postdrome
The postdrome stage usually lasts for a few hours up to 48 hours. Symptoms feel similar to an alcohol-induced hangover, which is why it’s sometimes called a migraine hangover. Some people also say it feels like a post-adrenaline crash.
Expect your brain to still be foggy and to feel wiped out from the experience.
If you’re someone who lives with chronic migraine, you may start the prodrome for the next attack while still in the postdrome from the previous attack. As a result, you may find it difficult to concentrate on school or work, and it may be difficult to hold a job without accommodations for the attacks.
NEXT: Primary Headache: Migraine Diagnosis and Treatment