Expert Answer: Multiple auras during a migraine

By Dr Marcus

2 min read

Question: Is it possible to 'relapse' during postdrome? I'm recovering from a migraine attack I had yesterday but just had another aura. Do people have multiple auras in the same attack?

Migraine can be divided into four phases:

The prodrome is a time of predictable symptoms before the painful part of a migraine. Common symptoms include mood changes, digestive symptoms, dizziness, problem concentrating, yawning, and neck pain. A prodrome occurs in about one in three migraineurs.
An aura is a temporary abnormality in nerve function that typically occurs before the painful part of a migraine and lasts about 5-60 minutes. Auras are most commonly vision changes, but can also include numbness, weakness, and confusion. Auras occur in about 10-20 percent of migraineurs.
The headache symptom phase can last a few hours to a day or longer. People will usually have sensitivity to noises, lights, and smells in addition to disabling pain.
The postdrome is a time of "headache hangover" after the headache phase when people often feel fatigued and experience difficulty concentrating and low grade pain. Postdrome symptoms occur in about three of every four migraineurs.

While people often think of migraine "starting" when the headache symptom phase begins, it's important to understand that the migraine begins when you start having your first symptoms, which might be prodrome or aura symptoms.

Phases of Migraine

^{Excerpted from The Woman's Migraine Toolkit by Dr. Dawn Marcus}

Although the books say migraine includes these four phases, your brain may not have read the books and you may not experience all of the phases. If you're successful at catching migraine early and intervening right away, you may seem to have several prodromes that never lead to the other migraine phases. Some people will also experience migraine as an aura that is not followed by the painful headache phase. When you're finishing up your postdrome, you may also experience a recurrence of your painful headache phase, like you're describing.

If your current treatment seems to relieve the headache phase but you go back to having more painful symptoms within a day or when you're still recovering from your postdrome, talk to your doctor. You may need to have a change in medication that will provide longer duration effect. For example, dihydroergotamine and some triptans, like frovatriptan and naratriptan, are longer lasting, reducing the risk for migraine recurrence. You might also add a nonsteroidal antiinflammtory drug to your triptan to boost triptan effectiveness. If your usual migraine pattern changes, for example, if you start having a new aura phase, be sure to talk to your doctor. Also, if you seem to experience some migraine phase most of the time, talk to your doctor about migraine prevention therapies.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Why does everyone so heavily promote triptans and ergotamines like they are wonder drugs? Not everyone can use these meds especially those of us with hemiplegic migraines. It would be nice to see other med suggestions rather than always seeing triptans.
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As a doc in her 50's, I started my career treating migraines with analgesics, Demerol, and phenobarbital. Ergotamines at that time were often poorly tolerated. We had poorly treated and generally dissatisfied patients, especially in the ER for severe attacks. The development of sumatriptan really revolutionized the care of migraine patients. Unfortunately, as you point out, not everyone can take or responds to triptans. Without triptans or ergotamines, analgesics are usually one's best bet for acute drug therapy. Luckily, there are a lot of effective non-drug treatments, too. The next big jump in migraine therapy will probably come when a new class of acute or prevention medications is developed, which may be especially beneficial for those not currently using triptans successfully for a variety of reasons.
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I use over the counter Annacin Regular strength X4 at once X2 times a day to kill it. If I catch it in time it's gone in 20mins plus with all the fight my body went through to get rid of it, the Annacin has allot of caffeine so the energy comes back enough to get through the remaining day. The only triptan I tries is Zomig and it no longer has effects on them. So now I go to the Emerge to get a shot of Maxaran, which within ten minutes it is gone. I have had it 4 times now since the 90's, to bad I always have to wait 16hours in well lit and lots of noise room to get it. No side effects whatsoever for me. I think to really test a migraineur is to experiment in a Hyperbarrick chamber. That will prove the barometric pressure is the main cause. At least for me, since I live in a mountain bowl. Dan
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I have experienced this many times. I believe when a migraine is full steem ahead and you intervene, but not kill it, that is when I get them. I do get this often. It's scary as you think you just managed to erase a migraine, but still get the aura. For me it means the next morning 3am I will be awakened with a level 10. Dan
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So ironic. I've had a migraine all day. Thought it was over. Trying to read this, but have to keep reading & can't understand & realize migraine's not over....
taralane Member
I have a migraine every day lasting about 4-12 hours depending on the weather, what I have or have not eaten, various things, and it it is an acute migraine which have slowed their frequency now to about 2 a month they last anywhere from 36 hours to 64 hours, just before the point where I would go to an ER for a rescue injection, and I try never to go to the ER, but use what I have and wait it out at home. After the major pain subsides - and it gets below a level 5 where I can deal with it, I do have auras which usually signify another migraine coming in and let me know by the quantity and density how severe it is going to be. This works somewhat, but not always. I have been tracking the barometric pressure lately, to find out what pressure I seem to be the most sensitive to and it is a surprising 30.2, not a lower one. At that point is when the migraine starts, and when an aura will start as well. My auras are of the flashing light variety, so pretty easy to spot and respond to, but I do get breaks from the auras, so I know when I get them, another migraine is on the way. I often get auras in the prodrome phase and did not even know there was such a phase until I started reading this newsletter!
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I get auras during prodrome phases of a migraine and have a migraine at least 5 days of every week if not 7. Most of these are below a level 5 and tolerable, some go a little higher, but I get lots of auras all the time - hard to say which aura is for what. When it is a really severe migraine, the auras tend to be longer and larger so I know what is coming. I did not even know there was a prodrome phase until I started reading this newsletter.
Member
I have dizziness 24/7 for 3 years now with migraines i also have presyncope my Dr don't believe me when I tell them i have stroke or seizure like episodes until I had one at the Dr office they called an ambulance. I refused to go because I told them again i have these all the time every 7 tie 10. Days now they are checking me for heart issues I so confused does anyone else have dizziness all the time not vertigo the feeling as if your falling and these episodes. Along with migraines ?
tware Member
Yes, some of us do get multiple auras during the same attack. My brother & I both get migraines where we experience multiple scintillating scotomas lasting up to an hour EACH while continuing to have pain throughout each round of aura (i.e. the migraine hasn't progressed into postdrome). Fortunately, I only have 4 or 5 of these kinds of migraines per year (out of the 30 to 90 or so I typically get) since they're typically more painful than the "regular" migraines with aura.

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