Understanding the 4-Stage Process of Migraine Attacks

Understanding the 4-Stage Process of Migraine Attacks

If you have migraine disease, you need all the information you can get about how it behaves, your unique triggers and symptoms, and how to treat attacks.

Eastern Iowans turn to Dr. Stanley Mathew at American Rehabilitation Center for answers. Here, he explains the four potential stages of a migraine attack to give you valuable insight into your condition.

What does a standard migraine attack feel like?

We’re glad you asked this question, because it’s one of the first things our patients ask when they suspect they’ve experienced one. The answer is that everyone who lives with migraine disease is different, and so are their experiences. 

We can tell you that they tend to follow a pattern that includes three to four stages of development and resolution. You may experience one or all four, so getting to know your unique response to migraine disease can help you learn to cope with and treat your condition. 

The four stages of a migraine attack

Understanding the four migraine attack stages empowers you to recognize warning signs at the start of an attack and identify markers that indicate the end. The following describes the four possible stages.

1. Prodrome

Some call this phase the “pre-headache” because it occurs before the classic head pain sets in. If you ignore your symptoms, you may not realize you're experiencing the prodrome stage. They vary from person to person and may include:

That’s a long list, but remember, you may only experience one or two of these precursors. Keeping a migraine diary can help you and Dr. Mathew identify your unique patterns, so you can be better prepared for what’s next.

Once you learn to spot the signs of prodrome, you can also take steps to mitigate the intensity of the coming attack by avoiding known triggers, practicing calmness and mindfulness, and taking prescribed medication if necessary. 

The prodrome stage can last an hour or two or up to several days before the main phase begins.

2. Aura

About 33% of people with migraine disease experience the aura stage, and those who do may not experience it with every migraine attack. If the aura is part of your condition, you may experience any of the following symptoms:

Most auras last 5-60 minutes, but they extend beyond an hour for about 20% of people with migraine disease. An aura is usually a warning sign of a coming attack, but it can occur out of order and follow the attack rather than precede it.

3. Attack

The attack phase is the intense headache pain most people associate with migraine disease. Most people have pain on only one side of their head; but some have pain on both sides. Most patients describe the pain as throbbing, or sharp pains they imagine would be inflicted if stabbed with an ice pick. Nausea, vomiting, and hypersensitivity to lights, sounds, and smells often accompany the attack phase.

A few of the lesser-known symptoms of the attack phase include:

Dr. Mathew can reduce your symptoms and their severity with medications like metoclopramide, prochlorperazine, and sumatriptan. These may alleviate your pain during an acute attack.

4. Postdrome

About 80% of people with migraine disease experience the postdrome phase, also called the “migraine hangover.” Common symptoms include fatigue, continued light sensitivity, body aches, and an inability to focus or concentrate. These are signs your attack is winding down. The postdrome can last for a day or two in some cases.

Help and hope for migraine disease

As a triple-board certified physician, Dr. Mathew is uniquely qualified to identify the underlying factors involved in your migraine attacks, pulling from his expertise in the areas of pain management, neurology, orthopedics, and spinal and musculoskeletal medicine. 

He listens well, investigates thoroughly, and persists until he finds a solution for your migraine symptoms. He may recommend massage therapy to reduce stress and stave off attacks or administer Botox® to decrease the frequency and intensity of attacks. He pulls from multiple medical fields and disciplines to develop a treatment plan that addresses your unique symptoms.

To talk to Dr. Mathew about your migraine experiences, contact us in Dubuque, Anamosa, or Cedar Rapids by phone or online. 

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