Although this is not a one size fits all description, typically migraines consist of 4 stages:
Each of these stages can have a variety of characteristic symptoms and varies in time course.
Approximately half a day to a day in advance sufferers may experience mood changes or gastrointestinal disturbances occurring before the onset of a headache. These and other symptoms can include:
- Diarrhea or constipation
- Craving certain foods e.g. sugar
- Difficulty concentrating
- Muscle stiffness
- Increased urination
- Mood changes
These symptoms may be early warning signs. It is useful to record these and subsequent symptoms and the context of your migraines in a diary to establish your pattern of migraines.
This stage is comprised of sensations that more immediately precede the headache, often being visual disturbances. Up to 30% of migraine sufferers may have an aura stage. The aura typically develops in 5-20 minutes and also varies in duration (5-60min).
Auras can be visual disturbances, changes in physical sensation or speech and language difficulties:
This is the most common symptom and typically occurs from the centre of the visual field and moves outwards.
- Blind spots
- Colored spots
- Flashes/ specks of light
- Zig zag lines
- Tunnel vision
- Temporary loss of vision
- Changes in sensation may start on one side of the body and then progress to the other side or different regions of the body.
- Pins and needles
Speech and language difficulties
There may be barriers in communicating such as:
- Difficulty speaking
- Slow speech
- Slurred speech
- Memory loss, feelings of confusion and fear are also possible at this stage. Rarer signs include partial paralysis and fainting.
The next stage which is the headache typically starts on one side of the head and is throbbing and intense in quality. The pain may be worse when you move and it may interfere with your daily functioning. The pain in some individuals may be on both sides of the head or spread to the neck or face. Feeling nauseous, vomiting and marked sensitivity to light, sound or even smell or touch. The duration of this stage tends to range from 4 to 72 hours.
Mood changes often accompany the resolution of the headache. It is possible to feel exhausted and tired for a few days. By contrast others can experience feelings of elation. Head movements may cause some pain to return in others.
When to see a doctor
If your migraines are severe, frequent or interfering with your daily life consult a doctor. Even if you have had headaches in the past, consult your doctor if the nature or pattern of these headaches change. See a doctor as soon as possible if the following symptoms apply to you:
- Sudden severe headache like a ‘thunderclap’
- Headache with fever / stiffness / confusion / seizures / other significant neurological symptoms
- Headache after an injury to the head
- Headaches that have a long duration that do not pass
- Headaches with other features that are not resolving
- Symptoms restricted to 1 eye
- New headaches after age 50
If sinister causes of your symptoms are ruled out and a diagnosis of migraines are made you can usually expect to be offered preventative treatment and medication to reduce your migraines or lower the intensity of the migraines. As aforementioned headache diaries for keeping track of your symptoms can be used to guide your treatment effectively and help you to make simple lifestyle choices to avoid migraines.