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Potential Migraine Phases and Symptoms

For people with Migraine disease, understanding as much as possible about Migraines is essential. That knowledge lets us work with our doctors as treatment partners, and it helps give us the foundation we need to make treatment decisions when we have a Migraine attack.

A Migraine attack can have up to four phases, and each of them has many potential symptoms. Not everyone experiences all four phases or all of the symptoms, and one attack can vary from the next. Some symptoms can occur during more than one phase. Lets take a look at the four possible phases and some of the potential symptoms of those phases.

The prodrome is the first potential phase of a Migraine attack, and it can begin hours or days before other phases. Its sometimes called preheadache or premonitory phase. Between 30% and 40% of Migraineurs experience the prodrome, and for those Migraineurs, it can be very helpful because it can serve as a yellow light of sorts, a warning that an attack is coming. Once you know what some of the prodrome symptoms are, you may find that you experience it, but never realized it.

Even though its experienced by only about 25% of Migraineurs, the Migraine aura may be the most often discussed phases of the Migraine attack. The possible visual symptoms are the best known, but there are many possible symptoms, visual and others.Migraine auracan also serve as a warning and, in some cases, allow Migraineurs to treat the Migraine early enough to stop it before it progresses to the headache phase.

The possible symptoms of Migraine aura include:

Alice in Wonderland Syndrome: a rare form of Migraine aura in which the distinctive symptom is a type of metamorphosia, a distortion of body image and perspective, which Migraineurs know, while its occurring is not real. Alice in Wonderland syndrome can occur at any age, but it is more commonly experienced by children.

allodynia: hypersensitivity to feel and touchto the point that what would be normal is painful

auditory hallucinations: hearing sounds that arent actually present

hemiplegia: one-sided paralysis (occurs in hemiplegic Migraine only)

olfactory hallucinations: smelling odors that arent actually present

one-sided motor weakness (occurs in hemiplegic Migraine only)

parasthesia: prickling, stinging, burning, numbness, and / or tingling, usually of the extremities or face

vertigo: sensation of whirling or spinning, not to be confused with dizziness

wavy lines (sometimes described as looking like heat rising from pavement)

phosphenes: brief flashes of light that streak across the visual field

scotoma: an area of decreased or lost vision. Some people describe scotoma as being like having tiny blank spots in their vision. Some compare it to tiny snowflakes.

unilateral (one-sided) (occurs in retinal Migraine only)

The symptoms of the headache phase are frequently, but not always, the most debilitating of a Migraine attack. Its important to note that symptoms are not limited to the head; they may affect other parts of the body as well. The pain of the headache phase can range from mild to severe, which can lead people with mild pain to not recognize that theyre having a Migraine. A Migraine attack can occur without the headache phase. When that occurs, the descriptive terms acephalgic or silent are applied (i.e. acephalgicMigraine without aura, acephalgic Migraine with aura, acephalgic basilar-type Migraine, etc.).

Symptoms and characteristics of the headache phase may include:

frequently unilateral (one-sided). The headache can shift from one side to the other, become bilateral (on both sides), or be bilateral entirely

duration of four to 72 hours in adults, one to 72 hours in children

Because the trigeminal nerve becomes inflamed during a Migraine, and because of its location, pain may occur around eyes, in the sinus area, and the teeth and jaw.

nasal congestion and / or runny nose

osmophobia (heightened sensitivity to odors)

phonophobia (heightened sensitivity to sound)

photophobia (heightened sensitivity to light)

Many people mention feeling hung-over after a Migraine. This is often actually part of the Migraine, the postdrome. Most Migraineurs have some symptoms after the headache phase, symptoms that may last hours or even a couple of days.

As you can see, Migraine attacks can be quite complex with many varied symptoms. Here are some points to remember:

Migraine symptoms can be unpredictable.

Not all Migraineurs experience all four phases of a Migraine attack.

A persons Migraine attacks can vary from one to the next, both in regard to which phases they experience and which symptoms they experience.

People who have no issues with depression, anxiety, or panic at other times can experience any of them during a Migraine, as a symptom of the Migraine attack.

Learning to be more aware of our bodies may help us recognize a Migraine attack early, and that can be helpful in treating the Migraine attack earlier, with better results.

The symptoms of a Migraine can also be symptoms of other health issues including TIA, stroke, and aneurysm. If our Migraine patterns change, if we experience new or disturbing symptoms, or if were having the worst Migraine weve ever had, its important to check in with our doctors to be sure that all the symptoms are Migraine and not another condition or even that needs attention.

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Written by: Teri Robert Last reviewed: August 2014.

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Marcus, Dawn A., MD; Bain, Philip A., MD. The Womans Migraine Toolkit. DiaMedica. New York. 2010.

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Calhoun, Anne H., MD; Ford, Sutapa, PhD; Millen, Cori, DO; Finkel, Alan G., MD; Truong, Young, PhD; Nie, Yonghong, MS. The Prevalence of Neck Pain in Migraine. Headache. Published Online: Jan. 20, 2010.

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