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The condition described as common migraine accounts for 80 per cent of migraine attacks. The rarer classical migraine has been recorded historically for over 2,000 years and has a more complicated, well-defined symptom picture. Both types usually share the symptom of a severe headache. Cluster headache is rarer and can be easily distinguished from the other types

The stages of a migraine attack

1 Warning or pre-headache phase.

2 The aura (classical migraine).

3 The headache.

4 The postdromal or 'hangover' phase.

Common migraine

The warning phase

The pre-headache phase is seen in both common and classical migraine although it is not experienced by all common migraine sufferers. It may last for a few hours or even for several days before an attack. The phase may include the following symptoms

Mood changes
Weight gain
Tension
Nausea
Irritability
Hunger
Confusion
Stuffy nose
Mental dullness
Raised blood pressure
Fainting
Extra energy
Fatigue
Euporia

The headache phase

The pain can last for a few hours to three days and is described by most sufferers as hot and pulsating; it affects the head, face, jaw and sometimes the neck and shoulder area. The latter may be the result of holding the head in a fixed position, since the slightest movement or coughing or sneezing can increase the pain. The pain may be worse on one side and attacks frequently occur around the time of menstruation. The sufferer usually notices the headache on waking, although it can actually wake them up.

Vomiting, diarrhea and constipation are frequently present, and these can lead to dehydration. The sufferer often describes their affliction as 'sick headaches'. Sufferers may feel hot/cold/sweaty, but a recent study showed that recorded temperatures were normal (Blau, 1991). Acute sensitivity to light, sound and smell can also be present. Neurological symptoms are rare in common migraine.

Abating of headache Symptoms improve with time and loss of body fluids through vomiting, diarrhea, increased flow of urine, tears, sweating or streaming nose.

The hangover phase

The sufferer often feels drained of energy and has to move slowly. Even thinking can be an effort.

Classical migraine

The pre-headache phase

Typically, classical migraine sufferers report that the aura is the first sign of an attack, but in some people the pre-headache phase is also experienced. This is sometimes called the 'prod Rome ', from the Greek prodromos meaning 'coming before'. The experience can be one of fearfulness and depression, or of feeling very well, full of energy -and creativity.

The aura

This is thought to arise from disturbances in the blood flow to the head. The symptoms depend on which part of the brain is affected. They can be frightening and bizarre and people often think they are going mad or having a stroke. The aura may only last for 15 to 20 minutes before the onset of the headache.

Visual disturbances

Visual disturbances often cause clumsiness and bumping into things. There can also be a distortion of body image or the sufferer may feel that part of the body is 'not there.

Symptoms of Classical migraine