Here’s What You Need to Know About ‘Migraine Hangovers’
When you think of hangovers, you might envision breakfast bagels or that movie about a bumbling group of dudes in Vegas. But migraines can lead to hangovers, too, one that arises after the pain recedes.
OK, so these aren’t the same as alcohol-induced hangovers, but they can feel eerily similar: brain fog, fatigue, moodiness, weakness, and sensitivity to light and sound can occur in both. “I don’t think a lot of [people with migraines] talk about it because they’re focused on the pain, but it’s a real phenomenon,” Kevin Weber, M.D., a neurologist who specializes in treating patients with headaches at The Ohio State University Wexner Medical Center, tells SELF. “I’ve experienced it myself.” Read on to learn all about migraine hangovers, plus what you can do to prevent them.
First let’s talk about the migraine itself, which doesn’t just crash into your head out of nowhere.
Migraines come and go in phases. First up is the prodrome phase, which happens a day or two before the pain strikes, sounding the alarm that a migraine is coming. According to the Mayo Clinic, the prodrome can include symptoms like constipation, mood changes, food cravings, neck stiffness, increased thirst and urinary frequency, and yawning more than usual. After that, if you’re one of the 15 to 20 percent of people who experience migraines with aura, your senses may start to go haywire, according to the Cleveland Clinic. For at least 20 minutes to an hour, you might see different shapes or flashes of light, experience vision loss, feel pins and needles, have difficulty speaking, hear things that aren’t actually there, or smell weird odors, among other symptoms.
The aura may stop or continue once you enter the attack phase, which is exactly what it sounds like: Migraine pain hits in its typical excruciating fashion, and it hits hard, typically lasting anywhere from four to 72 hours, says the Mayo Clinic. Symptoms like nausea, vomiting, fatigue, dizziness, and sensitivity to light, noise, and smells can accompany the pain.
The migraine hangover is actually what’s known as the post-drome phase, which sets in once the pain has left.
“It’s the end part of migraine when pain is on its way out, but brain functioning isn’t completely back to normal,” Jessica Ailani, M.D., associate professor of neurology at MedStar's Georgetown University Hospital and director of MedStar Georgetown Headache Center, tells SELF. In this period, you might feel confused or have brain fog, plus some similar symptoms to those from the attack phase, like dizziness, mood problems, weakness, and sensitivity to light and sound. Some people may even feel elation, but the negative symptoms are more likely, the experts say.
Overall, this is a pretty appallingly excessive thing for your brain to do to itself. “When you put all of this together, a migraine can be happening for at least three days,” Dr. Ailani says.
Experts aren’t sure why migraines, much less migraine hangovers, happen.
The general thinking is that migraines come about when nerve cells prompt blood vessels to dilate, which aggravates nearby nerves and causes the release of inflammatory, pain-inducing substances like prostaglandins and serotonin, says the Cleveland Clinic. However, the exact cause of this kind of mechanism isn’t clear.
There is much discussion about how various parts of the brain contribute to migraines, like the hypothalamus which governs hunger, thirst, and sleep, the cerebral cortex, which helps process information, and the brain stem, which transmits information (including about sensations). Dr. Ailani notes that the trigeminal nerve, which sends messages about pain in the face and head to your brain and which is connected to the brainstem, is thought to be involved.
Beyond that, experts only know that migraines are a complex constellation of triggers and risk factors. Things like fluctuations in estrogen, alcohol, stress, fatigue, environmental changes, genetics, and more can all be involved. As for migraine hangovers specifically, the most widely held theory is that they have to do with cortical spreading depression, which is known to play a role in migraine aura. “It’s essentially an electrical wave in the brain that occurs with a migraine, and the after-effects are thought to be neurochemical changes associated with that,” Dr. Weber says. “We’re still not 100 percent sure.” (This obviously isn’t electricity like the kind powering the lights in your home; cells in your brain generate an electrical current to send and receive messages.)
No matter the cause, a migraine hangover is kind of like your brain trying to recover after it ran a marathon. “During a migraine, the brain is overactive. During a hangover, it’s just exhausted and saying, ‘I can’t take it anymore, I need to rest and reset myself,’” Dr. Ailani says.
The best way to prevent a migraine hangover is to stop the pain in its tracks ASAP.
Migraines are still pretty mysterious, which means there’s no conclusive way to fully prevent someone from getting a migraine hangover once the pain has started. The best option you have is to cut the pain off as quickly as possible.
“Treating a migraine effectively in the onset makes you less likely to get these hangover symptoms because your brain doesn’t have to shut the process down itself,” Dr. Ailani says, adding that her patients are more likely to experience this post-drome phase if they haven’t yet found a medication that really works for them. “I use this as a way to push my patients to take better care of themselves,” she says. Dr. Weber agrees: “Having a good abortive treatment for migraine is the most effective way of preventing the hangover.”
The list of potential migraine treatment medications is about as long as your arm, and it varies based on whether your head pain is mild, moderate, or severe. For example, a mild migraine may respond to something as simple as aspirin, says the Mayo Clinic. A moderate one may require drugs called triptans, which make blood vessels constrict instead of dilate and obstruct pain pathways in the brain. For severe head pain that doesn’t respond to any other treatments, opioids may be necessary, although of course they come with the risk of addiction.
There are also preventive medications to ward off migraines altogether, which you should discuss with your doctor if you’re having migraines more than once a week or your medications aren’t working well enough. Talking with a medical professional is really the only way to determine if you’re on the best migraine medication for your situation. “There are lots of effective options, and more on the horizon,” Dr. Weber says.
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