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 postdrome phase, i.e. the part of your migraine episode where the worst is over but you’re not exactly back to 100% yet.
“During a migraine, your body undergoes this huge storm of activity that affects all different parts of your brain,” says Dr. Deborah I. Friedman, 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.”
According to a 2016 study in the journal Neurology, the postdrome phase is pretty common. Of 120 patients evaluated, 97 reported having “at least one non-headache symptom in the postdrome,” with these symptoms ranging from fatigue and difficulty concentrating to neck pain and residual headache.
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 impact of the postdrome phase.
“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, 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 episodes.
Dr. Monteith also says that if you suffer from at least four migraines per month, getting on a preventative medication—such as 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.
One thing to keep in mind: some triptans, a class of prescription drugs designed to stop a migraine after it starts, 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.)
“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 less side effects, so you should talk to your doctor if you feel like your triptan is making the postdrome phase worse.”
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 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.”