Prodrome: 4 Clues that You’re About to Feel the Pain of Migraine

Once an episode of migraine is underway, you’re most likely in for several hours of pain and discomfort. Wouldn’t it be helpful to know if migraine pain is about to start, perhaps even prevent it? Can certain predictors give you a clue that a migraine is pending?

The initial stage of migraine, which actually occurs before head pain begins, is known as the prodrome, or premonitory, phase. Prodrome symptoms can occur 24 to 48 hours before migraine headache begins. By staying alert to this “early warning system,” you may be able to avert migraine head pain before it takes hold. 

‍Stages of Migraine 

Episodes of migraine attack typically have distinct stages: 

• Prodrome/Premonitory Stage: Prodrome symptoms that occur up to two days before a migraine attack commonly include yawning, a feeling of euphoria, depression, irritability, food cravings, constipation, and/or neck stiffness. 
• Aura Stage: About 35 percent of people with migraines will then experience aura before their headache commences. Aura symptoms may include flashing lights or bright spots, zigzag lines, and vision changes, typically lasting 5 to 20 minutes (and rarely longer than 60). 
• Headache/Attack Stage: Headache pain is, of course, the most widely recognized phase of migraine. Pain usually begins gradually, intensifies over a period of one to several hours, and resolves slowly at the end of the episode. Frequently affecting only one side of the head, the 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 pain subsides, the postdrome presents as non-headache symptoms, including fatigue, impaired concentration, and reduced mood. Postdromal symptoms may last 24-48 hours after the attack. 

‍Stay Alert to These 4 Prodromal Symptoms 

To help you better prepare for a migraine that’s on the way, let’s focus on the prodrome stage. 

Just like the variable symptoms possible during migraine head pain stage, prodrome can manifest with several symptoms as well. Dr. Ken Landow, Clinical Professor of Dermatology at the University of Southern California, explains how “prodromal symptoms of migraine are usually constant in an individual but often vary between individuals.” 

To recognize when a migraine is about to begin and get a head-start on managing the situation, begin to keep a migraine diary of any symptoms or patterns you typically experience pre-migraine. A recent study showed that, by journaling, 72% of migraine sufferers were increasingly able to predict the onset of their headache within 72 hours from their prodromal symptoms.

‍Stay alert to these 4 common prodromal symptoms that may predict that migraine pain's on the way: 

1. Cognitive and mood changes

• Irritability
• Depression
• Feeling of euphoria

2. Fatigue and changes in alertness

• Yawning 
• Muscle stiffness, particularly neck stiffness

‍3. Homeostatic and hormonal changes

• Constipation
• Cravings for certain foods
• Need for frequent urination
• Nausea

4. Sensory sensitivity

• Sensitivity to light 
• Sensitivity to sound 

Prodromal symptoms can actually be present during any phase of a migraine attack, although they may become less noticeable once head pain begins. 

By journaling, 72% of migraine sufferers were increasingly able to predict the onset of their headache within 72 hours from their prodromal symptoms.

‍Migraine Triggers and Early Symptoms 

It can be challenging to distinguish prodromal symptoms from migraine triggers, and certain early symptoms of migraine may actually be misclassified as triggers. 

In a 2015 study, researchers exposed a large group of migraine sufferers to common triggers — certain foods, bright lights, and loud sounds. They found that individuals who reported these triggers as provoking their migraine were more likely to report the associated symptoms (food cravings, light and sound sensitivity) in the prodrome phase. 

This suggests that triggers such as hunger, light, or sleep deprivation could actually be symptoms of the earliest phase of migraine. Migraine can change brain activity hours to days before the onset of migraine pain, producing real physiological symptoms days before the headache starts.  

Dr. Peter Goadsby, Director of the National Institute for Health Research at King’s College London, concurs that “people often do not recognize some nonspecific symptoms as being associated with the migraine, interpreting them instead as triggers.” 

‍Treatment During Prodrome

Although prodromal symptoms of migraine can be uncomfortable, they can be excellent indicators that an episode of migraine is imminent.

It is therefore recommended to take any prescribed medication during this time to help prevent an attack; certain home remedies may also help relieve symptoms. Note that it’s essential to consult with your physician before taking medication or attempting home remedies outside the time frame that you’ve been prescribed. 

‍Finding Relief from Migraine

In the past two decades, much work has been done to improve our understanding of the prodrome stage of migraine. 

Research is underway to better comprehend pre-migraine symptoms, the brain regions connected with each symptom, and how these may contribute to a migraine episode. These insights will benefit the search for new treatments and complement targeted, individualized therapies, such as those available through Mable. 

Prodromal symptoms extend the discomfort of migraine. Mable can help. 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. Over time, we can work with you to help reduce the frequency and severity of your migraine. Ready to find relief? Take our quiz.

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