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Prodrome and Postdrome and what they mean for Chronic Migraine sufferers


So, as a chronic migraine sufferer, I obviously have to do research on migraines. Why? Because knowledge is power, especially in this world where the more I know the more that I can expect. I didn't know that migraines caused fatigue. I just thought it was my busy schedule or the fact that migraines and my medication disrupt my sleep. I didn't know that migraines could cause difficulty concentrating. Once against I thought it was the pain or the medicine. So on and so forth.

And in my research I found out about prodrome and postdrome. Once upon a time, I didn't have chronic migraines this bad. Were they bad enough to be labelled Chronic? I don't know, the second time around they literally lasted weeks, so possibly. But regardless, there's been on issue.

A lot of abortive medication demands that you take it before the migraine takes hold. You have to take it when you feel a migraine coming on. Once it takes hold, the medicine is as useless as sugar pills. The problem? How am I supposed to know? Other than triggered migraines which come on immediately, I had no way of telling if I was about to get a migraine or if this headache I had was going to be a migraine. I've always had issues with other types of headaches. Lack of sleep. Allergies. Caffeine. You get the point. How do I know this one is a headache or migraine?

Well, not I'm reading about prodrome and postdrome. My first thought is, "Hell, that would have been useful back then. My second thought is what does that mean for Chronic migraines? If I can got two days without a migraine it's a miracle. Prodrome and postdrome stages could last up to days before and after a migraine. So for me who literally always has a migraine, what does that mean for me? Do I experience these stages? Are my "good days" just consumed by these stages? Do they occur even during a migraine? Is this a piece of information that has no affect on me because I literally have some stage of a migraine all of the time? Are these mini migraines (usually a level 4 and lasting a couple of hours) part of these stages?

It's really confusing, because I have instances like the last couple of days. No migraine, but I've been exhausted. I try to make up for it my a boost in caffeine, sugar, water, etc. Maybe I wasn't paying enoguh attention to my own nutrition during my migraine. Maybe I'm just exhausted because a migraine can literally sap the energy from you. But what about the nausea? Is that prodrome or postdrome? My depression?

Considering how well I do at my top (aka when I DON'T have a migraine), every little upset is really the cause of them. The fact that my grammar and vernacular aren't as good as they used to be. The fact that I get stressed so easily. The fact that I can't learn as well as I usually could. When I'm not experiencing migraines, I'm really impressive. When I am (even a couple of days a month) I'm as useless as a brick. So, as a chronic migraine sufferer, I was wondering if prodrome and postdrome mean anything to me considering I rarely have more than one day without any type of migraine in a row.

  1. Hi faeriefate,

    Great questions - I can see you've put a lot of thought into this topic. I'm not sure I have an answer for you. But something you may want to think about is keeping a detailed migraine diary, especially if you haven't done so recently. This will help determine any patterns our attacks have, you can keep track of prodrome/postdrome symptoms, and see what medications work or don't work. I've been keeping one since August when I started Botox and am seeing certain patterns. I print out a calendar keeping track that way instead of an app. I can include the things that pertain to me. Here is information on how to keep a migraine diary:

    Chronic migraine is when we have 15 headache days, of which eight are migraine, per month over a three month period not including medication overuse headache. Episodic migraine is the other migraine sub-type, which is defined as less than 15 headache days per month.

    Forgive me if we've discussed this before, but do you take something every day to help relieve the pain? A number of migraine experts I've spoken with have told me over 50% of the patients they see for chronic migraine also have medication overuse headache. And the thing is if we have medication overuse headache or moh, our migraine attacks will be more difficult to treat and we will end up in a daily cycle of pain that too is hard to break. If you haven't seen this article, take a look:

    I wish there was a better answer for you. Let me know what you think,

    1. Hello and so sad to hear you are going through the same thing as me. When you have chronic migraines fifteen or more days a month it's so hard to know really what stage your of migraine your in because it's almost constantly there to one degree or another. And yes it is very annoying to feel as if your losing a grip on your vocabulary and even your memory at times. I wish I could say something significant to you in terms of meds or treatments that I've found to work but I haven't been lucky enough to find anything but temporary relief for maybe twelve hours at a time. Mostly from Triptan meds such as imitrx and maxalt. Fiorcet along with them helped for years but then finally caused stomach problems so I no longer take it. Plus med overuse will cause rebound headache too so every couple months I have tried to go "cold turkey" off all migraine meds for ten days or as long as I can possibly stand the pain. Usually after about seven days the pain subsides for a couple days and when it comes back the seem to work better and faster plus the migraines are not as frequent for perhaps a week or two. Then they return to their daily barrage and I start the medication routine all over again. It's is very hard to endure constant pain for hours or days without taking something to stop it.
      I have met a lucky few migraineures who could tolerate the prophylactic meds that are used and who have then experienced a dramatic decrease in frequency of migraines. I myself am not able to tolerate any of those type of meds actually have gotten neuropathy from them which is rare but can happen.
      Bottom line is that you must be as strong willed as you possibly can be to keep your moral up and keep a positive mental attitude. This may be the hardest thing you've ever done under the circumstances. Also stick to the migraine diet and light exercise as often as your able. There is also a new electronic gadget that has been approved by the FDA last year called Cefaly. It is a small portable device that is rechargeable and very easy to use. A doctors prescription is needed in order to buy it online. This has occasionally helped me but may work better for you. I really believe that most meds and other treatments for migraine isn't really meant to treat chronic migraine. Yet they do seem to be effective for the occasional weekly or monthly migraines.
      Well I wish you the best of luck with treating your migraine and maintaining a positive attitude. We migraineures realize it is the little things that actually do count and we must appreciate them.

  2. faeriefate thank you for this post and questions. I am new to migraines and have been in constant chronic migraine pain for almost two months now. I consider my good days a day where the pain is a 5/6 on their 10 scale. I don't know when a migraine ends and one starts other than increased pain and auras most times. I am now down to 25mg topomax a day, not working but the zombie head is gone, using rizatriptan when it gets too bad. I have been prescribed an anti-depressant, but don't want another drug. Trying accupuncture and they are setting off strong migraines. Trying not to lose faith or get depressed. Reading about migraines and all the posts from people on this site, it seems to be a search for what works for you. I'm trying to live by the motto Don't give up, and don't give in, but some days are harder than others. I hope you find what works best for you, and thank you.

    1. I struggle with the same thing. I have similar symptoms in prodome and postdrome so its really hard to tell if the migraine is just ending or another starting. The extreme fatigue - literally barely able to lift my head I'm so tired, nausea, blurry vision, moderate headache pain (more so postdrome), slow thinking and forgetting words. I do tend to get yawning attacks only at the beginning of a migraine and literally the SECOND I get a pulse of pain from one side of my head I grab an imitrex nasal spray - my only way possible of aborting it. I have gotten looser on my meds so if its been half or day or so since the last bad pain I will take an imitrex and see if that helps - yes -> migraine, no -> take baclofen (muscle relaxant) or ketorolac (NSAID) One of my other only prodome symptom is having less pain and having tons of energy. Yup that's right, my only good days are foiled with the "there is a bad migraine coming tomorrow" message .... life is ironic.

      I also sit at 5-6/10 so the "take before pain starts" is impossible to listen to so I really have to watch for that first pulse of worse pain - tablets don't work fast enough so I use the expensive nasal spray.

      I wish I would go back to the old days ..... I actually miss the 4-5 day hangover phase because I knew the pain was going away and would soon be gone.

      1. Hi Tamara,

        Thank you for sharing your thoughts with us. Chronic pain is debilitating and exhausting. I'm sorry you are going through that right now.

        If I've mentioned this before please forgive me. We can unknowingly create another problem called medication overuse headache or moh if we take migraine medications (like Imitrex) and/or pain relievers, whether they are over-the-counter or prescription more than two to three days a week. If we are in an moh cycle, which was formerly called rebound, we can end up in daily chronic pain that is extremely frustrating and it will make our migraine attacks more difficult to treat. This is a tough cycle I've been in myself, but can be broken. When you get a moment take a look at this information;

        Let me know what you think,

    2. Nancy - If I use my meds more than 10 days a month it is literally because I have hit the max I can handle and I'm afraid I will do something horrible to myself: that moment where it is unbearable. I am normally around 10-13 pain (imitrex and ketorolac together) med days. I have not got a clear response on how many days I can safety use the baclofen, family doctor said it didn't matter and psychologist (but he is part of the pain clinic) thought he nope it counts under the 10 day limit.

      My pain management doctor who I see twice a week for trigger point injections and nerve blocks (he did my Botox and does more Botox than the headache clinic because he actually works and have available appointments, has also been offered a job by them) has told me I am fine taking my extended release tramadol daily because I am having no success with prevention and it's fine for now to bring me a like bit of relief. Psychologist told me it would cause MOH and I should come off it and my general useless neurologist wouldn't take me off (he decided not to change any of my mds because I had two good weeks - the weather was consistent!), now I've been to urgent care twice in two weeks because weather was back to up and down.

      But I FINALLY Have an appointment with the headache clinic neurologist on may 10!!! Only took 26 months (I hate Alberta health care). So we shall see what happens. All I know is a can't function like this much later - emotionally and finically because I don't make enough money to support myself, no family that I can live with (mom has a tiny house, dad gone and brother rents a room) but make too much to get any sort of government assistance.

      Sigh. The life of a chronic migraineur.

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