Up to four symptom phases can accompany a migraine: prodrome phase, auras, the attack, and the postdrome phase. These phases may not occur in every patient or every headache.
The prodrome phase is a group of vague symptoms that may precede a migraine attack by several hours, or even a day or two. Prodrome symptoms may include:
- Sensitivity to light or sound
- Changes in appetite, including decreased appetite or food cravings
- Fatigue and drowsiness
- Mood changes, including depression, irritability, or restlessness
Auras are sensory disturbances that occur before the migraine attack in 1 in 5 patients. Visually, auras are referred to as being positive or negative:
- Positive auras include bright or shimmering light or shapes at the edge of the field of vision called scintillating scotoma. They can enlarge and fill the line of vision. Other positive aura experiences are zigzag lines or stars.
- Negative auras are dark holes, blind spots, or tunnel vision (inability to see to the side).
- Patients may have mixed positive and negative auras. This is a visual experience that is sometimes described as a fortress with sharp angles around a dark center.
Other neurologic symptoms may occur at the same time as the aura, although they are less common. They may include:
- Speech disturbances
- Tingling, numbness, or weakness in an arm or leg
- Perceptual disturbances such as space or size distortions
Migraine Attack Symptoms
If left untreated, attacks usually last from 4 - 72 hours. A typical migraine attack produces the following symptoms:
- Throbbing pain on one side of the head. Pain also sometimes spreads to affect the entire head.
- Pain worsened by physical activity
- Nausea, sometimes with vomiting
- Visual symptoms
- Facial tingling or numbness
- Extreme sensitivity to light and noise
- Looking pale and feeling cold
Less common symptoms include tearing and redness in one eye, swelling of the eyelid, and nasal congestion, including runny nose. (Such symptoms are more common in certain other headaches, notably cluster headaches.)
After a migraine attack, there is usually a postdrome phase, in which patients may feel exhausted and mentally foggy for a while.
Review Date: 11/04/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.