Migraine attack symptoms

Migraine stages

Although this is not a one size fits all description, typically migraines consist of 4 stages:

Prodrome
Aura
Headache
Postdrome

Each of these stages can have a variety of characteristic symptoms and varies in time course.

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Prodrome

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
Irritability
Difficulty concentrating
Confusion
Muscle stiffness
Tiredness
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.

Aura

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:

Visual disturbance

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

Physical Sensation

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
Vertigo
Dizziness
Numbness
Weakness

Speech and language difficulties

There may be barriers in communicating such as:

Difficulty speaking
Slow speech
Mumbling
Slurred speech
Memory loss, feelings of confusion and fear are also possible at this stage. Rarer signs include partial paralysis and fainting.

Headache

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.

Postdrome

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.