The Stages of a Migraine - Prodrome & Aura

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Did you know? That a migraine can occur in 4 stages? It is also a myth that migraine sufferers will experience all the stages. Prodrome, aura, migraine attack and postdrome make up the 4 stages in which a migraineur may experience.

Today, we’ll be placing focus on the first 2 stages! Over the course of the next few weeks, more articles related to the remaining stages of a migraine will be released so remember to stay tuned!

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Prodrome 

With reference to the picture above, the prodrome phase of a migraine can occur anywhere between a few hours to a few days before the actual attack. It is also said to be the “first part of an attack when the ‘normal’ equilibrium of the central nervous system has been disrupted”. 

When a prodrome occurs, the migraineur may begin to notice that something isn’t right, which is why some people refer to prodrome as a “warning sign” or “premonitory phase” before an attack! At other times, it may be the loved ones or people close to the migraineur who notices these symptoms before the migraineur does. As mentioned previously, not everyone will experience the prodrome stage. That also doesn’t mean people who have prodrome will experience prodrome with every migraine attack! 

Approximately 30% of migraineurs experience the prodrome phase. Some of the symptoms may include: 

  • Irritability/Excitement

  • Depression

  • Repetitive yawning

  • Increased frequency and urge of urination

  • Food cravings

  • Increased thirst

  • Photophobia (sensitivity to light) 

  • Phonophobia (sensitivity to sound)

  • Difficulty concentrating

  • Difficulty sleeping

  • Nausea

  • Fatigue 

  • Muscle/Neck Stiffness

  • Aphasia (difficulty speaking and reading) 

  • Cold extremities

  • Bowel changes 

  • Memory changes

Difference between Aura and Prodrome

The divide between prodrome and aura has been clarified over the past few years. The latter was defined as being a “focal neurological deficit (visual, sensory, etc.)”, which allowed for the diagnosis of migraine with aura.

By definition, an aura does not last for over 60 minutes. Aura is related to focal cortical activity. On the other hand, prodrome symptoms are more likely linked to different areas of the central nervous system (CNS) and are characterised more by behavioural features. Prodrome symptoms usually last longer and they may not necessarily resolve prior to the onset of pain. Some of the symptoms may even be under the symptoms which accompany the pain phase. 

Aura 

Auras are mainly visual disturbances which can take the form of flashing lights, light spots, sudden bright coloured lights or even temporary loss of sight. Read here for a more in-depth representation of what visual auras may be! Auras can also be in the form of sensory, motor or verbal disturbances. 

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Sensory aura can occur simultaneously with visual aura, after or standalone. This is characterised by numbness and tingling on part of the body which gradually moves to different parts of the body. 

Dysphasic aura is another kind of aura, which causes speech or language problems. Commonly, a migraine aura will precede the migraine attack. However, it is possible that it can occur during the attack too. 

Shown here is a list of the Top 5 most common Migraine Auras as reported by Migraine Buddy users! ‘Fatigue/Achiness’ and ‘Tingling in Head’ are the most common, followed by visual disturbances, tingling in neck and tingling near eye(s).

Have you experienced similar symptoms? If not what are some of those you experience? We’d love to hear from you in the comment section down below!  

Emily Neo