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Anatomy of a Migraine

by Teri Robert, Lead Health Guide

When many people think “migraine,” they think only of the pain of migraine. In reality, a migraine (often called a "migraine attack") consists of far more. The typical migraine attack actually consists of four parts, referred to as phases or components. It's important to note that not every migraineur (a person with migraine disease) experiences all four phases. Also, attacks can vary with different phases experienced during different attacks.

The four potential phases of a migraine attack are:

  • prodrome
  • aura
  • headache
  • postdrome

The Prodrome
The prodrome (sometimes called preheadache or premonitory phase) may be experienced hours or even days before a migraine attack. The prodrome may be considered to be the migraineur's “yellow light,” a warning that a migraine is imminent. It's estimated that 30 to 40% of migraineurs experience prodrome, but it's also thought that may be a low estimate. According to Dr. Peter Goadsby, the prodrome is "common if you ask about it, but patients often don't think to tell about those symptoms." For those who experience prodrome, it can actually be very helpful because, in some cases, it gives opportunity to abort the attack. For migraineurs who experience prodrome, it makes a solid case for keeping a migraine diary and being aware of one's body. (See Recognizing the Migraine Prodrome for more information.)

Potential symptoms of the prodrome include:

  • concentration problems,
  • depression,
  • difficulty reading (aphasia)
  • difficulty speaking (aphasia)
  • diarrhea,
  • fatigue,
  • food cravings,
  • hyperactivity,
  • hypoactivity,
  • increased thirst
  • increased urination,
  • nausea,
  • phonophobia,
  • photophobia,
  • repetitive yawning,
  • sleep issues, and
  • stiff neck.

The Aura
The aura is perhaps the most talked about of the possible phases. The symptoms and effects of the aura vary widely. Some can be quite terrifying, especially when experienced for the first time. Some of the visual distortions can be exotic and bizarre. It's interesting to note that migraine aura symptoms are thought to have influenced some famous pieces of art and literary works. One of the better know is Lewis Carroll's "Alice in Wonderland."

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