After the headache phase, people living with migraine just want it to be over. But many people still have the migraine hangover to contend with, says Sarah Alexander-Georgeson.
At the beginning of my migraine journey, I never understood why I didn't snap back to "normal" after a migraine attack. While the pain in my head would (thankfully) fade away, I'd suffer through a fug of other symptoms for 24 hours after the episode.
After some research and a conversation with my physician, I discovered this was the "final stage" of a migraine attack - commonly known as "postdrome" or "the migraine hangover."
The 4 stages of a migraine attack
Though not everyone will experience every phase, there are four stages of a migraine attack:
Stage 1: Prodrome. Symptoms include:
- Feelings of depression
- Food cravings
- Sensitivity to light and sound (also known as Photophobia and Phonophobia)
- Difficulty speaking
Stage 2: Migraine aura. Symptoms may include:
- Visual disturbances
- Temporary sight loss
- Numbness and/or tingling in the extremities or other body parts
Stage 3: The Headache.
- Throbbing or drilling sensations in the head
- Sensitivities to light, smell, sound
- Neck pain
- Nasal congestion
Stage 4: Postdrome or the migraine hangover. Symptoms can include:
People without the condition may think migraine is just a nasty headache. Or, if they've done some research, they may assume an attack will be over and done with after a few hours.
In reality, it can take days - or even weeks - to cycle through the four stages of an episode.
Is the postdrome phase really that awful?
Compared to the symptoms of stages one to three, the postdrome phase doesn't sound too bad. After all, some tiredness and confusion must be better than a banging headache, right?
On paper, yes, but when I'm living it, no. Migraine hangovers take the wind out of my sails every time.
Throughout the postdrome stage, my whole body feels weak - to the point I can barely lift my arms. The muscles in the upper half of my body feel like they're made of lead. My head feels heavy yet painfully delicate. Aches run up and down my whole body. On top of that, keeping my eyes open is a real struggle. All I want to do is sleep until it's all over.
Holding a conversation is a nightmare. I can't concentrate on what the other person is saying or even think much about what I want to say. Reading with this level of brain fog is pointless. I can't focus on television at all.
I'm also very unstable on my feet. Getting up and standing means I instantly feel lightheaded and dizzy. My whole body is crying out for a shower as I've been in bed for days nursing a migraine. Unfortunately, I also get allodynia (when my scalp sends pain signals at even the lightest touch) and this makes washing my hair impossible. I can't even lift my hair to tie a ponytail without reeling in agony.
When unable to function like this, I treat it as my body needing a recharge after a vicious biological attack. Perhaps that's what postdrome is all about: your body demanding some R&R after going through the mill.
Self-care during a migraine hangover
A severe migraine hangover can last anywhere from six to 48 hours. And they're never the same. Sometimes I get all symptoms together; other times, I'm "lucky" enough to only have a few.
Either way, taking things easy is vital during the postdrome phase. Physical and psychological stress is a huge migraine trigger, so forcing myself into action will push me back into the prodrome phase. Instead, I rest as much as I can and stay hydrated.
Comfort food and caffeine prove helpful because they lift my mood and show me that I'm somewhat out of the woods. I also love sitting back and listening to an audiobook or podcast as I can close my eyes and have the lights on low. I won't get the same eyestrain I would from a book, phone game, or the television, but there is still something to occupy and distract my mind.
Finally, an ice pad across my forehead and a cuddle with my dogs help keep my mood calm and happy. Going through a migraine alone is horrific, so the dogs are my best friends during hard times.
Tracking your migraine phases and taking it easy
At the end of a migraine hangover, I usually update the migraine diary on my phone, so I can spot any triggers, irregularities, or patterns.
Not everyone experiences postdrome, and those that do won't all have the same experiences. If you are one of these people, find a way of managing it that suits your needs. Don't feel forced to spring into action because others expect or demand it.
It's your health, your body, and you know how to look after yourself best. Even though it's the final hurdle, you're still experiencing migraine during the postdrome phase. Be kind to yourself.
NOTE: The information presented is solely for educational purposes. It is not intended as specific advice for managing migraine symptoms. Please consult with a professional who can apply best practices and appropriate resources to your situation.
NPS-ALL-NP-00651 AUGUST 2022