There are four phases of migraine: prodrome, aura, headache and postdrome. Not every person experiences every phase with every migraine.
Migraine is generally episodic, does not cause death and is not contagious. Consequently, migraine is the least publicly funded of all neurological illnesses relative to its economic impact.
Migraine affects some cross-sections of the population more than others. In particular, migraine is three times more common in women than in men. Although migraine affects all ages, it usually begins in adolescence and is most disabling for individuals between 35 and 45 years — typically a highly productive period of life.
Migraine can be espisodic, occuring only a few times a year, or chronic. In chronic migraine, headaches occur more than 15 days a month. Treatment of chronic migraine is problematic because when used more than a few days a week, acute therapies actually worsen the headaches in most people, underscoring the importance of effective prophylactic treatments that lower attack frequency.
More than one-third of people with migraine experience the aura — one or more transient sensory disturbances that may include geometric visual hallucinations, loss of vision, spreading numbness and tingling on one side of the body, language disturbance, and muscle weakness on one side of the body that ranges from mild clumsiness to paralysis.
A migraine is caused by changes in your nervous system. Migraines may progress through four stages: prodrome, aura, attack and postdrome. Not everyone experiences all the stages.
Many people with migraines experience the prodrome phase — subtle changes one or two days preceding the attack. This may include constipation, depression, diarrhea, drowsiness, food cravings, or hyperactivity and irritability. Alternatively, you might not notice any symptoms.
Some people with migraines experience a more distinct migraine warning sign in a second phase, called the migraine aura.
Auras are usually visual but can also be sensory, motor or verbal disturbances. Visual auras are most common.
A visual aura is like an electrical or chemical wave that moves across the visual cortex of your brain. Here, you see a functional MRI of a person during an actual visual aura. The yellow and red colors indicate activation in the visual cortex — the part of the brain that processes visual signals. As the activation spreads during an aura, a person loses normal visual function.
The best known visual aura is called a fortification spectrum because its pattern resembles the walls of a medieval fort. It may start as a small hole of light or sometimes as bright geometrical lines and shapes in your visual field.
This visual aura may expand into a sickle- or C-shaped object, with zigzag lines on the leading edge. As it moves, it may appear to grow. Auras aren't the same for everyone, so you might also experience bright spots or flashes. Auras are sometimes accompanied by a partial loss of vision referred to as a scotoma. Auras commonly last 10 to 30 minutes.
A sensory aura can occur at the same time as the visual aura, directly afterward or on its own. A sensory aura begins as a tingling in one limb or a feeling of numbness that travels up your arm over 10 to 20 minutes. The sensation can spread to one side of your face and tongue.
Another aura causes transient speech or language problems referred to as dysphasic aura. In the rarest of auras, the limbs and possibly the face on one side of your body might become weak; this is referred to as hemiplegic migraine.
A migraine aura usually precedes the migraine attack but can also occur during the attack. A migraine aura can also occur without an associated headache. The migraine attack itself can last as little as four hours or as long as several days. The attack is followed by a postdrome phase, where you might feel drained or washed out.