Migraine Attacks: Duration and Phases to Monitor
The span of a migraine attack can vary widely, ranging from just a few hours to several days. Extended episodes that persist beyond this duration necessitate medical evaluation.
On average, an episode can unfold over 4 to 72 hours, but it isn’t uncommon for some to experience prolonged periods of discomfort. Tracking the progression of individual episodes may provide insights into their length and pattern.
For younger patients, migraines may not linger as long. Children over the age of five often experience symptoms lasting between 1 to 2 hours, while for those younger, a brief 30-minute duration could suffice.
The anatomy of a migraine typically unfolds in four distinct phases, although one may not experience every phase in each attack:
- Prodrome Phase: Early signs that signal the imminent arrival of a migraine.
- Aura Phase: Pre-headache sensory disturbances.
- Headache Phase: The peak period of pain.
- Postdrome Phase: The concluding phase of recovery.
The duration of these phases varies, with some lasting briefly and others extending longer. Not every individual will encounter each phase with every migraine occurrence. Documenting these experiences in a migraine journal can prove beneficial in recognizing patterns and adopting preparatory measures for future attacks.
Diving deeper into the Prodrome Phase, this term describes the initial symptoms that precede the primary stage of a migraine. Roughly three-quarters of migraine cases commence with a suite of indicators that bear no connection to the headache itself.
Prodromal symptoms may encompass:
- Specific food cravings
- An increase in thirst
- Stiffness in the neck
- Mood shifts, such as irritability
- General fatigue
- Symptoms of anxiety
These early signals typically occur several hours and could start up to two days before the aura or the actual headache phase manifests.
During the Aura Phase: Signs and Sensations
Approximately 25% of migraine sufferers experience an aura, which typically emerges 10 to 60 minutes prior to the headache phase and may persist for up to one hour.
This neurological precursor can manifest a variety of sensory anomalies, including:
- Visual disturbances such as colored or dark spots, “stars,” flashing lights, zigzag patterns, and visual phenomena resembling “heat waves”
- Physical sensations like numbness, tingling, or weakness
- Feelings of dizziness, along with anxiety or confusion
- Speech and hearing disruptions
In uncommon instances, one might encounter symptoms more severe, such as fainting or partial paralysis, which may endure beyond an hour.
While these symptoms traditionally herald a migraine in adults, they can also arise concurrently with the headache. Sometimes, the aura might occur without a subsequent headache altogether.
Headache Phase: Core Migraine Experience
A majority of migraine episodes transpire without the prelude of aura symptoms, transitioning directly from preliminary signs to the headache stage.
The characteristics of this phase are generally uniform, regardless of the presence of aura, and may encompass:
- Throbbing pain on one or both sides of the head
- Acute sensitivity to light, sound, odors, and sometimes touch
- Blurry vision
- Nausea and potentially vomiting
- Loss of appetite
- Feelings of lightheadedness
- Pain escalation with any physical activity
Many find themselves debilitated during the migraine, unable to partake in work or daily routines. The duration of this phase is highly variable, spanning from just a few hours to several days.
Postdrome Phase: The Aftermath
As the migraine recedes, individuals may enter what is known as the recovery phase, which can elicit a broad spectrum of reactions, from fatigue to a surprising sense of euphoria. Additional sensations might include mood swings, dizziness, confusion, and weakness.
These postdrome sensations often echo the symptoms one experienced during the warning stage. For example, a previously diminished appetite could suddenly shift to a pronounced hunger.
These post-attack symptoms may linger for up to a day post-headache. In children, postdrome effects, which may include tiredness, thirst, and cravings for certain foods, usually resolve within 12 hours.
Seeking Relief from Migraine Pain
Each individual’s approach to relieving migraine pain is unique, and there is no universally correct method for treatment. For those who experience migraines sporadically, there’s the option to manage symptoms with over-the-counter (OTC) remedies as they arise.
However, for those with chronic or intense migraines, OTC solutions may not make the cut. In such cases, it may be necessary to consult with a healthcare provider who can prescribe more potent medications to not only address the symptoms in the present but also curb the frequency of future episodes.
At-Home Remedies
Simple changes to your surroundings can sometimes significantly alleviate migraine discomfort.
Go for the calm of a dimly lit room, switching to lamp illumination over harsh overheads, and cover windows to keep out sunlight.
Electronic device screens can intensify your discomfort, so it’s wise to cut down on screen exposure during a migraine. Pressing a cold compress to your forehead or soothing your temples with gentle rubs might offer relief. If nausea isn’t on the list of symptoms, increasing your water intake is beneficial.
Being aware of and sidestepping your migraine triggers can substantially lessen your symptoms and help prevent recurring episodes. Common triggers include:
- Stress
- Specific foods
- Missed meals
- Alcoholic or caffeinated beverages
- Certain drugs
- Lack of sleep
- Hormonal fluctuations
- Weather shifts
- Head trauma
OTC Medications
For mild or less frequent symptoms, OTC analgesics may be suitable:
- Aspirin (Bayer)
- Ibuprofen (Advil)
- Naproxen (Aleve)
For more intense symptoms, a combined analgesic and caffeine medication, like Excedrin, could be efficacious. Since caffeine can both prompt and alleviate migraines, be cautious with such treatments unless certain that caffeine is not one of your triggers.
Usage of these medications should be kept to no more than 10 to 15 days a month to steer clear of medication overuse headaches.
Prescribed Treatments
Should OTC options prove ineffective, a medical professional might prescribe stronger, target-specific drugs to mitigate your pain.
Prescription options include:
- Triptans, like sumatriptan (Imitrex, Treximet) and zolmitriptan (Zomig)
- CGRP antagonists, such as rimegepant (Nurtec ODT) or ubrogepant (Ubrelvy)
- Serotonin 1F receptor agonists, such as lasmiditan (Reyvow)
Your doctor might also recommend medicines to subside nausea.
For recurring migraines, preventive medication could be prescribed, with rimegepant doubling as a preventative treatment. Other preventive drugs include:
- Beta-blockers like propranolol
- Anticonvulsants like topimarate (Topamax)
- Antidepressants like amitriptyline
- Monoclonal antibodies like erenumab (Aimovig)
Each treatment plan is tailor-made to meet the individual’s needs and must be supervised by a healthcare professional.
Seeking Medical Guidance for Migraines
When confronted with your initial migraine, home remedies and over-the-counter medication may suffice to alleviate discomfort. However, for those who are dealing with recurrent migraine episodes, consulting with a physician is advisable. They can conduct a thorough evaluation and craft a personalized treatment approach.
It is imperative to seek immediate medical attention in the following scenarios:
- You suffer migraine symptoms following a head injury.
- Your migraine persists beyond a duration of 72 hours.
- You are experiencing a migraine for the first time and are aged 40 or older.
- A sudden, excruciating headache arises.
- You are above the age of 50.
- There is a noticeable change in the characteristics of your headaches.
- Your headache is accompanied by neurological anomalies such as one-sided body weakness, numbness, vision impairment, or loss of consciousness.
Timely consultation with a healthcare provider ensures that any serious conditions are ruled out and that appropriate measures are taken to manage and treat migraine symptoms effectively.