Today’s post outlines what the 4 phases of a migraine are, including the fourth stage – ‘postdrome’ – and it explains why chronic migraine can feel like you’re permanently stuck in a state of postdrome. But it’s not all bad news; it also provides some ideas about how to change your predicament.
According to Migraine.com, there are 4 phases to a migraine:
- Prodrome
- Aura
- Headache
- Postdrome
1. Prodrome can start 24 to 48 hours before a migraine ‘attack’ (the obvious pain-part of a migraine). This ‘pre-headache phase’ often includes symptoms such as irritability, fatigue, mood changes, food cravings, yawning, stiff neck or sensitivity to light and noises. According to the site, 80% of migraineurs experience these sorts of pre-migraine symptoms.
[I get all of these, but also occasionally get the opposite of fatigue, and become hyper-active and have a sudden burst of energy that makes me clean the house in a whirlwind… and then, when I get sick soon after I wonder if I ‘over did it’ on the cleaning and that’s why I’m sick… it’s taken a long time to figure out it’s not cause and effect, rather, the hyperactivity is actually an effect that’s brought on by the cause… if you get what I mean?]
2. Aura can manifest in different ways. The one that is most often talked about are visual changes (sparkles, zigzags or rainbow overlays to everything people are looking at). BUT there are other sensory changes that can occur too. Some patients notice that their sense of smell becomes more acute, they hear a ringing sound or distorted noise, or the way things feel in their hands changes. Others have a burning feeling in their mouth, extreme dizziness, or a form of paralysis. Apparently 25% of patients report they experience aura, and aura can last from anywhere between 5 minutes and an hour. (Around 4% of patients have the aura but no later pain.)
[I’m going to go out on a limb and suggest the number of people who have aura is probably a bit higher, it’s just that many of us don’t notice it’s happening. My bad migraines involve hemiplegia where one side of my body becomes paralyzed, and I can’t get my mouth to form words (it’s as if I have had a stroke). By the time this was happening, I had minutes to get myself to bed (or the backseat of a car) before the full-blown migraine arrives. Only in the last couple of years have I become aware of much more subtle aura-symptoms. For me, the hint that a migraine is getting close is that my face feels ‘funny’ and I notice tingling in my fingertips; it’s very subtle, but now I recognize it, I notice it more and more.]
[But sometimes there are even subtler ‘tells’. One day I was feeling OK, but as I was washing my hands, I noticed I could REALLY smell the soap. For a second I was confused why the soap was suddenly so extra-fragrant, and then I remembered auras, and realized I was about to have a migraine attack. I was able to take my medication and get to bed, and whilst the migraine did arrive, it didn’t get the chance to take off into a full-blown 3-day mountain of misery… which brings us to…]
3. Migraine – if you weren’t lucky enough to pickup on the first two stages and take action to abort the migraine’s progress, then you reach Stage 3. In this stage you’re likely to have excruciating pain on one side of your head, accompanied with vomiting, vertigo, insomnia, and/or neck pain. The migraine event usually lasts 4-72 hours.
[Here’s a couple of posts describing my first and worst migraines.]
4. Postdrome – is the final stage, where patients feel drained, exhausted, and hungover from their recent migraine experience. A few people feel a sense of elation in this stage, but most patients still have trouble concentrating and often feel moody or depressed. Some patients come out of a migraine attack starving, while others feel too queasy to eat. This stage typically lasts a day or two.
[When I used to only have occasional migraines, I didn’t know the terms that applied to the stages, but I did recognize that post-migraine, I was not myself. I used to describe it to other people as feeling “punch-drunk”, as if I had gone a few rounds in a boxing match with myself and now I felt all beat up and worn out… still nauseous and sooooo tired. (I remember a comment once: “how can you be so tired if you just spent three days in bed?” Ugh.)]
If you’re (un)lucky enough to only have occasional migraines, then more often than not, you get through the four stages and come out the other side… then get on with your life. Even episodic migraines (such as menstrual migraines) can hit you hard then leave you alone.
Unfortunately, chronic migraine is different.
To qualify for chronic migraine (in Australia), you have to be suffering from migraine symptoms at least 15 days a month. That’s a lot of time spent sick from migraine. As a result, sometimes the postdrome feelings can merge with the prodrome symptoms of the next attack… you can feel as if you’re trapped in postdrome, always recovering from the last episode, waiting for the next one to take hold.
I suppose I could say that I felt trapped in prodrome – since I was technically on the cusp of getting another migraine – but for some reason, it’s the post- phase that resonates most with me… a constant state of “ugh… I’m exhausted from all this”.
So what to do about it?
According to BiologyInsights.com, the best ways to minimize the effects of postdrome is:
Prioritize hydration – sip water, electrolyte drinks, or soda if tolerable.
Eat light – focus on bland, easily digestible meals that will nourish your body.
Create a soothing environment – stay somewhere quiet and dark for a while longer to reduce sensory overload, and limit your screen time.
Reduce stiffness and tension – by applying a cold compress to the head or warm compress to the neck and shoulders. Do gentle stretches, or light self-massage.
Medicate carefully – “If residual discomfort or body aches are present, over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, might offer relief if appropriate for your situation. However, typical abortive migraine medications are not always effective for postdrome symptoms.”
[Disclaimer – I’m not a medical doctor – please don’t take medication advice from my site, or others on the internet – see a trained professional for information regarding what medications will help YOU and your migraines, determined in consideration with your individual health situation.]
The BiologyInsights article then points out some other lifestyle changes you can implement which will help postdrome symptoms, and potentially reduce the chance of more migraines:
Regular sleep – aim for 7 to 9 hours of sleep every night, preferably with consistent start and end times.
Exercise – gentle, regular exercise will improve your general health and wellbeing.
Manage your triggers – keep tabs on what triggers your migraines and do your best to minimize those triggers (there’s a free trigger tracker on my REOURCES page.)
and YAY
Mindfulness – try stress management techniques to further improve your wellbeing (click here for my free PDF download for a mini-mindfulness course with lots of ideas to get you started).
Ok – so I know that probably feels like a lot – but it’s all good advice – and all of it has helped me immensely.
If you’re suffering from chronic pain, and migraine postdrome seems like your day-to-day existence – know that I see you, I totally understand – I was you. (Send me a note on the contact page if you’re struggling and want a chat.)
Just remember – I got better, and I really believe that you can too.
Knowledge is power, so keep learning about your condition and stay curious about ways you can help yourself heal.
Hang in there people and take care taking care, Linda xx
The Mindful Migraine 
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