There are five well-defined phases of a classic migraine attack: prodrome, aura, headache, termination, and postdrome. You may experience more than one phase, although not necessarily all of them.Prodrome Phase
The prodrome phase occurs hours to days before the headache. During this time, about 60% of migraine sufferers experience symptoms. The symptoms can be psychological (such as depression or extreme happiness), neurological (such as enhanced smell or heightened sensitivity to light), or constitutional (such as fatigue, loss of appetite, or increased thirst).
Some people also experience gastrointestinal symptoms such as nausea, constipation, or diarrhea. Although symptoms in the prodrome vary widely, each person usually has his or her own specific set of symptoms that signal a migraine.
The aura phase immediately precedes or accompanies an attack. About 20% of migraine sufferers experience neurologic symptoms (the aura), usually developing over 5 to 20 minutes and lasting less than an hour. Migraines with visual disturbances are called classic migraines. The most common aura is flashing lights in a her- ringbone pattern. Some people see bright lights in other geometric patterns, or half of their visual field is blank.
Others may experience difficulty speaking, weakness on one side of the body, or numbness or tingling in a hand or arm or on one side of the face. The most prevalent form of migraine (common migraine) occurs without an aura. Common migraines typically last longer and occur more often than classic migraines.Headache Phase
The typical migraine headache is throbbing, with pain starting on one side of the head and then spreading to both sides. jabs and jolts of sharp, shooting pain in various areas of the head are common. The onset is gradual, with the pain increasing in intensity for the first 30 minutes to 2 hours, then leveling off and slowly subsiding. The average duration of the headache phase is a day, but it can last for up to 3 days. In 90% of people, the headache is accompanied by nausea, vomiting, or loss of appetite. Other accompanying symptoms include blurred vision, nasal stuffiness, diarrhea, neck stiff- ness, memory impairment, and difficulty concentrating.Termination Phase
In this phase, pain relief occurs. The pain gradually decreases in intensity over a period of several hours, leaving most people with fatigue and irritability. In many people, vomiting or falling asleep signals the end of an attack.Postdrome Phase
The postdrome phase is the period after the pain subsides. During this phase, some sufferers feel drained or irritable, while others are refreshed or euphoric. Some residual symptoms may persist after the pain is gone.
There are several unusual forms of migraine. In familial hemiplegic migraine, the aura involves paralysis on one side of the body; the affected person usually has a family member with the same symptoms.
Some people have a migraine aura (such as changes in vision) without headache; this type of migraine is more common in midlife or later. in ophthalmoplegic migraine, the aura includes partial paralysis of the eyes. The most severe form of migraine involves a stroke that occurs in association with the migraine.
Source: Harvard Medical School Family Health Guide, Anthony L. Komaroff, Editor in Chief, Simon and Schuster
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