Understanding the Stages of Migraine: Prodrome (Pre-Attack) and Postdrome (Post-Attack)
Daisy Swaffer
Migraine manifests differently for everybody. Some deal with attacks coming out of the blue, some have an “aura” right before an attack starts, and others may have subtle symptoms that act as “warning signals” for an oncoming attack.
Daisy Swaffer knew very little about migraine before her diagnosis. After seeking help from neurological specialists, she learned about the “prodrome” and “postdrome” phases of a migraine attack (i.e., the before and after stages). Today, she explores what her prodrome and postdrome symptoms look like – and the struggle to accurately tell when an attack is beginning or finally over.
When I was first diagnosed with migraine, my GP gave me no further information beyond: "Just take these tablets when it happens.”
It took moving cities, changing to another primary care provider, and seeing neurology experts at the hospital to learn more about migraine. Things started to fall into place in my understanding of my experience of the disease.
It was wonderful not to feel like I was going mad. The first time I realised I wasn't alone was when I talked about my "migraine hangover." I was told it was a normal postdrome experience.
That was when I finally learnt about migraine prodrome and postdrome. These are the effects we experience before and after the migraine attack. Today, I wanted to share what I’ve learned with you, in case you’re struggling with the same issue. If my experiences are relatable or sound familiar, please speak to your doctor, nurse and specialist to get all the necessary information.
The prodrome phase
It would be easy to think that prodrome refers to a migraine aura. Actually, for those that have migraine with aura, the aura starts after prodrome, immediately before the migraine.
Many people think that everyone with migraine experiences aura. This may be because "aura" is often flagged during awareness campaigns. They are surprised when I tell them that only about 25% - 30% of people experience aura with migraine!
For people with aura, it can be considered their starting pistol. They can often predict how long the aura will last and what will happen when it's gone.
Like most people who live with migraine, I don't experience an aura, which means I don't have that starting pistol to alert me to the incoming migraine. I must pay much more attention to my prodrome symptoms to understand when a migraine will happen, so I can take my medications at the right time.
Every time I've met with the occupational health advisor at one of my jobs, I have had to explain the migraine prodrome stage. This is difficult because it can vary, and these variations impact when I need to leave the office. It's hard for many people to understand that many of my migraines feel different, and it's not always easy to recognise the symptoms.
More often than not, it isn't me who identifies that I am in the prodrome phase. Instead, it's my husband or close friends, as they can see the changes in me easier than I can see them in myself. Despite not knowing what migraine feels like, seeing and recognising my prodrome symptoms can give a much clearer picture of what's happening.
Recognising prodrome symptoms can be tricky
I usually (but not always) have a building headache through the prodrome phase, focused on one half of my head. You would think this alone would be enough to identify prodrome. But when you also have chronic daily headaches, you're used to ignoring head pain. This "programming" means I'm much less likely to recognise the specific type and feel of the headache I'm having, which is often my warning signal.
A runny nose is one of my more reliable (but very late) prodrome symptoms. Of course, this doesn't happen every time. Still, if I'm questioning whether I am overreacting to other symptoms and get a runny nose, I know what I am in for. It's time to batten down the hatches because the storm is imminent.
Sometimes I get food cravings, usually for something salty and sweet. However, it can be hard to tell if this is a food craving related to prodrome or if I really fancy eating something in particular.
Other times I completely lose my appetite, and trying to force food down feels like trying to eat ash.
Aphasia (when I can't find simple words or when I can't understand what people are saying) is related explicitly to migraine for me. I only experience it in prodrome or during a migraine. Still, it is very hit-and-miss whether I will even have aphasia, so it’s not a reliable guide.
My prodrome symptoms aren’t reliable indicators of what’s to come
Even when I identify that I'm in the prodrome phase, it's tough to know how long I've got until the migraine attack hits. It could be minutes, it could be a couple of hours, or it could even be a day or so until it starts. I'm still surprised that I still can't reliably know when one is coming after the vast amount of migraines I've had and how frequently I've had them.
Keeping a migraine diary and writing down anything unusual will help you identify your prodrome symptoms.
The postdrome phase
I don't tend to refer to the period after the migraine as postdrome. Instead, I refer to it as "the hangover" because that is what it usually feels like – a really bad hangover.
I have found that this part of the migraine experience is most relatable for people who don't experience migraine themselves. When I have been back in the office after a migraine but am still in the postdrome phase, people think that because I am back at work, I am past the migraine. I explain that I am actually in the final stage of the migraine and how much it feels like a bad hangover.
Sometimes I can see in their face as they flicker back to a memory of a bad hangover. It's funny to see them recalibrate their estimation of what the last two days have been like for me.
The migraine hangover comes with a new set of problems
My hangover-like symptoms always include a raging thirst. An absolutely unquenchable thirst. It is also usually accompanied by a sensitivity to light, although usually less severe than during the migraine itself.
Fatigue and dizziness are some of the more difficult aspects to manage. After going through a migraine attack (which usually means three days of confinement to my bed), I want to be able to get up and do things afterwards. But my body crumples underneath me, even when I try to do the simplest things.
And when I can finally think again after the migraine-induced brain fuzz, I still can't focus. I would begin to do a task and zone out. It's like I can't keep things right in my head.
Sudden sleepiness is another symptom. I would finally feel more "normal" and then fall asleep without realising how tired I must have been. Despite all the resting during a migraine, an attack remains exhausting.
Like a bad hangover, postdrome sometimes includes nausea and vomiting. Unfortunately, these symptoms aren't limited to the migraine phase itself.
Of course, the severity of my postdrome symptoms varies from migraine to migraine. Sometimes I don't seem to have a postdrome at all. This makes it very difficult to know what I can do now, even when the migraine is over, and what's still beyond my capabilities.
The takeaway
Understanding your prodrome and postdrome symptoms is important in living with migraine. Even better, having people around you who recognise your pro- and postdrome signs can keep you one step ahead. Having other people identify my prodrome phase has helped me so many times.
Likewise, when people understand my migraine phases, they manage their expectations of me after a migraine. To me, that's just as important as understanding how debilitating the migraine itself is.
© 2023 Life Effects by Teva Pharmaceuticals
The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.
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Date of preparation: August 2023
D: COB-GB-NP-00192 (V1.0) / T: COB-GB-NP-00232 (V1.0) / M: COB-GB-NP-00212 (V1.0)
