After the headache phase of a migraine attack, Sarah Alexander-Georgeson says the final postdrome stage can still take the wind out of her sails.

Today, Sarah explores why you can feel "hungover" after a migraine attack and shares the best ways to get on the road to recovery.

At the beginning of my migraine journey, I never understood why I didn't snap back to "normal" after a migraine attack. While the pain in my head would (thankfully) fade away, I'd suffer through a fog of other symptoms for 24 hours after the episode.

After some research and a conversation with my physician, I discovered this was the "final stage" of a migraine attack - commonly known as "postdrome" or "the migraine hangover."

The 4 stages of a migraine attack

Though not everyone will experience every phase, there are four stages of a migraine attack:

Stage 1: Prodrome. Symptoms include:

• Feelings of depression
• Food cravings
• Sensitivity to light and sound (also known as photophobia and hyperacusis)
• Nausea
• Difficulty speaking

Stage 2: Migraine aura. Symptoms may include:

• Visual disturbances
• Temporary sight loss
• Numbness and/or tingling in the extremities or other body parts

Stage 3: The Headache.

• Throbbing or drilling sensations in the head
• Nausea
• Vomiting
• Insomnia
• Sensitivities to light, smell, sound
• Neck pain
• Nasal congestion

Stage 4: Postdrome or the migraine hangover. Symptoms can include:

• Fatigue
• Nausea
• Body aches
• Photophobia and Phonophobia
• Dizziness
• Difficulty concentrating

People without the condition may think migraine is just a nasty headache. Or, if they've done some research, they may assume an attack will be over and done with after a few hours.

In reality, it can take days - or even weeks - to cycle through the four stages of an episode.

Is the postdrome phase really that awful?

Compared to the symptoms of stages one to three, the postdrome phase doesn't sound too bad. After all, some tiredness and confusion must be better than a banging headache.

On paper, yes, but when I'm living it, no. Migraine hangovers take the wind out of my sails every time.

My whole body feels weak throughout the postdrome stage - to the point I can barely lift my arms. The muscles in the upper half of my body feel like they're made of lead. My head feels heavy yet painfully delicate. Aches run up and down my whole body. On top of that, keeping my eyes open is a real struggle. All I want to do is sleep until it's all over.

Holding a conversation is a nightmare. I can't concentrate on what the other person is saying or even think much about what I want to say. Reading with this level of brain fog is pointless. I can't focus on television at all.

I'm also very unstable on my feet. Getting up and standing means I instantly feel lightheaded and dizzy. My whole body cries out for a shower as I've been in bed for days, nursing a migraine. Unfortunately, I also get allodynia (when my scalp sends pain signals at even the lightest touch), which makes washing my hair impossible. I can't lift my hair to tie a ponytail without reeling in agony.

When unable to function like this, I treat it as my body needing a recharge after a vicious biological attack. Perhaps that's what postdrome is all about: your body demands some R&R after going through the mill.

Self-care during a migraine hangover

A severe migraine hangover can last anywhere from six to 48 hours. And they're never the same. Sometimes, I get all symptoms together; other times, I'm "lucky" enough to only have a few.

Either way, taking things easy is vital during the postdrome phase. Physical and psychological stress is a huge migraine trigger, so forcing myself into action will push me back into the prodrome stage. Instead, I rest as much as I can and stay hydrated.

Comfort food and caffeine are helpful because they lift my mood and show me that I'm somewhat out of the woods. I also love sitting back and listening to an audiobook or podcast, as I can close my eyes and have the lights on low. I won't get the same eyestrain I would from a book, phone game, or the television, but there is still something to occupy and distract my mind.

Finally, an ice pad across my forehead and a cuddle with my dogs help keep my mood calm and happy. Going through a migraine alone is horrific, so the dogs are my best friends during hard times.

Tracking your migraine phases and taking it easy

At the end of a migraine hangover, I usually update the migraine diary on my phone to spot any triggers, irregularities, or patterns.

Only some people experience postdrome, and those that do will have different experiences. If you are one of these people, find a way of managing it that suits your needs. Don't feel forced to spring into action because others expect or demand it.

It's your health and body, so you know how to look after yourself best. Even though it's the final hurdle, you're still experiencing a migraine attack during the postdrome phase. Be kind to yourself.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen. 

NPS-ALL-NP-01090 SEPTEMBER 2023