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Anatomy of a Migraine: Steps I Take at Each Phase

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If you’ve never experienced a migraine, you might assume that the pain begins with a headache. But you might be surprised to learn that there are many symptoms of my migraine attacks that start well before the onset of a headache — and that continue long after the initial migraine pain has dissipated.

For me, no two migraine experiences are alike. However, the various stages of my migraine attacks are always clear. Here’s a look at those stages and how I cope.

1. Prodrome

Prodrome occurs between a few hours or even up to a couple days in advance of a migraine attack.

When I am experiencing Prodrome, often days before a migraine hits, I tend to experience light sensitivity, irritability, “fogginess,” slowed thinking, and exhaustion. It’s often impossible to combat these elements of my migraine; however, I try to stay positive, make sure that I am getting enough rest and sleep, and drink enough water.

During the hours prior to migraine onset, the symptoms tend to increase in severity. During this time, I often experience nausea and difficulty thinking and speaking clearly. I will often notify the people that I am with that a migraine is about to start and that I am likely not thinking or acting like my usual self.

2. Aura

Minutes before a new migraine hits, I often experience nausea and difficulty thinking or speaking clearly. Oftentimes, part of my face or the tips of my fingers feel numb.

Another aspect of this phase is the aura. I like to describe my aura as a visual disturbance of kaleidoscope-like colors that have a strobe-like effect. The display of flashing colors often starts as a small spot and within minutes takes over my full field of vision. Fortunately, my visual disturbances have decreased with time and this is now a rare occurrence.

When I’m in the aura stage and experiencing intensified symptoms, I try to find a dark place where I can rest for a while. To combat nausea, I drink ginger tea or suck on a ginger chew.

3. Headache

The headache pain itself usually lasts between a couple of hours to a few days for me. During this phase, it feels like I am wearing a weighted blanket, and like my head is too heavy to rest up on my shoulders. I feel a throbbing and stabbing pain in the back of my head (although this placement often moves). I also feel pain all over my face — almost as if it’s bruised. This stage is especially exhausting.

During this time, I tend to focus on coaching myself through the pain and find that affirmations work best. I say things like “You can do this” and “You’ve been through pain like this before and you can do it again.”

I also tend to drink lots of water, even when it feels impossible to lift my head off of the pillow.

4. Postdrome

Postdrome is the phase that follows the migraine attack. It’s a period of time, roughly a couple days, when my migraine pain lingers. The pain feels slightly different from the actual migraine attack, but it is still quite painful. On top of that, I experience serious fatigue, clouded thinking, and depressed mood.

I’m unique in that I have intractable migraine, meaning that I have a migraine that will not go away. So, even after the attack subsides, the pain lingers. I haven’t had a break from my migraine pain in over five and a half years.

During the lingering pain, I try to rest and not push myself too hard. This means that I often need to cancel plans to avoid worsening the pain.

Regardless of whether I am in bed or returning “back to life,” I continue to coach myself through the seemingly ever-lasting pain — it sounds simple, but it helps.

How I cope

I wish that I could always go to a dark room and be in bed during the various phases of my migraine attack, but, unfortunately, that is not my reality. That’s because if I let myself retreat to my bed each time a migraine hits, I would never be able to maintain a job or have any semblance of a life.

As a result, I have had to find ways to deal with the pain and push through as often as possible. The good news is that I have a thorough understanding — and a lot of experience — of the various stages of my migraine attacks and have learned a lot of useful tips over the years to help manage the pain and other symptoms I experience.

I pay attention to my triggers, stay on top of my medications, make sure I’m hydrated and well rested, and find ways to take strategic breaks at work when the pain hits. Living with migraine often means you have to get creative — with your schedule, your lifestyle, and well, just about everything — to find what works best for you in each migraine experience.

For more information on how to manage migraine, reach out to your doctor or healthcare team. 

Article sources:

MIG-US-NP-00134 MAY 2019