Postdrome

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“For people who do not have migraine, the worst “headache” they ever experience may be the one that accompanies their hangover after a night of heavy drinking. A migraine hangover or postdrome is much more complicated—it is a distinct phase in a migraine attack that begins once peak head pain dissipates. It symptoms can closely resemble the hallmarks of a typical “hangover,” like fatigue, dehydration, body aches and mental “fogginess.” For many, the effects of a migraine hangover may be just as debilitating as the period of head pain that precedes it.”

The fourth and final phase of migraine is the postdrome phase. Almost three of every four people who suffer from migraine experience a migraine postdrome. This phase starts after the symptoms during the headache phase have faded, and it typically lasts for several hours to 1 day.

 

Accordions

Cause
  • Irregular Blood flow
  • Exhuastion
Symptoms
Treatment

What is Postdrome?

Once a headache is over, the migraine attack may or may not be over. The postdrome (sometimes called post-headache) follows immediately after its occurrence. The majority of migraineurs take hours to fully recover which lasts sometimes to days.  Many people describe postdrome as feeling “like a zombie” or “hung-over.” These feelings attribute to medications taken to treat a migraine. The symptoms may include:

  • Lowered mood levels, especially depression
  • Poor feelings of well-being
  • Fatigue
  • Poor concentration and comprehension
  • Lowered intellect levels

Clinical features:

The symptoms can broadly be grouped into

  • Neuropsychiatric
  • Sensory
  • Gastrointestinal

Symptoms

Tiredness, concentration difficulty, and neck stiffness are the most typically reported postdrome symptoms. The average duration of the postdrome records in different studies varies from 18 to 25.2 hours. Postdrome symptoms also appear to be common, with 81% to 94% of patients reporting these symptoms in various studies. Although treatment with triptans can be helpful in managing the headache phase.No fundamental alteration appears to occur in the underlying diencephalic and brainstem mechanisms. Involved in migraine pathophysiology this to explain some of the symptoms in the postdrome.

Also, no dominant role appears to exist for comorbidities such as anxiety and depression in the occurrence or absence of the postdrome.

However, several of the symptoms in this was very hard to distinguish. For example, it is not easy to know the clinical criteria used to distinguish between a subdued mood, depressed mood, bad mood, and introverted mood. As a result postdrome symptoms into four main groups: neuropsychiatric, sensory, gastrointestinal (digestive as per the authors of the study), and general symptoms. This gave clarity in classifying and assessing the symptoms. Future research may tell us if it is possible to localize some of these symptoms.

Postdrome Treatment

  • Acute medications for use at the onset of a headache attack to try to break it. Limitation on a number of uses of acute medications to avoid medication overuse and reduce the risk. Triptans are migraine-specific acute medications. They are contraindicated in the setting of a hemiplegic migraine, migraine with brainstem aura and retinal migraine.
  • Preventive medication to help reduce the frequency and severity of headache attacks. Preventive medications should be considered based on patient preference when migraines are occurring more than once per week. The migraines are interfering with routine activities, and acute medications are ineffective or contraindicated.
  • Non-medication preventive treatments including biofeedback, cognitive behavioral therapy
  • Addressing risk factors such as depression, anxiety, snoring, obesity, etc.

Reducing the Risk of Postdrome: Migraine postdrome can be reduced, or better managed, by maintaining good headache hygiene. When consistently practiced, these preventative measures can reduce the severity and length of a migraine hangover.

Stay well hydrated throughout all four phases of a migraine. While it can seem daunting, getting out of bed, stretching or very light activities can help the healing process. Avoiding factors which exacerbate the symptoms is important, and avoiding overstimulation may hasten the pace of recovery.

Caffeine during the prodrome phase can have a positive effect on some people, but others find it makes their symptoms worse. Many find comfort food, ice packs, heating pads, massages and additional rest helps to soothe their migraine hangover. Ignoring or pushing through the effects of the postdrome phase doesn’t give the body a necessary time to recover, and can increase the risk of having another attack. Take it easy and rest during this time.

Seeking Treatment

Prevention is the key to avoiding a prolonged migraine hangover, and in managing your migraine health on a daily basis. Maintaining a headache diary will help you track your symptoms and their changes during the phases. Which can help you identify patterns, like behaviors or foods correspond with your attacks, helping you reduce your exposure to triggers?  Working with a headache specialist will help you better understand your migraine. To find medications that may relieve some symptoms and obtain a better understanding of your headache disorder.

A migraine with aura slightly increases the risk of having a stroke so women need to think carefully about the potential risks associated with birth control pills that contain estrogen or hormone replacement therapy.