The two major categories of migraine are migraine with aura and migraine without aura, according to Sandhya Kumar, MD, a neurologist and headache specialist at Wake Forest Baptist Health in Winston Salem, North Carolina. Typically, migraine attacks progress through four stages, or phases, which distinguishes them from severe tension or other nonmigraine headaches: prodrome, aura, headache, and postdrome. In other cases, the headache phase doesn’t occur. According to Dr. Kumar, “In an ocular migraine, a person might not have much of a headache or no headache all, but then they have all these visual auras where they see things like flashing lights or visual phenomena. Some people say it’s like looking through a kaleidoscope.” Several signs and symptoms are associated with the prodrome phase. They can include:
ConstipationDepressionFood cravingsDifficulty focusingIrritability and changes in moodMuscles stiffness, especially in the neck and shouldersUncontrollable yawningFrequent urination
Recognizing these signs and symptoms as part of the prodrome phase and treating them accordingly — whether it’s by taking medication, avoiding migraine trigger, or practicing mindfulness meditation or relaxation techniques — may lessen the severity of the resulting migraine or even prevent it.
Visual Seeing various shapes and geometric patterns, bright spots, or flashes of light, or experiencing vision lossSensory Touching sensations, such as a pins-and-needles feeling in an arm or legMotor Movement-related problems, such as limb weaknessVerbal Speech problemsAuditory Hearing noises or music
Auras typically begin gradually and increase in intensity. They can last for several minutes or up to an hour, but for most people they last much less than an hour, says Dr. Spears. For some people, aura is their only migraine symptom, with no headache. Other people always experience a headache after the aura phase, and still others with aura sometimes have a headache and sometimes don’t. According to Kumar, the following symptoms can occur during the headache stage of a migraine attack:
Pain on one or both sides of your head (possibly beginning on one side and then including both sides)Throbbing or pulsating painSensitivity to light, sounds, or smellsNausea and vomitingBlurred visionLight-headedness and fainting
“You don’t have to have all the symptoms for it to be a migraine attack,” adds Kumar. When a person has a migraine attack, the symptoms are made worse by routine physical activity, so people typically don’t want to move around, says Spears. “Usually people want to sit or lie down in a dark, quiet room and try to sleep it off,” he says. Allodynia is a common but often misunderstood symptom of migraine. It’s hypersensitivity and pain that results from otherwise nonpainful stimulation — such as taking a hot shower, resting your head on a pillow, gently brushing your hair, and other things that you wouldn’t think twice about outside of a migraine attack. During postdrome, although the headache pain has subsided, you may feel fatigue, experience body aches, and have trouble concentrating, all of which can be severe enough to be debilitating. Sensitivity to light and strong smells may persist. Drinking a lot of water and getting rest can help you get over this feeling, according to Spears. Some people can experience quite the opposite during the postdrome, according to Spears. “There are people that are elated, almost what you would call euphoric, because they don’t have the pain anymore. They’re so full of energy they can almost be hyperactive,” he says. Children who experience attacks of abdominal pain associated with loss of appetite, nausea, vomiting, and pallor (or sometimes flushing) — but no headache — may be diagnosed with abdominal migraine, assuming other causes of these symptoms can be ruled out. When very young children and even infants have migraine, it can be challenging to diagnose because they can’t articulate their symptoms and you have to look for signs, says Kumar.
Vertigo
Benign paroxysmal vertigo — in which a person senses motion when there is no motion or has an abnormal sensation during normal motion — is believed to be associated with migraine when it occurs in otherwise healthy children.
Benign Paroxysmal Torticollis
Some experts believe that benign paroxysmal torticollis is a migraine variant. There is often a family history of migraine in children who have this disorder.
Additional reporting by Becky Upham.
