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There are four stages of progression that migraineurs experience with the oncoming onset of a migraine headache, including:

• Prodrome period - This is the period right before the onset of a headache that can begin up to one day before the actual pain is felt. During this period, the patient may experience strange sensations including:

  • Irritability or depression
  • Thirst
  • Feelings of elation
  • Feelings of being highly energized
  • Craving for sweet food
  • Fatigue
  • Muscle tension
  • Subtle changes of sensation, such as a strange odor or a funny taste in their mouth

• Aura - a visual disturbance that precedes a migraine headache by approximately 15-30 minutes. It is experienced by approximately 20-30% of people suffering from migraines and may consist of:

  • Zigzag lines
  • Blind spots
  • Temporary loss of vision in one eye

• Headache - usually occurs on one side, though not always the same side for each individual.

  • Approximately 30-40% of patients have a headache on both sides (bilateral)
  • More than 80% feel nauseated and some may vomit
  • Approximately 70% of migraineurs are sensitive to light and sound
  • Headache lasts 4-72.

• Postdrome period - period following a bad headache during which some symptoms may linger such as fatigue, loss of appetite, or difficulty concentrating or focusing on any task.

Headache Stages in Children/Adolescents

• Prodromal period - child senses a change, such as increased or decreased appetite, joy or sadness, sleep changes, or increased social involvement or withdrawal. Children who are old enough can identify these changes as early warning of an impending attack.

• Aura - this occurs in 10-20% of children and tends to appear within 30 minutes of the attack. Auras can be very vivid or severe and be more disruptive to the child than the headache itself. Auras usually last between 5-20 minutes. There are many images that have been described by children as characteristic of auras including:

  • Zigzag lines
  • Sparks or flashes of light
  • Black dots
  • Patterns of many colors
  • "Alice in Wonderland" syndrome - sense of time warp, levitation, or dreaming

• Headache - migraine attacks in children are shorter than for adults and usually last less than 4 hours but can continue for up to 48 hours. Some may last only 10-20 minutes. Some of the symptoms described that accompany a migraine in children include:

  • Chills
  • Cold hands or feet
  • Nausea/vomiting
  • Diarrhea or constipation
  • Increased urination
  • Sensitivity to light, sound, and smell
  • Confusion
  • Excessive sweating

• Postdrome period - child typically feels drained or exhausted though some children report feeling energized. This period can last hours or days.