Migraine signs and symptoms may be divided into five phases :
- Prodrome
- Aura
- Headache
- Headache termination
- Postdrome
All five phases are identifiable in some attacks, but many episodes have fewer than this and occasionally only one. Most migraineurs experience two or more phases during their attacks.
Prodrome
About 60% of migraineurs experience premonitory phenomena hours to days before the headache itself begins. The prodromal features of migraine are :
- Mental and mood changes (e.g. depression, anger, euphoria etc.)
- Stiff neck
- A chilled feeling, peripheral vasoconstriction
- Sluggishness / fatigue / excessive tiredness / yawning
- Increased frequency of urination
- Loss of appetite
- Constipation or diarrhoea
- Fluid retention
Aura
Focal neurological symptoms, typically evolving over a period of 5 to 20 minutes and generally lasting less than 1 hour are characteristic of the aura. They may be visual, motor, sensory and disturbances in brainstem. In most cases, a headache follows the aura, often by 5 to 20 minutes, although the interim may be as long as 60 minutes. Occasionally, a migraine episode may include an aura but no headache at all. The aura phase is experienced by only about 20% of migraineurs.
Headache
Migraine headache is usually unilateral and throbbing, but the features can vary. The pain may be felt anywhere about the head or neck. Approximately 60% of migraine headaches are unilateral; however, pain may be bilateral at onset or become generalised. Headache may occur at any time, but occurs most often on arising in the morning. The pain tends to develop gradually.
Symptoms accompanying the headache
Gastrointestinal disturbances
- Anorexia
- Nausea and vomiting
- Diarrhoea
Visual (Eye) disturbances
- Blurring
- Light sensitivity (Photophobia)
Others
- Fatigue / depression / irritability / anger / mental dullness / hypomania / confusion
Motor abnormalities
Sensory abnormalities
Fluid retention / polyuria
Hypertension / hypotension / nasal congestion / tachycardia (fast heart rate)/ bradycardia (slow heart rate)
Nausea occurs in 80 to 90% and vomiting occurs in 40 to 70% of migraineurs
Headache Termination
This phase is the period during which the headache pain tapers and eventually ceases.
Postdrome
For many migraineurs, general fatigue sets in after headache resolution. This postdromal period is often characterized by tiredness, listlessness and a washed-out feeling. The patient may be irritable or have difficulty in concentrating. The scalp may be tender, and muscles may feel achy and weak. Food cravings or loss of appetite may be experienced. Mood may be one of euphoria or of depression.