4x4 MAGNUM Basics on Migraine Disease & Treatment Protocols

The Four Phases Of Migraine Disease &
The Four Areas Of Migraine Disease Management

By MAGNUM, The National Migraine Association 2004

Everyone touched by Migraine disease should at least have a basic understanding of the mechanics on their illness and the best practices approach to disease management. So often when Migraineurs contact us they are amazed when we talk about the phases of Migraine, such as prodrome for example. We have heard over and over again comments such as "my goodness, I have experienced food cravings and slurred speech every time before I had a really bad Migraine, but no one ever told me it was related to an upcoming Migraine attack. Yet I am told early intervention is important to taking my abortive meds."

For others, their current care provider is only treating them preventively leaving the patient to suffer every month without any pain management or abortive treatments.  Sometimes even blaming the patient for their failure to "get better".   So a patient who understands they need to approach their treatment plan addressing all aspects needed to manage their disease,  just as one would with other complex disorders such as diabetes or heart disease, would have a realistic chance of a bringing their Migraine disease under control.   Access to an effective protocol regarding you Migraine or headache disorders will lead to a much better quality of life. These are good things to discuss with you doctor if they are not being addressed in your current care. If you current provider is unreceptive to these ideas, you might want to consider finding a better doctor, as there are plenty of good physicians out there that understand Migraine!

The Four Phases Of Migraine Disease

Migraine disease can be divided into four phases: the prodrome, the aura, the Migraine attack, and the postdrome. Keep in mind that some Migraineurs do not experience aura during a migraine episode or do not recognize it.


The prodrome phase can occur hours or days before the Migraine itself. During the prodrome phase, a person may experience the following: Constipation, depression, diarrhea, drowsiness, euphoria, food cravings, hyperactivity, irritability, loquaciousness, loss of appetite, sensitivity to light or sound, slurred speech, and yawning to name a few.


The aura phase occurs in classic migraines (now referred to as Migraine with aura), but not in common migraines (now referred to as Migraine without aura). It typically precedes the Migraine by an hour or less. Most aura symptoms last between 15 and 60 minutes, but some Migraineurs observe aura manifestations continuing into the attack. The aura can be characterized by visual, sensory, or motor symptoms and may also involve disturbances in speech and language.

The most common auras are visual. Symptoms include the appearance of flashes, specks, zigzag lines, stars, or shimmering areas. Blind spots or tunnel vision may also occur. Less common auras involve speech disturbances, confusion, tingling or numbness, weakness of the limbs, and confusion.

The aura phase is thought to result from a decrease in blood flow or electrical activity in certain areas of the brain.

Attack (Also called headache phase)

The Migraine attack phase itself lasts anywhere from several hours to three days in adults. In rare cases status Migrainious can occur, whereby this painful phase of the disease can last for 4, 5, 6 days or more, even weeks. It is characterized by throbbing pain on one side of head, which can spread to affect the whole head. Most people experience nausea, with or without vomiting. Extreme sensitivity to light and noise is also common. A person suffering from a migraine may be pale and sweaty and have cold hands and feet. Visual disturbances, faintness, numbness, diarrhea, a stiff or tender neck, aversion to food may also occur, or stroke like symptoms may also occur. Physical activity tends to aggravate the symptoms. It's interesting to note that some people may experience all these symptoms sans the head-pain! Which is why Migraine is a neurological disease and not a headache.


During the postdrome phase, which occurs after the Migraine attack breaks, a person often feels exhausted and unable to concentrate. Many Migraineurs note a marked euphoria, while yet others experience symptoms which may include irritability, depression, or euphoria.

The Four Areas Of Migraine Disease Management

No one treatment protocol will bring difficult Migraines under control. Prescribed drugs that help prevent attacks OR prescribed drugs that treat pain during an attack, but not both. However, the best protocol approach to Migraine management is what MAGNUM calls a MULTIFACTORIAL approach, which involves addressing all four aspects of Migraine health care.

Proper Migraine treatment can be divided into four key areas:

Preventive Treatment

Preventive, or prophylactic, medications are prescribed to prevent or reduce the number of attacks in patients who experience frequent Migraines, typically two or more per month. In general, these medications act over time to prevent blood-vessel swelling; however, they do not treat the Migraine-associated symptoms and are non-selective. Many sufferers using preventive treatments will still have to take attack-aborting medications to relieve pain and other symptoms.

Trigger Management

Trigger management is important in preventing Migraine attacks. Triggering factors can cause Migraine, and if recognized and/or avoided, may impede an impending attack. Triggers vary from person to person and can be additive as well, that is it may take several triggers for many individuals to cause an event.

Abortive Treatment

Attack-aborting medications are used to relieve the severity and/or duration of Migraine and associated symptoms. Abortive medications include the triptan family of drugs as well as the ergot family of drugs. In general, most attack-aborting medication should be taken as early as possible in an attack, during aura or prodrome to achieve early intervention.

General Pain Management

General pain management protocols may include simple over-the-counter (OTC) analgesics for mild Migraine, but caution should be noted with OTC use. If you receive little or no relief from OTC pain management do NOT increase doses or continue use as this can lead to Rebound headaches, an addition head pain problem you want to avoid. Rather talk to your physician; obtain a specialist about finding more effective pain management prescription medications. Weather used for rescue when abortives fail, or when effective pain management is required, there are safe and effective pain medications to turn to. There are many good medications available such as non-narcotic prescriptions, or the prescription of, narcotic analgesics, which act on the central nervous system and alter the patient's perception of pain. These drugs generally relieve pain. However, because they are narcotic, they may be addictive, and such usage should be done in an appropriate manner to return a reasonable quality of life for the intractable Migraine sufferer.

Non-drug pain management methods should also be included in your treatment plan. Look into passive simple but effective things like retreating to a dark room and lying down, sleep and rest (if the pain does not wake you). In addition to above or separately applying an ice pack can be therapeutic. As can Yoga, relaxation techniques, acupuncture, message, to name a few things you can add to your arsenal to fight pain.

About MAGNUM  ●  What's New  ●  Migraines: Myth & Reality  ●  Disability & Impairment
MigraineBlog  ●  Treatment & Management  ●  Where To Turn for Help  ●  Communications & FAQs
Find a Doctor  ●  Privacy Policy  ●  MAGNUM In the Media  ●  Discussion Forums
Bookstore  ●  Gift Shop  ●  Search  ●  Sponsors  ●  Home

  Web  www.migraines.org 

All information offered on the Web Site, whether by a lay person or a health care professional, is for educational purposes only and should not, in any way, be construed as medical advice, diagnosis, or recommendation for treatment. While this information can provide you with a basis for discussion with your health care team, it cannot take the place of professional medical care. Please consult your practitioner.
1999 - 2012 and all other years MAGNUM, Inc. All rights reserved.
Artwork Michael John Coleman, Janet McKenzie, or Cara Weston. All other artists noted by 1976-2012