Migraine Hangovers: The Postdrome Phase of a Migraine Explained

In this article, we'll explain everything you need to know about migraine hangovers, also referred to as the postdrome phase of a migraine. If you've ever felt drained or "hungover" after a migraine attack, you may be experiencing postdrome symptoms. We'll break down what this phase involves, how long it typically lasts, common symptoms to look out for and different treatment options for managing migraines.

Key Takeaways

Here are the five biggest takeaways from this article about migraine hangovers:

• The postdrome phase, commonly referred to as a migraine hangover, is the final stage of a migraine attack.

• Migraines generally consist of four phases: the prodrome phase (early warning signs), the aura phase (neurological symptoms), the headache phase (intense pain), and the postdrome phase (recovery).

• Symptoms during the postdrome phase vary among individuals but commonly include feelings of tiredness, body aches, neck stiffness, difficulty concentrating, digestive issues, mild head pain, and changes in appetite or mood.

• While there is no cure for postdrome symptoms, various management techniques can help. Gentle exercise, comfort foods, hydration, rest, and the use of heat or ice packs can alleviate discomfort.

• Over-the-counter pain relief, such as ibuprofen, may help manage mild discomfort during the postdrome phase. For those requiring stronger relief, prescription medications (such as Sumatriptan and Rizatriptan) can be considered.

What is a migraine hangover?

A migraine hangover, also known as the postdrome phase, is the final stage of a migraine attack. It isn't triggered by alcohol, but the symptoms can feel similar to a traditional hangover. After the intense headache and other main symptoms, like dizziness or nausea, have passed, the postdrome phase can set in. During this stage, you may still feel unwell for several hours or even days. The postdrome is a common part of a migraine that many people experience, even though the worst of the migraine symptoms have passed [1].

Below are the phases of migraines that people typically experience, with an explanation of what they are:

Prodrome phase

The prodrome phase is the first stage of a migraine attack and serves as an early warning sign that a migraine is on its way. It occurs before the main symptoms of a migraine, such as the intense headache or aura. Unlike the aura, which only affects around 25% to 30% of people with migraine, the prodrome phase can be experienced by anyone who suffers from migraines.

Symptoms in the prodrome phase can be varied and subtle, making it tricky to recognise. Some common signs include mood changes, food cravings, fatigue, difficulty concentrating, and physical symptoms like a stiff neck or sensitivity to light and sound. Keeping track of these symptoms can help you to anticipate when a migraine is likely [2].

Aura phase

The aura phase is the second stage of a migraine attack and occurs after the prodrome phase. This phase involves a range of neurological symptoms, with visual disturbances being the most common. People experiencing aura may see flashes of light, zigzag patterns, or have blurry vision. 

The aura phase typically lasts anywhere from a few minutes to an hour. While it can be unsettling, especially with the temporary changes in vision or sensation, it is not dangerous. It is important to be aware that only about 25% to 30% of people with migraines experience aura [3].

Headache phase (migraine attack)

The headache phase of a migraine is the third and most intense stage of a migraine attack. This is when the well-known, severe throbbing or pulsating pain occurs, typically on one side of the head but sometimes on both. The pain can range from moderate to severe and often worsens with physical activity, movement, or exposure to light and sound. Many people will also experience symptoms such as nausea, vomiting and dizziness during this phase.

Postdrome (recovery) phase

The postdrome phase, also known as the recovery phase, is the final stage of a migraine attack. After the intense headache and other main symptoms subside, many people feel drained, fatigued, or as though they have a hangover. This phase can last for several hours or even days [4].

What are the symptoms of migraine postdrome?

The postdrome phase can cause a number of symptoms that vary from person to person. Common postdrome symptoms include:

• Feeling drained, tired or physically weary

• Body aches

• Stiff necks

• Difficulty concentrating (brain fog)

• Digestive issues such as nausea and bloating

• Mild head pain or discomfort

• Hunger or thirst

• Mood changes

The symptoms of the postdrome phase may mirror the symptoms you felt at the beginning of your migraine in the prodrome phase. For example, if you felt lethargic during the prodrome phase, you may feel energetic during the postdrome phase.

Is depression a symptom of the postdrome phase of a migraine?

While depression itself is not a direct symptom of the postdrome phase, it is common for people to experience mood changes during this stage, which can include feeling down or low. Acute depressive symptoms are more likely to occur during the headache phase of a migraine rather than in the postdrome phase, however, the physical and emotional strain a migraine can have on you can leave you feeling emotionally drained and down [5].

How long does the postdrome phase of a migraine last?

The duration of the postdrome phase varies from person to person. For most people, it will last several hours to around a day. In some cases, it can extend over multiple days before you feel entirely normal again [1]. While the severity of symptoms reduces over time, it is important to note that the actual amount of time before you fully recover will vary.

How to manage the symptoms of postdrome

There is no definitive cure for the symptoms felt during the postdrome phase, however, there are several ways you can manage your symptoms and help yourself feel better [1]. 

Gentle Exercise

Gentle activities such as light stretching or a massage can help to ease discomfort.

Comfort Food

Eating comfort food and drinking caffeinated beverages can be helpful, however, caffeine is a common trigger of migraines, so caution is advised. It is important to remain hydrated during the postdrome phase.

Rest

Resting and getting plenty of sleep can aid recovery and is perhaps the most critical symptom management option.

Ice Packs, Heat Pads or Hot Water Bottles

Using an ice pack, heat pad, or a hot water bottle can help to provide relief from aches and tension.

Don’t Push Yourself

People often feel guilty or annoyed that they’re not feeling normal after the initial migraine has passed, however, it is important to remember that the postdrome phase is still part of the migraine.

Visit Your Doctor

If you are concerned about your symptoms, it is important to visit your doctor. They will be able to monitor your symptoms and check for further issues.

What are the treatment options for Migraine postdrome?

While there is no cure for migraines or the postdrome phase, several treatment options can help manage the symptoms of a migraine hangover. Over-the-counter pain relief, such as ibuprofen, can be effective in reducing general body aches, neck stiffness and mild discomfort experienced during postdrome.

If over-the-counter remedies aren’t sufficient, stronger options are available, including prescription migraine medications such as Sumatriptan, Rizatriptan, Zolmitriptan and Frovatriptan.

If you feel you are in need of medication to help with your migraines, it is important to consult with your doctor for further advice.

Sources

[1] Postdrome: The migraine hangover - Migraine Trust

[2] Understanding Migraine: Prodrome and Postdrome - Teva UK

[3] Understanding The Aura Migraine Phase - Nerivio

[4] Stages of a migraine attack - Migraine Trust

[5] Depressive symptoms during the different phases of a migraine attack: A prospective diary study - ScienceDirect

Further Reading

Migraine Hangover (Postdrome) - WebMD