A migraine attack can progress in three to four phases, but usually begins directly with a headache (“migraine without aura”).
Migraine phases
- Harbinger phase: an approaching attack exhibits symptoms such as appetite and mood swings, ravenous hunger, hyperactivity/underactivity, increased irritability, difficulty concentrating, severe yawning, fatigue, or hypersensitivity to light and taste.
- Aura phase: this occurs in about 10 to 15 percent of sufferers (“migraine with aura“, formerly “classic migraine”). Here, as symptoms temporarily neurological disorders occur, for example, eye flicker, visual field failures or visual impressions such as flashes of light in the visual field area, hemiplegic sensory disturbances (tingling, numbness), more rarely also speech disorders.
- Headache phase: with the disappearance of the aura after no more than one hour, throbbing, pounding headaches begin. This pain begins in some sufferers in the neck, is localized in the course rather on one side of the head, often in the area of the forehead, eyes and temples and usually intensifies with physical activity. In most sufferers, these migraine headaches are accompanied by severe nausea (up to and including vomiting) and chills; hypersensitivity to sensory stimuli such as light, sounds and smells is also typical. Therefore, sufferers usually retreat to darkened, quiet rooms.
- Regression phase: after 4 to 72 hours, the symptoms gradually subside – the first sign is often a strong urge to urinate. Back remain at first usually still fatigue, exhaustion and weakness, also neck tension, irritability and loss of appetite.
Special forms of symptoms
In addition, there are numerous special forms. For example, there are courses in which the aura lasts particularly long, neurological disorders (for example, of the vision: eye migraine) are in the foreground or affected persons have no headache at all, but only neurological deficits (migraine equivalent).
Abdominal migraine (abdominal migraine) occurs predominantly in children, with severe, diffuse pain localized in the abdomen; it is accompanied by pallor, loss of appetite, and nausea. This form is difficult to recognize and often later turns into a usual migraine.
How often migraine attacks occur varies greatly from person to person: for many sufferers, regularly once to six times a month; but very irregular and long intervals also occur.
A diagnosis can almost always be made on the basis of the typical symptoms. Imaging procedures such as X-ray, CT and MRI or methods for testing brain function are only necessary in exceptional cases, for example, if another underlying disease is suspected.
