Migraine Unpacked: Four Stages of a Migraine with Amanda Ellison

Short Summary

In this Strange Health episode, Amanda Ellison, a neuroscience professor at Durham University, explains that migraines are a whole-body biological event, not just head pain. She outlines the four stages of migraine: prodrome, aura, pain, and postdrome, and describes how changes in brain chemistry and vascular responses drive the experience. The conversation weaves personal anecdotes about aura experiences, including visual phenomena and the rare case of ocular migraine, and discusses how neurotransmitters like serotonin can rebalance during prodrome. The host emphasizes the difference between a migraine and other headaches, highlighting the global impact on the brain and behavior.

• Migraine is a brain and body event, not solely a head problem
• Prodrome may reflect neurotransmitter rebalancing
• Aura can be perceptual or non-perceptual and is tied to brain activity
• Pain results from vascular dilation and neurotransmitter misalignment
• Postdrome includes grogginess and potential mood shifts

Understanding Migraine: The Four Stage Model

The Strange Health podcast features Amanda Ellison, a professor of neuroscience, discussing the biology of migraines beyond mere headache pain. Ellison presents a four-stage model of migraine: prodrome, aura, pain, and postdrome. She frames migraine as a complex, systemic brain event that involves shifts in neurotransmitters, brain excitability, and cerebrovascular responses. The dialogue blends scientific explanation with personal anecdotes, illustrating how patients experience these stages in diverse ways, including cases of ocular migraine that affect vision rather than the eyes themselves.

Prodrome: Early Warnings and Neurochemical Balance

The prodrome is the phase when a migraine is on its way. It can be subtle, with symptoms such as fogginess, tiredness, yawning, and cravings for sweets. Ellison explains this phase as a window where the brain attempts to rebalance neurochemicals that have fallen out of sync, potentially setting the stage for the upcoming attack. Craving chocolate, she notes, may relate to tryptophan content in chocolate, which can convert to serotonin, a neurotransmitter often reduced during migraines. This phase can be difficult to recognize, both for the sufferer and those around them, because it may resemble ordinary daily tiredness or stress. The prodrome acts as a rough accelerant for the body to reestablish homeostasis before the next phase begins.

Aura: Perception and Brain Activity

Following prodrome, many individuals enter an aura phase that can present as perceptual changes such as flashing lights or gaps in the visual field, or as sensory phenomena like pins and needles. Ellison emphasizes that what a person experiences visually often mirrors internal brain activity; if the brain is highly eloquent, a perceptual aura arises, while others may have the same neural events without conscious perceptual symptoms. She shares anecdotal experiences of experiencing auras on Saltburn Beach, describing the visual distortions as both terrifying and fascinating. Ocular migraine is discussed as a brain-based phenomenon expressed through vision rather than an eye problem. The aura is tied to a wave of excitation that can precede the pain stage and may or may not progress to headache.

Pain: The Core of the Migraine Experience

The pain phase is marked by a localized headache often described as a drilling sensation. Ellison explains that this arises from a vascular response to earlier neural disturbances. During aura, there is a wave of excitation followed by a wave of depression, which disrupts subcortical and cortical networks and triggers cerebrovascular dilation. This rebound dilation leads to the pain signal and photophobia, a hallmark of migraine. The brain prioritizes safety, attempting to stop the process that is seen as dangerous, which reinforces the perception of pain. The duration of the pain phase can vary from hours to a day or longer depending on how neurotransmitter systems and vascular responses rebalance.

Postdrome: After the Storm

Once the pain subsides, sufferers may enter the postdrome, often described as a groggy, hungover feeling. Some individuals report a rebound mood elevation or euphoria, possibly linked to serotonin and dopamine normalization after a migraine. Ellison shares anecdotes from patients who use the migraine experience to navigate emotional and cognitive states, illustrating the variability of postdrome symptoms. The discussion reinforces that migraine is not only about the attack itself but also the immediate aftereffects that influence daily functioning and well-being.

Why This Matters: Clinical Insight and Practical Takeaways

The conversation highlights that migraines are not simply episodic head pain; they reflect a coordinated, multi-region brain network involving neurotransmitters, cerebral blood flow, and perceptual processing. Recognizing the prodrome and aura can aid in early intervention, while understanding the postdrome helps in managing residual symptoms. The episode underscores the importance of self-awareness and knowledge about the condition, and it emphasizes that migraine pathophysiology is a biology-story that touches behavior and quality of life as a whole. Readers and listeners are invited to consider the brain’s integrated response to migraine and to value the ongoing research into preventive and therapeutic strategies.