The phases of a migraine attack
- Premonitory phase. Warning signs in the hours or day before, including mood changes, brain fog, food cravings, yawning and nausea.
- Aura phase. Visual disturbances or other neurological symptoms, usually within an hour before the headache. Not everyone with migraine gets aura.
- Headache phase. Severe throbbing pain, typically on one side, often with nausea and sensitivity to light and sound.
- Resolution phase. The pain eases, sometimes with fatigue and sometimes with a sense of relief or elation.
- Postdrome phase. Brain fog and difficulty concentrating, often lasting a day or more. Frequently described as a migraine hangover.
- Interictal phase. The period between attacks.
Recognising the premonitory phase is practically useful, because it is the point at which a plan agreed with your doctor can be started.
How migraine is diagnosed
Diagnosis is made through consultation and examination. There is no specific diagnostic test for migraine. What the assessment relies on is the pattern: how often attacks come, how long they last, where the pain sits, what comes with it, and what precedes it.
A headache diary is the most useful thing a patient can bring. Recording the date, duration, symptoms, what preceded the attack and what was taken gives a clinician far more to work with than recall alone.
Imaging is used where the history suggests something other than migraine, not to confirm migraine itself.
How migraine is usually managed in Australia
Management splits into two lanes that work together, and most people with frequent attacks end up using both. One deals with an attack already underway, the other with how often attacks arrive at all.
Acute treatment addresses an attack in progress: rest in a dark quiet room, pain relief medicines, and triptans, which are specific to migraine. Timing matters, and treating early in an attack generally works better than treating late.
Preventive treatment aims to reduce how often attacks come. It includes identifying and managing triggers, regular sleep and meals, and preventive medicines for people with frequent attacks. Botulinum toxin injections are used in some cases of chronic migraine.
Overusing acute medicines can itself cause more frequent headaches, known as medication overuse headache, which is one reason frequency is reviewed rather than left to escalate.
