Migraine episodes have four phases: prodrome, aura, headache, and postdrome. The severity of each phase varies from person to person and from migraine to migraine.
Sometimes, my migraine episodes send advance warnings a day or two before the headache. They’re more subtle than Paul Revere, whispering, “The migraine episode is coming, the migraine episode is coming,” so quietly that I don’t always get the message.
Then, sometimes, the messages are so bold that I can’t ignore them.
One night recently, I was in a Zoom meeting when I started shivering and yawning out of the blue. Aware of how rude I must appear to the group, I still couldn’t control it.
I logged off, piled blankets on myself in bed, and told my husband — between frantic yawns — to Google my alarming symptoms.
Only after the episode passed, I figured out that this was a new (to me) variation of the migraine prodrome.
Migraine episodes come in four phases:
- prodrome
- aura
- headache
- postdrome
How severe each phase is varies from person to person and from migraine to migraine.
In my teens and 20s, a migraine episode would come and go with a short aura and headache lasting no more than a day. I bounced back like a very young rubber ball.
Lately, the prodrome messengers are coming more often, and the postdrome hangover is lasting a little longer.
Prodrome, the phase before a headache when you may experience other symptoms, may last a few hours to a few days. An aura typically lasts 5 to 60 minutes, the headache lasts 4 to 72 hours, and the postdrome can hang on another 1 to 2 days.
If you do the math, one migraine episode can last from 1 day to a whole week, and only a (relatively) small interval may be the actual headache.
For me, the prodrome is usually made up of:
- crushing fatigue
- nausea
- brain fog
- irritability
The signs are easy to mistake for a garden-variety bad mood.
Many times after the onset of a headache, a light bulb goes on (ouch), and I think, “Oh yeah. That’s why I felt so weird yesterday.”
I’m learning to be more aware of when a migraine episode is coming so that I can take steps to prepare.
If I suspect my weird feelings may manifest as a full-blown migraine headache later, I will …
- take preventive medications
- adjust my schedule so that I’m not slammed with activities on a headache day
- eat enough and drink more water
- focus on resting
- fill my family in on what’s happening
After the prodrome, the aura phase starts. (Not everyone has auras, but I almost always do.)
My migraine aura symptoms typically include some kind of visual disturbance like blind spots or bright zigzagging lines. It’s like I stared at the sun too long.
In fact, looking at bright lights can trigger a migraine episode, too. Sometimes, my hands feel numb, and the food tastes strange.
I cope by taking a mandatory break for safety, especially if I’m driving. I remind myself that this is the shortest phase of the migraine episode, and it will be behind me soon.
Then comes the head-buried-under-a-pillow phase, the one people probably imagine as a typical migraine experience: nausea, sleepiness, blurry vision, sensitivity to light and sound, and, oh yeah, head pain, ranging from no big deal to devastating.
Every person with migraine has their own coping strategies for the headache phase. For me, it works best to slow way down, or I risk starting the aura/headache cycle starting over again.
Often, even when the migraine episode is over, we have the hangover to cope with. It can feel like fatigue, depression, and brain fog. Or like a literal hangover with breakthrough head pain and an iffy appetite.
I have strategies to get through postdrome days. These include …
- managing expectations at work and home
- treating it like a half-speed day
- drinking all the water (I don’t know why, but this seems to make everything better)
- giving up the pressure to “bounce back” like I did 20 years ago
- remembering that ramping back up to full speed too fast after a migraine episode can make the cycle start all over again
Migraine episodes are practically a lifestyle. I have lived with them for decades, and their frequency ranges from a few per year to a few per week.
Now, even when the headache is mercifully tolerable, other weird symptoms before and after can be incapacitating.
On a prodrome day when language is all jumbled (this is referred to as the migraine episode bubble), working, reading, and writing have to take a back seat.
If a postdrome day leaves me feeling depressed that I can’t be more productive, I have to remember to have compassion for myself.
After all, it’s not as if a migraine episode is the equivalent of a tension headache that goes away with a few ibuprofen. The bounce back after a migraine episode is much more complicated.
In this phase of living with migraine episodes, I’m working to understand my symptoms as they evolve and do my best to anticipate and alleviate migraine symptoms throughout the four stages.
My main coping strategy is acceptance. The migraine episodes are coming. Now, what can I do to manage?