Migraine Prodrome: First Symptoms of an Attack

A migraine is a severe type of recurring headache. The attacks can come with other severe symptoms, including light sensitivity, nausea, and vomiting. What does it feel like when a migraine is coming? Signs a migraine is coming include difficulty sleeping, mood changes, and trouble focusing. This is known as prodrome, or the first phase of a migraine.

There are four phases of a migraine: prodrome, aura, headache, and postdrome phases. Prodrome occurs 24-48 hours before the headache phase. You may also experience aura, or visual disturbances. Aura occurs just before the headache phase. Some people have postdrome, which causes exhaustion and weakness after a migraine.

Migraine is one of the most common headache disorders. About 12% of people in the United States experience migraines. Read on to learn about signs leading to a migraine and how to treat and prevent prodrome.

Migraine Stages 

There are four phases of a migraine, including:

• Prodrome: You may develop symptoms 24-48 hours before the headache phase. These include frequent urination, food cravings, mood changes, swelling, and yawning.
• Aura: This includes visual disturbances, such as bright, flashing lights and zig-zag lines, and muscle weakness.
• Headache: Migraine usually causes a severe, throbbing headache that affects one side of your head. Other symptoms include sensitivity to light, noise, and smells; nausea and vomiting; and pain with activity.
• Postdrome: This is known as a "migraine hangover." You may feel confused, exhausted, and weak for up to one day after a migraine.

Keep in mind that not everyone will experience each phase. Only 30% of people with chronic migraine, for example, go through the aura phase. Some people with chronic migraine do not experience the headache phase.

What Do Migraine Prodrome Symptoms Feel Like?

Prodrome symptoms usually develop 24-48 hours before the headache phase. The average attack lasts four to 72 hours if untreated.

Cravings

Some people crave certain foods before a migraine attack occurs. Research has shown that what people perceive to be migraine triggers may instead be early migraine symptoms. Some people crave chocolate, for example, which is a common migraine trigger.

Feeling Cold and Sweating

Changes in body temperature and sweating are common before a migraine. It's unclear what causes migraine, but some evidence suggests that excitable brain cells trigger the hormone serotonin. This causes blood vessels to constrict, which may result in chills, sweating, and shivering.

Frequent Urination

A migraine attack may be coming if you need to urinate more than usual. Frequent urination is a common prodrome symptom. You may develop excessive thirst before a migraine, which causes increased urination.

Mood Changes

Mood changes begin in the prodrome phase. Prodrome symptoms vary widely: Some people feel depressed or irritable, while others experience euphoria.

Migraine is also associated with high rates of mood disorders, such as anxiety, depression, and post-traumatic stress disorder (PTSD). People with chronic migraine, for example, are 2.5 times more likely to have depression than others. Chronic migraine and psychiatric disorders may have the same genetic risk factor.

Neck Pain

You might develop a stiff neck or a throbbing pain behind your neck before a migraine. Seek medical attention right away if you develop a headache, fever, nausea, and vomiting, in addition to a stiff neck. These symptoms can be a sign of a more severe health condition.

Restlessness

Waking up tired or having trouble falling asleep is common in people with chronic migraines. You may feel restless before a migraine attack strikes, making it tough to get a good night's sleep.

An inability to sleep can be the start of a vicious cycle. Research has found that sleep disturbances are one of the most common migraine triggers. You might be lethargic, which is another early sign of a migraine attack, if you do not get enough sleep.

Sensitivity to Light and Sound

You might seek refuge in a dark, quiet place during a migraine attack. Bright lights and loud noises can trigger a migraine or intensify pain. Light sensitivity may also be a symptom of the prodrome phase.

Swelling

Fluid retention is another early sign of a migraine attack. This results in swelling (edema), or when fluid builds up in your body's tissues and cavities. Swelling can affect the entire body, especially the ankles, feet, and legs.

Visual Changes

Visual changes are common with migraine, especially if you experience aura. Some people may also have trouble focusing their vision during the prodrome phase. This causes blurry vision.

Yawning

Yawning too much is another sign that a migraine is coming. You may excessively and uncontrollably yawn every few minutes. A study published in 2018 found that 45% of people with chronic migraine reported yawning, both in the prodrome and headache phases.

Prodrome vs. Aura 

Prodrome and aura both come before the headache phase. Aura includes visual changes, such as flickering lights, zigzag lines, and blind spots.

Some people who experience aura also can have hearing disturbances, such as tinnitus (ringing in your ears), music, or noises. About 10% of people experience language changes, such as trouble understanding or finding words. Although rare, some people have motor auras with weakness on one side of the face or body.

Aura typically lasts between five minutes to one hour. These visual changes can develop within one hour of the headache or along with it. Some people may experience aura without a headache. Prodrome, in contrast, occurs 24-48 hours before the headache phase.

Prodrome Treatment 

How do you stop a migraine during a prodrome? A healthcare provider may prescribe medications, such as ergotamine and triptan drugs, if you have chronic migraine. Take these medications as soon as you notice prodrome symptoms. The earlier you take the medication, the more likely it'll stop a migraine.

Other prodrome treatments include:

• Applying a cold compress to your forehead
• Avoiding triggers (e.g., bright lights, loud noises, and smells)
• Not skipping meals
• Staying hydrated
• Taking a nap or relaxing in a dark, quiet room

Prevention 

Some of the same techniques that treat a migraine can prevent an attack. Avoid triggers as much as possible, and take medication as a healthcare provider prescribes.

You can also prevent migraine by:

• Avoiding alcohol and tobacco
• Getting plenty of rest each night
• Keeping a migraine diary to figure out what triggers an attack
• Keeping a routine meal schedule
• Limiting your caffeine intake
• Managing stress
• Regularly exercising

A Quick Review

Prodrome is the first phase of a migraine attack, which may occur 24-48 hours before the headache phase. Symptoms include difficulty sleeping, mood changes, and trouble focusing. Some people with chronic migraine experience aura, or visual disturbances, just before the headache phase.

Talk to a healthcare provider if you frequently have migraines. They can prescribe medication to stop a migraine from progressing during the prodrome phase. Other prodrome treatments include applying a cool compress to your forehead and relaxing in a dark, quiet room.