Postdrome: The Hangover Effect after Migraine

When your migraine pain ends, there’s no question that the relief is real. But your migraine may actually not be over yet. For some people, certain symptoms that occur after head pain ends can feel a bit like a post-migraine “hangover.” 

This final phase of migraine, known as postdrome, can last from 24 to 48 hours after migraine pain ends. According to research, the severity of the actual migraine attack doesn’t seem to affect how long this back-end hangover effect lasts. 

Despite the fact that postdrome symptoms are experienced in over 80% of migraine attacks, they’re studied considerably less than symptoms of the prodrome (or premonitory) stage — that is, the phase that sometimes precedes a migraine. 

In fact, according to Dr. Peter Goadsby, director, National Institute for Health Research, King's College, London, and an advisor to Mable, postdrome is the least understood stage of migraine. Many people in the postdrome stage may simply feel that symptoms of some sort are to be expected following the resolution of their head pain, or they attribute postdrome symptoms to their migraine pain treatment. Others may not recognize hangover-effect symptoms as symptoms at all.

‍The 4 Stages of Migraine

Episodes of migraine typically occur in four distinct stages:

• Prodrome/Premonitory Stage: Symptoms can begin up to two days before migraine pain and commonly include excessive yawning, a feeling of euphoria, depression, irritability, food cravings, constipation, and/or neck stiffness. 
• Aura Stage: About 35% of people with migraine experience aura just before their headache begins. Symptoms can include flashing lights or bright spots, zigzag lines, and vision changes, and typically last 5 to 20 minutes (and rarely longer than an hour). 
• Headache/Attack Stage: Head pain is, of course, the most widely recognized phase of migraine. Migraine headache usually begins gradually, intensifies over a period of one to several hours, and resolves slowly. Frequently affecting only one side of the head, pain tends to be dull and steady when the migraine is mild to moderate in severity; throbbing or pulsating, when more severe.
• Postdrome Stage: After head pain subsides, postdrome can include non-headache symptoms such as fatigue, impaired concentration, and moodiness. Symptoms may last 24 to 48 hours after the headache stage. 

‍Easing Postdrome Symptoms

Interestingly, as many as 255 symptoms have been reported in the postdrome stage! Among those, the most common include:

• Tiredness
• Less severe headache
• Cognitive/concentration difficulties
• Mood shifts
• Dizziness
• Reduced appetite

Prevention can be key in averting not just the head pain phase of migraine but a prolonged hangover effect as well. Keep a headache diary to track your symptoms in each stage of your migraine. This can help you identify patterns — such as behaviors or foods coincidental with your attacks — and help you reduce your exposure to migraine triggers.

There is currently little evidence that specific prescription treatments help relieve prodrome symptoms. But Harvard Women's Health suggests these measures to help avoid lingering symptoms once migraine head pain has gone:

• Stay hydrated! Drink plenty of water on a regular basis.
• Practice good headache hygiene — maintain regular eating and sleeping patterns and ease stress.
• Discontinue pain medicine once the headache ends.
• If possible, try to lighten your workload and other activity for 24 hours after your headache pain ends.

‍What Does Research Tell Us?

Recent studies highlight a similarity between prodrome and postdrome symptoms of migraine. Dr. Nazia Karsan, MRCP, PhD, King's College London, notes that patients often report similar symptoms — such as “tiredness and lack of concentration” — both before and after migraine head pain. She suggests these “pre” and “post” phases may not actually be distinct stages at all, but instead a continual presence throughout the entire migraine attack — a presence that simply becomes less noticeable during the headache/attack stage itself. 

However, while some drugs, such as triptans, effectively treat migraine headaches, they don’t alter the fundamental mechanisms in the brainstem that generate migraine to begin with. So although triptans ease head pain, non-headache symptoms of migraine can persist. 

Further research into postdrome may bring better understanding of the entire migraine process. Better knowledge about how, when, and why migraine episodes end can help identify key biological mechanisms, and potentially lead to better treatments. 

‍Find Relief from Migraine

Symptoms of prodrome may extend the discomfort caused by your migraine episodes. Mable can work with you to help reduce their frequency and severity. 

We offer streamlined migraine diagnosis and treatment assisted by world-leading experts in migraine care. Our headache specialists help tailor your DNA-guided migraine treatment plan based on the latest evidence and clinical practice. 

Ready to find relief? Take our quiz.

‍