By Rajnish Mago, MD (bio)
On another page on this website, I gave reasons why all mental health clinicians should continue to learn more about migraine and try to identify the presence of migraine in our patients. Migraine is much more than simply a form of headache. First, on this page, let’s look at the different phases of migraine. Then, on other pages on this website, I’ll explain the clinical features of each of these phases (for links to those pages, please see Related Pages below).
Phases of migraine
Though migraine is a type of headache, a wide variety of symptoms other than headache are usually present as well. We’ll look at the clinical features of migraine in four phases. Not all the phases have to be present in a particular patient or in the same patient over time.
In the order in which they occur, these phases are:
1. Prodromal phase: A phase that lasts for hours or even days before the headache (or aura, if that is present) starts.
Recognizing the prodromal phase is extremely important because the aim should be to develop pharmacological and non-pharmacological strategies that could be used in the prodromal phase to prevent the headache from coming on or to at least reduce its severity.
2. Aura: This consists of short-lasting focal neurological symptoms that typically occur before the headache starts.
About one-third of patients with migraine have an aura at some time in their lives. But, typically, patients tend to sometimes have an aura and sometimes not (Kahriman and Zhu, 2018).
3. Headache and associated symptoms (like photophobia, phonophobia, neck pain, and so on)
4. Postdromal phase: This is the period from the end of the headache until when the person returns to baseline.
Prodromal phase versus the aura
The prodromal phase is not the same as aura because:
– The aura consists of focal neurological symptoms while the prodromal phase does not.
– The aura occurs with the headache or immediately before (in the one hour before) the onset of the headache. But, the prodromal phase, if it is present, occurs for hours or even several days before the onset of the headache.
For a description of the clinical features of each of the phases, tips on how to diagnose migraine, and brief reviews of its treatment, see Related Pages below.
Dodick DW. Migraine. Lancet. 2018 Mar 31;391(10127):1315-1330. doi: 10.1016/S0140-6736(18)30478-1. Epub 2018 Mar 6. Review. PubMed PMID: 29523342.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202. PubMed PMID: 29368949.
Kahriman A, Zhu S. Migraine and Tension-Type Headache. Semin Neurol. 2018 Dec;38(6):608-618. doi: 10.1055/s-0038-1673683. Epub 2018 Dec 6. Review. PubMed PMID: 30522135.
Copyright 2019, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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