Majority of Migraineurs Experience Disabling Post-migraine Symptoms

Mechanic covering his ears in garage

Since there is little published on the migraine postdrome, Dr. Leslie Kelman, Medical Director of the Headache Center of Atlanta, in Atlanta, Georgia, interviewed patients visiting his clinic to document the frequency, duration and types of symptoms of postdrome. The 827 headache patients (85.2% female, 14.8% male) in the study had been diagnosed with migraine with or without aura and/or chronic migraine according to the International Headache Society diagnostic criteria.

At the first visit, the phases of migraine were explained to the patients, including the concept of postdrome. They were asked if they experienced a postdrome and, if so, to describe the duration and symptoms.

Of the 827 patients, 68% reported postdrome (69.1% females, 56.8% males). Postdrome occurred 1-33% of time in 29% of patients, 34-66% of time in 31.5%, and 67-100% of time in 39.4% of the patients.

In slightly more than half of the patients the postdrome lasted for 12 hours or less and it lasted for longer than 24 hours in 12%. The average duration is 25.2 hours, which is significantly more than the 18 hours documented in a previous study.1 Patients with migraine with aura 100% of the time tended to suffer a longer duration postdrome than those with other migraine types.

The most common symptoms of postdrome were tiredness, head pain, cognitive difficulties, feeling “hungover”, gastrointestinal symptoms, mood change, and weakness and dizziness. These symptoms are similar to those found in an earlier study.

Interestingly, patients who experience a postdrome tend to have migraines with more triggers, a prodrome aura and associated symptoms, higher intensity migraine, pain with head movement, and more disability. Patients with prodrome report similar findings, as do patients with aura.

Dr. Kelman says it is not yet understood whether postdrome is a unique phenomenon or simply a lessening of the acute headache symptoms. However, there is certainly a high frequency of postdrome in migraine, and disability due to postdrome is well documented1. He concludes by saying, “In the quest for improved quality of life for migraineurs…more attention should be focused on the postdrome in routine clinical management of patients.”