Expert Answer: Multiple auras during a migraine
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.
How much has your migraine disease changed or evolved over time?