As a courtesy, I’ll warn you now that I am about to describe a migraine attack in pretty graphic detail. If you suffer from migraines, this alone may be enough to trigger an attack. Be careful, and read on with caution. Share this with a friend or loved one to give them an idea of what you are experiencing.
I recently suffered yet another migraine attack. As I was progressing through, I wondered if other sufferers like me had defined the experience into stages.
It turns out, the answer is yes. In fact, scientists have figured this out for themselves, and hopefully not the hard way.
There are four distinct stages of a Migraine headache. Clinically speaking, they are:
- The Prodrome — a one or two-day pre-attack period of subtle warning.
- The Aura — the initial onset of symptoms which are usually visual and last for 5 to 20 minutes.
- The Attack — a physically-painful period of suffering that can last hours or days.
- The Postdrome — a trailing period of fragility that can last hours to days.
Personally, this was news to me. I’d identified four distinct phases of my migraines but I referred to them as:
- Everything is fine and I’m having a good time.
- Oh, no, here come the sparkles; why? WHY?!
- Somebody kill me.
- Fragile: handle with care.
I wasn’t really too far off. Let’s take a look at each stage of a migraine in more detail.
The Prodrome Period
The Prodrome period is a pre-migraine period where subtle signs offer a warning. I’ll be honest; I didn’t even know this existed, or that I should be paying attention. For the most part, I’m too busy to notice the kind of subtle changes that define the Prodrome period, so I’ve hardly noticed this phase of my experience.
The Prodrome period can last anywhere from one to two days. Subtle signs might give you clues. These signs might include constipation or mood changes. They can also be cravings for certain foods, stiffness in your joints, thirst, or yawning. In other words: a pretty normal day for most of us. And that is one of the reasons this warning period is so hard to identify.
The trick to spotting the Prodrome period is to look for unusual patterns, increases in frequency, or radical changes in your habits. Still, hard to spot but at least now you know to keep an eye out.
The Aura
For me, the Aura is about as bad as seeing the grim reaper enter your room and point a long bony finger in your direction. Only painful.
I refer to this period as “the sparkle.” It can last anywhere from five to twenty minutes.
For me, my eyes start to see small, subtle sparkles. The sparkles quickly progress to chaos and confusion in my vision. Quite literally my vision breaks into fragments. It’s a lot like looking at the world through a kaleidoscope. It’s hard to make sense of letters, words, and shapes. My eyes can’t land on anything or comprehend what they are seeing.
If I don’t close my eyes immediately, the sparkle phase gets worse and worse. If I wait too long, my vision closes in from the sides and becomes a mass of sparkly nonsense that looks like an old TV that is tuned to a dead channel. At this point, it is common to experience nausea, vomiting, and disorientation.
And then comes the pain…
The Attack
The transition from The Aura to The Attack is a lot like parking a truck on your head and trying to relieve the pressure with ice picks. I hate to be so graphic, but there have been times when I imagined that description to be a welcome alternative. No kidding, and I think most migraine sufferers would agree. It hurts, and the pain is as physical as it can get.
For me, the pain starts in my eyes. If I didn’t know better, I would guess I was being stabbed. Soon the pain creeps over my brain and feels like shards of glass are packed in my head. Any motion I make feels like I’ve set the shards cascading around my cranium like it was a rock tumbler. At this point, there seems to be little I can do to get relief. If you are reading this and your loved one, friend, or most hated enemy is a migraine sufferer, know that at this point death is a reasonable option, and likely at the forefront of our consideration. Please take care of us through this period.
The Attack stage of a migraine can last anywhere from a few hours to a few days. Most sufferers learn to mitigate the pain and duration by taking measures as early in the process as possible. For me, this means a rush to my nearest Excedrin depot. Excedrin is my preferred drug. It doesn’t help a lot, but it helps. I keep them near me all the time and wherever I go. There’s a bottle in my computer bag, a baggie in my truck, some in the cupboard, and a few in my jacket and suitcase.
If I ever have an attack while away from my many sources, I plan to hand my wallet to the nearest store clerk and offer them anything they want in exchange for a couple of tablets. I’ve learned that the faster I can get a few of those down, the better life will be over the next two hours.
For the record, I’ve tried a few prescription medications. It’s a tough call — some require you to take them in advance, which is tough for me because I only get one every month or two, so it’s hard to stay ahead of them on a regular routine. The other drawback is the woosy side effects. The prescription medications I’ve tried haven’t helped a lot, and in most cases added to the misery with additional weirdness that I didn’t like. Many sufferers have found success with medications. I’d love to hear about them in the comment section.
I also go into complete shutdown mode. I close my eyes as soon as I can. After that first sparkle, you’ll find me feeling my way to the nearest place to lay down, eyes closed and probably with my sunglasses on if I have them. Sunglasses on in the house is often my wife’s first indication that I am experiencing an attack. If I can, I get to a dark place quickly, hope for some quiet, and settle in for a visit to Hell.
Thankfully I have a sympathetic and helpful wife and family. It helps to have someone around to darken the room, turn off the noise, and start recycling freezer packs. Ice on my head and eyes seems to help.
The Postdrome
After the initial attack, things settle down. My vision will eventually return. It is painful to see in this stage. I can open my eyes and if they are making sense of things again I can even watch TV through my sunglasses as long as there isn’t too much action. I refer to this stage as the fragile stage. Everything feels like it might break if I move too fast or experience any jarring. Everything slows down and for at least a day or two I just want to take it easy.
Quick motions during the Postdrome stage can be painful. We’re talking sharp physical pain. Sneezing hurts, turning your head too fast hurts and sometimes thinking hurts. I can be productive during the Postdrome stage, but it takes a day or two to get back to full speed.
And that’s it. It’s a miserable experience and as frustrating as it is mysterious. I track my migraines so I can look for patterns and identify possible triggers. Migraines are an elusive affliction and most sufferers have unique nuances that mean we can’t easily put our finger on a cause. Tracking your migraines will help you identify the frequency and duration of attacks. This information can be helpful when talking to your doctor. It can even help you plan ahead.
For me, Simple Migraine Tracker does the trick. It’s a free app from the App Store for iPhone (currently) and it tracks a variety of data points with a single tap of the button. My previous solution for tracking required a slew of questions and form fills. Playing 20 questions while navigating the depths of Mordor is not my cup of tea, so Simple Migraine Tracker is my go-to for one-tap tracking.
Check it out if you are looking for a simple migraine tracker that does what you need with less effort and concentration.
Beyond that, I hope you are well and that knowing the four stages of a migraine headache will help you better manage your experience.
Good luck, be safe and stay well.