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.

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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

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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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Migraine: Headache stage

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We are all aware of the headache stage. Many people thing it is the only stage which is why we need to raise awareness of the neurological processes to the disease.

It lasts anyway from 4 hours to 72 hours. Yeah. It can in fact last that long. And it certainly does. When it lasts longer it is a different, called a status migraine which is important due to the risks associated with it. It is mild to severe in intensity.

It is pulsating and throbbing. Definitely made worse by movement.

Generally migraines are diagnosed as one-sided pain. But they can in fact be bilateral from the get go. They can become bilateral into the attack. They can also switch sides during an attack.

It is not necessary to a migraine attack. Silent migraines have no headache stage.

In this stage is the migraine symptoms that are most familiar to someone who does not suffer from a migraine. Such as the sensitivity factor: To Sound. To Light. To Odours.

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And it can include:

 

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Not to mention jaw pain, facial pain, vertigo and dizziness and more.

The pain is hard to describe in its intensity. It is hard to think through pain. Hard to want to move pain. Constantly distracting pain. With your senses all heightened making your environment quite unpleasant and aggravating.

Migraine: Aura stage 2

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I see I have a type it is Stage 2, not 1.

The aura is the flashy portion of the migraine. Often people without migraines think we all get but in fact only about 25% do. Of those who actually do experience migraines with aura, they themselves do not necessarily get a migraine with every attack… it is around 20%. Some of us get only the aura for an attack and this is a silent migraine. I have had a few of these myself.

Tactile auras- like numbness, tingling

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Allodynia: is one of the worst symptoms that can occur in this stage. It is hypersensitivity to touch in a fiery nerve pain sense. Very common for people with migraines to get it in the scalp but can in fact occur anywhere. I get it severely on the back and clothes touching my skin is hellish pain.

Visual hallucinations, auditory hallucinations, olfactory hallucinations- all the weirdness of migraines.

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Dizziness and vertigo- both of these can get pretty nasty. And vertigo can make you feel very disorientated. Not to mention cause drop attacks; where you think the ground is there but you brain says ‘nope’ so you feel you are falling and do, or over compensate and fall the other way to recover.

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Tinnitus is a EeeEeeeeEeeeing nightmare. It gets pretty high pitched with a migraine. Then your hearing goes out or goes muffled in one ear and All you hear is that ringing.

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HM migraines have their paralysis symptoms and stroke like effects.

Here is a short visual representation of an aura that typically lasts 60 minutes

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Visual auras can be:

  • Scotoma; the area of decreased or lost vision.
  • Phosphenes; brief flashes of light.
  • Blurry vision.
  • Wavy lines: like seen through a heat wave
  • Scintillations
  • Other visual symptoms

Others

  • numbness or tingling
  • pins and needles
  • weakness on one side of the body
  • dizziness
  • Vertigo

What is the cause?

The scientific term cortical spreading depression (CSD) describes a local disturbance of the brain function that is characterised by a transient and local suppression (depression) of the spontaneous electrical activity in thecortex (cortical) that moves slowly across this brain region (spreading). Aristides A.P. Leão, a Brazilian studying for a PhD at Harvard University was the first to describe this phenomenon in 1944 (Figure 1). He made this discovery while studying epilepsy. One year later, a better characterisation of CSD, especially of its progression, allowed Leão and his colleague R.S. Morison to propose, for the first time, that the malfunction of cortical nerve cells suspected to cause the aura might well be CSD. Indeed, both the suspected nervous malfunction and CSD shared surprisingly many common properties.Migraine Trust

Criteria for migraine with aura:

  • A. At least 2 attacks fulfilling criteria B–D.
  • B. Aura consisting of at least one of the following, but no motor weakness*:
  • 1.Fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision).
  • 2. Fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness).
  • 3. Fully reversible dysphasic speech disturbance.
  • C. At least two of the following:
  • 1. Homonymous visual symptoms1 and/or unilateral sensory symptoms.
  • 2. At least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes.
  • 3. Each symptom lasts ≥5 and D. Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes.
  • E. Not attributed to another disorder.

5 Basic things I tell people about migraines

People ask me about migraines all the time and the information they have is very limited. So here is my post about my migraines. 5 things about my migraines.

1) It is not just a headache: still get a lot of people thinking it is just a bad headache when in fact it is a neurological disease. When you have an attack, the headache might not even be a part of it as is the case with a Silent migraine.


2) They have stages. The migraine attack comes in four stages: the prodrome, aura, headache and postdrome. These stages are flexible since some stages last longer than other. They are variable, as in sometimes you have no headache. With the aura, only migraine with aura gets that stage and not with every migraine.

3)Auras are not all visual: Auras can be tactile like feeling numbness or tingling anywhere on the body. You can have aphasia, causing problems with communication; written or verbal. You can have vertigo. And yes, also the light show.

4) Migraines can be daily. Migraines over 15 a month are chronic and yes they can even be daily.

5) High Episodic migraines have the same impact on lives as Chronic migraines do.

And here is an image for a bonus: