Aura, then Headache? What’s Your Sequence?

When we talk about the different phases of migraine – we throw around words like prodrome, aura, headache, and so on – you might get the idea that the phases come in a sequence, one after another.

Well, there does tend to be a sequence – in other words, usually you don’t have aura and then headache.  But the phases are not always clear-cut stages.

Dr. Jakob M. Hansen from Glostrup Hospital in Denmark, has done some work on auras and migraine.  He gave a report about aura at the annual meeting of the American Headache Society.

His study suggested that the headache phase – and other symptoms – may start sooner in many patients.

This is what seemed to happen within 15 minutes of the start of migraine aura:

Google Chart

How does that compare with your experience?

Dr. Hansen, as quoted at Clinical Neurology News:

These results do not seem to be consistent with the current ICHD-2 [International Classification of Headache Disorders, second edition] classification that states that migraine headache usually follows the aura symptoms; that’s not the case here.

“Furthermore, we have already headache at the onset of aura, and that does seem to conflict with the idea that you have to have a [cortical] spreading depression to activate the trigeminovascular system to cause headache.

These data suggest that the phases of migraine attack may not be as discrete as originally believed. This is food for thought.

Dr. Hansen is not the only one who has seen this in real life.  Dr. Alexander Mauskop has seen a few (though a minority) of patients report aura and headache starting at the same time.  Dr. Werner Becker of the University of Calgary also reported seeing nausea, and sensitivity to light and sound, very early in the migraine chain-reaction.

This report is a change from what many migraine specialists have long believed.  On the other hand, some like Dr. Mauskop intend to question their patients more closely regarding the sequence of events.  Knowing what happens when gives us clues into what goes on in the brain, and helps us get the proper treatment sooner.

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2 comments… add one
  • Heather Oct 9, 2012

    For 15 years, it was always 30 minutes of aura followed by a headache that would last three days if untreated. In the last year, my auras have increased, and sometimes they now come 2 or 3 days AFTER my migraine, and the resulting headache lasts for only one day.

  • Aurora Nov 25, 2012

    My auras are inconsistent. Some attacks are preceded by cravings of some types of food, but that doesn’t always happen. Sometimes, the attack is preceded by a blue coloured blurb and the inability to concentrate. Sometimes my ring and little fingers become numb, and then there’s the sagging of the right side of my face. All of these occurences are followed by a contraction in my head (as if one hemisphere is pushing the other out of the skull). The food craving lasts for about a day, but the other auras last about half an hour. I was able to monitor the last time the right side of my face sagged. was having a video chat with my sister when I suddenly noticed my right eyelid had fallen halfway. My sister confirmed my face was assymetric. We continued chatting, then for about 20 minutes, I felt a contraction in my head as if the one brain hemisphere was pushing the other out. Then the headache began with the host of symptoms that go with it…I had an attack last month. I was in an hotel room with 3 other people; one of them sprayed her perfume. Then within the hour, I didn’t want to communicate, my left hand became numb, then the headache with, of course, the host of symptoms. The same happened to me when I accompanied a friend at a duty free shop. The smell of perfumes overpowered me then I just suddenly felt depressed, lost my appetite then the feeling that my head was shrinking. The most difficult part of this attack was that i was to board a plane and I was cranky even before the plane took off. I talked back to the stewardess when she asked me to take off my headphne (talking passengers annoyed me). I vomitted all the way from London to Amsterdam. I was disoriented and almost half blind and the roar of the plane’s engine was so deafening. I would have been denied to board the plane because the airport security personnel thought I was drunk. My travelling companion explained I was sick, not drunk. I can’t say if an attack was imminent by the time I smelled the scents in those two occasions. All I can say, I also do not like to smell perfumes, however expensive, whenever I have a migraine attack. It is true in my experience that one can have aura while having the headache. As we believe, we must not take our meds during the aura and only on the onset of the headache. I said the to my neurologist, the aura comes and goes any time during the course of the headache. So I was confused as to when I had to take my meds.

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