Interictal Migraine Phase: The ‘In Between State’

There’s a misconception that symptoms disappear between migraine attacks. But that’s not always the case. Migraine is not just a headache disorder. It’s a complex neurological disease where symptoms occur in phases.

While headaches are the hallmark symptom of migraine, they’re just one piece of the puzzle. Many people with migraine experience symptoms between attacks. This is known as the interictal migraine phase.

In this article, we’ll cover the symptoms of interictal migraine and how they can help you manage future migraine attacks.

What is Interictal Migraine?

Interictal migraine is commonly called the ‘between headache state.’ It’s the phase of a migraine cycle where no headaches occur.

But being headache-free doesn’t always mean being symptom-free. Many experience symptoms before and after a migraine attack.

To quickly recap, here are the four phases of a migraine:

Prodrome (or premonitory) phase: Roughly 60% of people with migraine have symptoms before the headache sets in. This usually happens between two to 48 hours before the pain begins.
Aura: Around 25% of migraineurs experience the aura phase. This causes sensory disturbances such as flickering lights, blind spots, numbness, or tingling. Aura can last anywhere between a few minutes to a couple of hours.
Attack (or headache): This phase is marked by throbbing pain that usually occurs on one side of the head. Migraine attacks can last up to 72 hours and vary from mild to debilitating.
Postdrome phase: Also known as a ‘migraine hangover,’ this is the period after a migraine attack ends.

So in a sense, interictal migraine refers to any non-headache symptoms that pop up outside of a migraine attack. This may occur in the prodrome, aura, or postdrome phases.

migraine phases

Why Do Symptoms Occur Between Migraine Attacks?

It’s tough to say. Some believe it’s because people with migraine have brains that are inherently different.

For example, migraine sufferers tend to be hypersensitive to pain during and between migraine attacks. In fact, 42% of people with migraine experience hypersensitivity between headaches.

Other research shows that people with migraine tend to have elevated levels of calcium gene-related peptide (CGRP) outside of migraine attacks. CGRP is a protein that causes inflammation and is involved in pain transmission.

So if you have chronic migraine, there’s a lot going on under the surface even when you’re headache-free.

Interictal Migraine Symptoms

Many physical and psychological symptoms may occur in the interictal phase between headaches. These include:

Mood changes such as anxiety, depression, and worry
Fatigue
Nausea
Food cravings
Neck pain
Yawning
Sensitivity to lights, sounds, and smells
Visual disturbances such as flashing lights, zigzags, or blind spots

Some may not even realize their symptoms are related to migraine and brush them off. But often these symptoms are a red flag a migraine is on its way.

This can cause many chronic migraine sufferers to feel constantly ‘on edge,’ wondering when the next attack will strike. This anxiety can greatly interfere with well-being between migraine attacks. This is known as interictal burden.

Interictal burden can disrupt work, school, family, and social life. And for some, it leads to avoidance behaviors. Social plans may be canceled or not made at all in anticipation of the next attack. Others may feel like they’re constantly playing catch-up with work and school due to previous attacks.

migraines disrupting social life

So, while the interictal phase may be free of headaches – it’s not free of stress. Luckily, interictal symptoms can offer clues to help you prevent and manage future migraine attacks.

Using Interictal Symptoms to Help Manage Migraines

Many migraine experts recommend tracking symptoms to ease interictal anxiety. Keeping track of symptoms such as neck pain, nausea, and fatigue can help you understand your migraine cycle better. But it can also help you pinpoint the triggers that brought on symptoms.

The easiest way to do this is to use a migraine diary (download one for free here). Note any symptoms that occur, as they may be warning signs a migraine is coming. This can help you plan ahead and know when to try preventative treatments.

Prevention could be as simple as resting, avoiding screens, drinking more water, or practicing deep breathing to ease stress.

Nutritional support may also help. In particular, magnesium, riboflavin, and feverfew are all proven to benefit those with migraine.

Living with migraine isn’t easy. But knowledge is power. Understanding your interictal symptoms can help you manage your migraine better, which may ease future attacks.