Migraine: The Postdrome

The Postdrome is called a `migraine hangover`for a reason… it is the hangover without having it drink it get it. Yay us. It can last for hours to days. Yay us.

The postdrome is a constellation of symptoms that persist beyond the resolution of headache. Many of these symptoms appear initially during the prodrome or with the headache phase. Commonly, patients report anorexia, nausea, muscle tension, fatigue, and cognitive impairment. This phase has been termed the migraine hangover and can last and produce disability up to 1 to 2 days beyond the headache phase. The pathophysiology of the postdrome is unknown, but likely represents a gradual recovery phase from the extreme neurologic disruption that occurs during migraine — Understanding the Patient With Migraine: The Evolution From Episodic Headache to Chronic Neurologic Disease. A Proposed Classification of Patients With Headache, Medscape

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Not much happens with the Postdrome but we feel Cruddy with it. So fatigued. And with brainfog like nuts. Once the pain is gone it is like the body and brain don`t turn back on yet… they are left lagging behind with no energy to run.

been-running-on-near-empty-a-long-time

out

And then, again, we get the mood symptoms back for a show. I have Never experience the euphoria… but that would be nice for sure. I have experienced the depressed mood though

odd-migraine-symptoms_-euphoriadeepmood

You can also feel sore all over with muscle tenderness. Just feeling uhg all over.

Here are the results of a study on 893 migraineurs:

RESULTS:

A total of 32.9% of IHS migraine 1.1-1.6 patients reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migrainereported 29.7% and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these symptoms were present together in 17% of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15.0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 patients showed similar findings. IHS 1.1-1.6 patients with prodrome differed from patients without prodrome in having more triggers as a whole (P <.01), more individual triggers including alcohol (P <.01), hormones (P <.01), light (P <.001), not eating (P <.05), perfume (P <.01), stress (P <.01), and weather changes (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <.05), longer time to peak of headache (P <.05), longer time to respond to triptan (P <.05), longer maximum duration of headache (P <.05), and more headache associated nausea (P <.05), more headache associated running of the nose or tearing of the eyes (P <.05), more postdrome syndrome (P <.05), and longer duration of postdrome syndrome (P <.001).

So symptoms vary as does that duration by quite a bit.

 

So now we are at the end of the migraine stages. But it is good to note these stages last for different durations. Sometimes you even skip a stage, assuming you even get the auras or the headaches. And sometimes you go from the headache stage right into another prodrome of another migraine. The stages are what a standard attack looks like, but every attack is different. You may not get a prodrome one time and have a long prodrome the next. Same with the postrome. It may be not there or last days. There is a lot of variability in there and it is good to know the symptoms to know what stage you are in. First it helps with immediately treating the migraine. Secondly it can indicate when a migraine is nearing its end… but is in still in effect.

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