Symptoms of a Migraine

Migraines are severe headaches that occur with throbbing or pulsating pain, often on one side of the head. Separating one from a mere "bad headache" involves understanding the distinctive symptoms that a migraine can trigger.

In fact, you can experience up to four stages during a migraine episode, each of which can be identified by its own set of symptoms. Understanding the range of symptoms can alert you to whether you're experiencing a migraine and which stage you happen to be in at the moment.

This article explains the four stages of a migraine and their associated symptoms. The article also describes the symptoms typically associated with migraine subtypes, the potential complications migraines can trigger, and when to see a healthcare provider.

Frequent Symptoms

Migraine episodes include several stages: prodome, aura, headache, and postdrome. You may cycle through all of these stages when you have a migraine or you might experience one, two, or three of them. The headache phase is the most common, while the aura is the least common.

Prodrome

The prodrome stage is characterized by premonitory symptoms of an impending migraine. It can begin hours or days before a migraine episode reaches its peak intensity. Most people who experience a migraine feel some prodromal symptoms. Taking migraine medication during this stage may stop the episode from progressing. Typical symptoms during this stage are:

• Constipation or diarrhea
• Difficulty concentrating
• Excessive yawning
• Fatigue
• Feeling cold
• Fluid retention, bloating
• Food cravings
• Increased frequency of urination
• Mood changes involving sadness, irritability, or anxiety
• Muscle stiffness or soreness, especially in the neck
  
• Nausea
  
• Sensitivity to light, sounds, or smells
• Vivid dreams

Aura

Approximately one-third of people who experience a migraine go through aura, which usually follows the prodrome stage and lasts for less than an hour. This stage is characterized by neurological symptoms, and it can be quite terrifying, especially when you experience it for the first time. The symptoms of migraine aura can include:

• A temporary loss of hearing
• Auditory hallucinations (hearing things that are not there)
• Confusion
• Difficulty finding words and/or speaking
• Olfactory hallucinations (smelling odors that aren't there)
• Partial paralysis
• Tingling, numbness, or hypersensitivity of the face or extremities
• Vertigo (a sense that the room is spinning)
• Visual changes like flashing lights, wavy lines, spots, partial loss of vision, blind spot, or blurry vision
  

Headache

The head pain of a migraine is often described as throbbing, pounding, or pulsating. You may also experience other symptoms along with the head pain. This phase usually lasts from four to 72 hours. Common characteristics of the headache stage may include:

• Dehydration or fluid retention
• Diarrhea or constipation
• Dizziness
• Hemicranial pain (on one side of the head) pain that can shift to the other side or become bilateral
• Hot flashes or chills
• Nasal congestion and/or a runny nose
• Nausea and vomiting
• Phonophobia (sensitivity to sound)
• Photophobia (sensitivity to light)
• Sadness or anxiety
  

Postdrome

After the most intense phase of a migraine, you may experience the postdrome stage before your migraine attack is completely over. The symptoms of this stage include:

• Concentration problems
• Dizziness or lightheadedness
• Fatigue
• Mood changes, which can include sadness, anxiety, or an elevated mood
• Muscle aches
• Scalp tenderness
• Stiff neck

Many people describe feeling "like a zombie" or as if they were hungover during this stage. Postdromal symptoms can be associated with abnormal cerebral blood flow and brain activity for up to 24 hours after the end of the headache stage. Even if you do not experience the headache stage, you may still experience a postdrome phase.

Childhood Migraines

Children also experience migraines, and the symptoms can differ from those of adults. If you see the following symptoms in your child, migraines may be the cause, especially if your child has a family history of the condition:

• Dizziness
• Excessive sleepiness
• Mood swings
• Motion sickness
• Nausea
• Stomachache
  

Be sure to discuss these symptoms with your healthcare provider. They could be signs of another medical condition. But if migraines are the cause, your child can take medication to help prevent and treat episodes.

Uncommon Symptoms

Rare symptoms are typically associated with migraine subtypes. Though similar to migraine aura, the main difference is that these uncommon symptoms are often the most prominent aspect of a migraine episode:

• Weakness, typically in one arm, occurs with hemiplegic migraine. If you have hemiplegic migraines, you may also experience several migraine stages and other aura symptoms. There is a strong hereditary tendency to develop this type of migraine.
• Stomachaches are a sign of abdominal migraine. More common in children than adults, these stomachaches often occur without a gastrointestinal cause and may involve nausea and vomiting.
• Eye issues such as double vision, blurred vision, a droopy eyelid, or an obvious inability to move one eye can be a sign of ophthalmoplegic migraine.

Complications/ Sub-Group Indications

Migraines do not typically cause complications, though they can. The most common complications are related to medication use.

Medication Effects

Side effects of overuse can include stomach pain and gastrointestinal bleeding from taking high doses of nonsteroidal anti-inflammatories (NSAIDs). Other medications, including triptans and ergot medications, can cause side effects such as dizziness, tingling, or even vascular complications when taken at higher doses than directed.

Keep in mind that all medications—whether over-the-counter or prescription— can cause side effects even at recommended doses. Rebound headaches (those that occur every day or almost every day) or medication withdrawal headaches can occur when you take migraine medications at high doses or for a prolonged time and then abruptly stop.

Migraine Complications

Complications from a migraine itself include some serious issues that require medical attention:

Status migrainosus: If your migraine lasts longer than 72 hours despite treatment, it's called status migrainosus. This condition is unlikely to resolve with your regular prescription. Seek medical attention because you may need treatment with intravenous (IV) medication.

Migrainous infarction: An infarction in the brain is a type of stroke caused by lack of blood flow. A migrainous infarction begins with migraine symptoms that can eventually involve stroke symptoms and may produce permanent neurological effects.

Seizure: A convulsive episode that may be characterized by involuntary shaking or jerking may occur as a result of a migraine. The physiological reason for this complication is not well understood.

When to See a Healthcare Provider/Go to the Hospital

Migraines do not normally require emergency medical attention. Nevertheless, when you feel unsure about symptoms, or when your migraine pattern changes, you should seek medical attention.

Urgent Medical Care

Symptoms such as paralysis, loss of sensation, difficulty communicating, loss of vision, and double vision can all be manifestations of a stroke, MS, meningitis, seizures, and other neurological illnesses. If you experience any of these rare symptoms, and they have not been attributed to migraines (or if you're unsure of their connection), then you should seek prompt medical attention.

Even if you have a diagnosis of migraine, you should have a medical evaluation if one occurs with:

• Falling/inability to maintain your balance
• Head trauma
• Recurrent vomiting/an inability to keep anything down
• The feeling that you're fighting the worst headache of your life
  

Summary

A migraine includes four stages, though you may not go through every one of them during your own migraine episodes. The stages include prodome, aura, headache, and postdrome. The headache phase is the most common while aura is the least common.

The variant nature of the symptoms makes a bit easier to tell one stage from one another. If you're new to migraines, it might help to keep a list of the symptoms with you. To give you an idea of the disparity, prodome symptoms often include constipation or diarrhea, fatigue, nausea, and sensitivity to light.

The aura stage is often marked by confusion, hallucinations (both auditory and olfactory), tingling or numbness, or vertigo. In the headache stage, you may encounter hot flashes or chills and sensitivity to light or sound. The postdrome stage may trigger dizziness, muscle aches, or a stiff neck.