You wake up tired, achy, and irritable, with a dull pain in your head and an overall feeling that you’ve been hit by a truck. (Ouch!) Sounds like a hangover, right? Except you didn’t have anything to drink last night—because you had a raging migraine instead.
Welcome to the migraine postdrome phase, sometimes called a migraine hangover. It’s the part where the worst of the episode is over but you’re not exactly back to 100% yet.
What is a migraine postdrome, and what does it feel like?
There are four stages of a migraine experience, according to the American Migraine Foundation:
- Prodrome phase: A few hours to a couple of days before a migraine. Prodromal symptoms include mood changes, food cravings, neck stiffness, and fogginess among others.
- Aura: 25% to 30% of people with migraine experience a migraine with aura five to 60 minutes before a migraine headache begins. Aura symptoms include visual disturbances and numbness or tingling.
- Headache: This pain phase can last up to 72 hours. Headache symptoms range from a throbbing to a drilling sensation, accompanied by nausea, insomnia, congestion, and more.
- Postdrome phase: It’s the phase of migraine that occurs after the head pain ends. Common symptoms are similar to a hangover, and can include:
- Fatigue or brain fog
- Light or noise sensitivity
- Body aches
- Difficulty concentrating
- Stiff neck
- Pale face
“During a migraine, your body undergoes this huge storm of activity that affects all different parts of your brain,” says Deborah I. Friedman, MD, MPH, professor of Neurology at the University of Texas Southwestern Medical Center and a member of the American Headache Society. “That doesn’t magically turn off [when the migraine stops] … it takes time for things to reset and come back to your baseline, which is different for everyone.”
The postdrome phase is pretty common, according to a 2016 study in the journal Neurology. Of 120 patients evaluated, 97 reported having “at least one nonheadache symptom in the postdrome,” with these after effects ranging from fatigue and difficulty concentrating to neck pain and residual migraine headache.
How long can migraine postdrome last?
Dr. Friedman says that the postdrome phase can last for a day or so after the migraine ends, and that there’s not much you can do to hurry the process along or feel better faster. But that doesn’t mean there’s no way to lessen the severity of the migraine postdrome phase.
How to get rid of a migraine hangover
“The best way to avoid the postdrome phase is to not have a migraine in the first place,” says Miami, Florida–based neurologist Teshamae Monteith, MD, a fellow of the American Academy of Neurology. “Migraine is a multi-phasic disorder, so once it sets in, chances are good that you’ll have the postdrome phase.”
To successfully prevent more migraines, Dr. Monteith suggests working with your doctor to:
- find the right combination of pharmacological treatments
- address any necessary lifestyle modifications, like your diet or exercise habits
- identify the foods, activities, or even hormonal changes that may trigger your migraine attacks .
Dr. Monteith also says that if you suffer from at least four migraines per month, getting on a preventative medication—such as Ubrelvy, Topamax (topiramate), beta-blockers, Botox injections, or a calcitonin gene-related peptide (CGRP)—can also be helpful because waiting too long to treat a migraine often makes the entire episode worse.
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Triptans are another class of prescription drugs to treat migraine pain. They’re designed to stop a migraine after it starts by constricting blood vessels to obstruct pain pathways in the brain. Keep in mind that some triptans can actually cause some of their own side effects and aggravate the effects of the postdrome phase. (Triptans include Imitrex, Maxalt, and Zomig, among others.) And it’s important to note that triptans cannot be taken during pregnancy.
“Triptans can be associated with fatigue, concentration impairment, chest tightness, neck pain, and achiness of the jaw,” Dr. Monteith advises. “But a long-acting triptan [like frovatriptan] may have fewer side effects, so you should talk to your doctor if you feel like your triptan is making the postdrome phase worse.”
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Finally, be sure to practice some serious self-care whenever possible during the postdrome phase. Your brain has been through a lot and needs time to recover. Dr. Monteith recommends getting extra sleep, limiting mentally-stimulating activities, minimizing stress, and managing any specific migraine symptoms as they arrive (like treating neck pain with a pain reliever).
“There also can be anxiety associated with these postdrome symptoms,” says Dr. Monteith, “so it may help you to simply be aware that postdrome is part of the migraine episode itself, and will pass.”