Migraine is a severe, throbbing headache that occurs in attacks and the pain comes on suddenly. Some migraine patients have warning signs in advance and there are also patients who have an aura immediately preceding a migraine attack. An aura is the set of usually short-lived symptoms that mark the beginning of a migraine attack. The origin of migraine must be sought in a temporary disturbed cooperation of blood vessels and nerve fibers in the brain. The cause is not (yet) known, but predisposition plays a role. It is not clear why one patient rarely has an attack and another very often. Sometimes an attack occurs after triggering factors such as excessive exertion, stress or sleeping in for a long time. Women sometimes have attacks around menstruation, which is called menstrual migraine. During pregnancy and after menopause, attacks often decrease.

• Migraine attack with and without aura
• Warning phase

• Signs that indicate an impending attack
• Extreme fatigue

• Aura phase
• Headache phase

• Clear beginning and end
• Various complaints
• Constantly having to pee

• Recovery phase

 Heavy yawning just before a migraine attack / Source: Stokkete/Shutterstock

Migraine attack with and without aura

A migraine attack consists of a number of possible phases. Not all phases occur in every patient and not all phases need to be present equally in every patient. The phases that can be distinguished are:

• Migraine attack with and without aura
• Warning phase

• Signs that indicate an impending attack
• Extreme fatigue

• Aura phase
• Headache phase

• Clear beginning and end
• Various complaints
• Constantly having to pee

• Recovery phase

Warning phase

Signs that indicate an impending attack

About one in seven migraine sufferers will experience early signs or warning signs in the hours or days before an attack. A few hours to days in advance you may experience a runny nose or cold, vomiting and diarrhea. You can also urinate little because you retain more fluid than normal. Excessive production of saliva also occurs. You may also experience sudden mood changes (agitation, depressive feelings or very active and energetic).Fatigue / Source: Istock.com/BartekSzewczyk

Extreme fatigue

Two to three hours beforehand you may be very cold, extremely tired or overly fit and experience (false) hunger. Some migraine patients experience a swollen stomach. You can also be hypersensitive to stimuli, such as noise, light and smells. Shortly beforehand you may yawn heavily due to extreme fatigue and you may experience red eyes and blurred vision. You can also remove white.

Aura phase

An ‘aura’ occurs in approximately one in three migraine patients. The aura phase of an attack often occurs before the headache phase begins and often lasts no longer than twenty minutes. An aura is a neurological phenomenon in which patients often suffer from visual disturbances. For example, you see flashes of light, black or colored spots, luminous dots or the visual field becomes smaller. An aura can also consist of a sensory disorder, a speech disorder or even a half-sided (facial) paralysis. This makes some people panic because they don’t know what’s happening to them. When no aura symptoms occur, it is referred to as migraine without aura.Blurred vision / Source: Gene Hunt, Flickr (CC BY-2.0)

Headache phase

Clear beginning and end

The headache phase or migraine phase occurs in almost all migraine patients and has a clear beginning and end. However, a small proportion of patients have an aura without a subsequent headache. Migraine without headache is called ‘migraine accompagnée sans migraine’.

Various complaints

The headache phase can manifest itself in countless ways and often consists of a combination of different complaints. First of all, there is the headache. It can start quite suddenly and reach maximum severity quite quickly, but the symptoms can also start very gradually and increase in severity over several hours. The headache often occurs on one side of the head, but you can also experience a headache on both sides. It often involves a throbbing or throbbing headache, which is very severe. During this phase you have no choice but to lie in bed, preferably in a quiet, darkened room due to hypersensitivity to light and sound. The headache is often accompanied by nausea and vomiting. Physical exertion often worsens the situation.

Constantly having to pee

There are patients who, as soon as their attack subsides, constantly have to go to the toilet to urinate. The cause is that they retained fluid prior to and during the attack. You can then be very cold. You may also feel very lethargic or very active when the attack subsides.

Recovery phase

After the headache phase, the recovery phase follows, during which you quickly feel tired and less concentrated. The recovery phase lasts on average one to two days, but can also take longer.

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