Migraine - acute - 2

Migraine episodes are typically divided into four separate components:

- prodrome
- aura
- headache
- postdrome

Not every component is experienced by all patients in every migraine attack. Within a given patient, the various components may vary from attack to attack.   

1. Prodrome

The prodrome is experienced by about 50% of patients from hours to days before the attack.
Typical prodromal symptoms are variable, but may include:
- Mental and mood changes (eg, depression, anger, euphoria, hypomania)
- Stiff neck
- A chilled feeling; peripheral vasoconstriction
- Sluggishness/fatigue/excessive tiredness/yawning
- Increased frequency of urination
- No desire to eat
- Constipation or diarrhea
- Fluid retention
- Food cravings

2. Aura

The aura is one or more of a variety of focal neurologic symptoms which typically lasts for less than one hour and is followed by the headache.
Although a feature which helps distinguish migraine from other types of headache, most migraines (80%) do not have aura.   
  Aura - may include
- areas of visual loss or distortion
- zig-zag lines, flashes of light
- Limb paralysis (mono/hemi/quadri paresis)
- hyper/hypo/para thesia
- dysphasia/aphasia
Cerebellar signs
- dysarthria/ataxia/vertigo
Brainstem signs
- reduced consciousness/diplopia  

3. Headache

The headache itself is usually UNILATERAL and THROBBING, but can be bilateral or become generalized. Commonly in the temporal area, but can occur anywhere. Although the pain may appear at any time of the day, most frequently it begins on arising in the morning, develops gradually, reaches a plateau and then subsides after 4 to 72 hours.

The pain is commonly exacerbated by physical activity; frequently, the patient retires to a darkened, quiet room. Nausea and vomiting are common accompanying symptoms and complicate the oral administration of anti-migraine drugs.

Sensitivity to light (photophobia), sound (phonophobia), and odors (osmophobia) are common.

4. Postdrome

After the headache has resolved, most patients feel different for hours. In over half of patients, signs and symptoms include lowered mood and intellect levels, impaired concentration, feelings of irritability, lifelessness, muddled thinking and inattentiveness. Physical tiredness and muscular weakness are common.