Complex Migraine
The 4 Phases / Stages

Written and verified by Holly Hazen

What are the warning signs of a migraine attack? A whole complex migraine episode goes through 4 phases: prodrome, aura, headache and postdrome. Some add a 5th stage for recovery. In order to abort an attack quickly and successfully, you must act as fast as you can when you feel the initial symptoms in the prodrome phase. 

By acting, I mean to take your prescribed medications asap, or whatever tools you use for treatment and prevention. First, let's look at the symptoms you may have so you know just how fast you need to act! And then we'll look at some treatment tips.

The pain phase is the most familiar to people without migraine disease. As a person living with migraine, you might be aware that there are other things that happen before and after the pain phase.

But are you aware of the biological chain reaction and other stages you go through during an entire attack?

You probably know about triggers and your own triggers...

Neck pain, perfume, no sleep, alcohol, the weather, chocolate – pick whatever trigger you like, it will start to spread the chemical electrical charge that causes the migraine episode.

You don't reach the headache (pain) stage until phase 3.

Migraines are complicated.

The process is composed of many interconnecting parts in the human brain and body that is so complex and hard to understand, that even scientists and specialists are not exactly sure what happens to cause this dysfunction.

It begins with chemical reactions, cortical spreading depression and nerve storms from an overstimulation of nerves from unpredictable triggers. All unseen, and possibly unfelt. 

Then come the symptoms (seen and felt) and most commonly, though not always, has these four phases. This first phase is when you need to act as fast as possible.

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Phase 1 - Prodrome

Symptoms hours or even days before a migraine episode provide an early warning signal that tells you a migraine is on its way.

I never knew about these warning signals initially, it took many years to figure it out. I might be aging myself but there was no internet when I was diagnosed... ok so now you know I'm old! And wise!

This is the phase you want to take action to help abort the attack. Waiting until the pain phase is too late. This is when you want to take your prescribed abortive, if you have one.

Getting to know your body and its symptoms have the potential to make your pain phase and life much more manageable.

Phase 2 – Aura

The symptoms of the aura phase vary widely between individuals.

Some can be quite terrifying like Serene Branson, the KCBS reporter, who spoke nonsense on her live report at the Grammys.

Initially her co-workers thought she was having a stroke, but was later diagnosed with just complex migraine headache.

JUST MIGRAINE!

Let's face it - Migraines are terrifying! How scary for Serene Branson, this was her first one. Luckily, she has already found a triptan that will work with her migraine type.

I have recently been losing my central vision, zig zag lines around the edges, I can see the peripheral and even sometimes I can see all the air particles.

I can see people’s auras! Sometimes I can speak, but I don’t recall what I just said. I feel like I am present, but within a minute I forget... and sometimes it remains forgotten for good!

Some people experience a tingling sensation and have numbness leading to partial paralysis of face and limbs – normally on one side of their body. Just like migraines are one sided, so is the paralysis. 

Don't let this freak you out... if you haven't experienced this yet, you may never. 

Some typical aura symptoms are:

• visual symptoms: flashing lights, wavy lines, spots, blank spots, blurry vision

• olfactory hallucinations (smelling odors that aren't there)

• partial paralysis or tingling or numbness of the face or extremities on the side where the headache develops

• difficult finding words and/or speaking

• confusion

• dizziness or vertigo

• auditory hallucinations or decrease in hearing

• reduced sensation

• hypersensitivity to feel and touch

Some migraine sufferers do not experience all phases, nor do they experience the pain. These are called "silent migraines" or "migraine equivalent". 

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Phase 3 – Pain

This is the most difficult part of the complex migraine headache phase that is tricky to describe.

I used to get asked “on a scale of one to ten – rate your pain”, and I used to answer 200! Please don't do this, it's not an effective way to talk with your doctor. I go over this in depth in my migraine pain management course. 

It is hard to comprehend just how intense the pain is if you have never experienced it.

Phase 4 - Postdrome

Complex migraine is not just headache pain... it can take hours or sometimes days to fully recover from an attack.

The aftereffects can look like this:

• melancholy

• depression

• fatigue

• poor concentration

• poor memory

• one, a combination or all of the above
  
  

Does this sound similar to the worst hangover you've ever had? Click here for my article to help you with post migraine symptoms.

There is also the chance you may feel euphoria. I used to after long migraines.

I would come out of my ‘meditation’ and go for a slow walk along the beach in awe of the beautiful ocean.

I’d watch the clouds and feel elated. That doesn’t happen these days because I don’t get the 10 day long episodes. Or those pain levels. Thank goodness.

Do you ever feel euphoric after an attack?

I hope so.

Until next time, be well.

Recommended Reading for More Complex Migraine Treatment & Prevention Strategies

• Acute drugs for migraines

• 10 Rescue Migraine Medications

• List of Migraine Medications

• How to Treat a Migraine

• How to Prevent Migraines

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