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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. For the 30 to 40% of Migraineurs 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.

Potential symptoms of the prodrome are:

  • food cravings
  • thirst
  • constipation or diarrhea
  • mood changes — depression, irritability, etc.
  • muscle stiffness, especially in the neck
  • fatigue
  • increased frequency of urination
  • yawning

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."

While most people probably think of aura as being strictly visual, auras can have a wide range of symptoms, including:

  • visual: flashing lights, wavy lines, spots, partial loss of sight, blurry vision

  • olfactory hallucinations — smelling odors that aren't there

  • paresthesia - tingling or numbness of the face or extremities on the side where the headache develops.

  • aphasia - difficult finding words and/or speaking

  • confusion

  • dizziness

  • hiccups
  • neck pain

  • partial paralysis (only in hemiplegic Migraine)

  • auditory hallucinations — hearing things that aren't really there

  • decrease in or loss of hearing

  • reduced sensation

  • allodynia - hypersensitivity to feel and touch

  • brief flashes of light that streak across the visual field (phosphenes)

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