Migraine Prodrome

Migraine prodrome is the first of four stages in the migraine timeline, preceding aura, attack and postdrome.

A migraine prodrome is one of the early warning signs of migraine. Spotting a prodrome gives you an opportunity to reduce the severity of a migraine attack or prevent one from happening.

This guide explains everything you need to know about the migraine prodrome phase, from symptoms to treatments.

What is the premonitory (prodrome) phase of a migraine?

The premonitory (prodrome) phase of a migraine is the warning stage. It’s the start of a migraine and gives you an opportunity to take steps to hopefully avoid an attack. The prodrome migraine stage can last from hours to days and is experienced by most migraine sufferers.

There are a number of steps you can take during the prodrome stage to avoid a full migraine attack or reduce its level of severity, such as:

• Minimizing known triggers
• Abortive medications
• Behavioural tactics

You won’t necessarily get the prodrome stage with every migraine episode you have. Some people move straight into the following stages of a migraine, reaching an attack sooner than those who begin with the premonitory phase.

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27 prodrome symptoms you need to look for

The migraine prodrome symptoms aren’t the same for everyone — you may experience migraine prodrome dizziness but not migraine prodrome anxiety. Prodrome symptoms range from person to person but these are the main ones you need to look for.

• Anxiety
• Confusion
• Constipation
• Cramp
• Depression
• Diarrhoea
• Difficulty sleeping
• Difficulty speaking
• Dizziness
• Energetic
• Excessive and repetitive yawning
• Excitable
• Fatigue
• Feeling cold
• Food cravings
• Irritability
• Muscle stiffness
• Nausea
• Problems concentrating
• Sensitivity to light (photophobia)
• Sensitivity to smells (hyperosmia)
• Sensitivity to sound (phonophobia)
• Stiff neck
• Thirstiness
• Urinating more frequently
• Vertigo
• Vivid dreams

These 27 symptoms can be broadly grouped into the following four categories.

Mood alterations during a migraine prodrome

Mood alterations during a migraine prodrome include:

• Anxiety
• Confusion
• Depression
• Excitable
• Energetic
• Irritability

Gastrointestinal issues during a migraine prodrome

Gastrointestinal issues during a migraine prodrome include:

• Constipation
• Diarrhoea
• Nausea
• Urinating more frequently

Muscular issues during a migraine prodrome

Muscular issues during a migraine prodrome include:

• Cramp
• Muscle stiffness
• Stiff neck

Changes in state during a migraine prodrome

Common changes in state during a migraine prodrome include:

• Difficulty sleeping
• Difficulty speaking
• Dizziness
• Excessive and repetitive yawning
• Fatigue
• Feeling cold
• Food cravings
• Problems concentrating
• Sensitivity to light (photophobia)
• Sensitivity to smells (hyperosmia)
• Sensitivity to sound (phonophobia)
• Thirstiness
• Vertigo
• Vivid dreams

Should I be treated for an attack if I have a migraine prodrome?

Prodrome is the first of the migraine phases and precedes a full-blown attack.

Migraine pathophysiology studies have shown it can be effective in treating attacks during the prodrome. However, these were largely small studies that haven’t been replicated on the larger scale required to provide an appropriate level of scientific certainty.

The overall assessment is that it could be appropriate for you to be treated for an attack if you have a migraine prodrome. If it is appropriate to seek treatment then it’s reasonable to say that the earlier you do so the better it will be for you.

There are two key studies that have assessed the effectiveness of treating migraine attacks during the prodrome phase. These are the studies:

• “Prevention of Migraine During Prodrome With Naratriptan” by Luciani, R.; Carter, D.; Mannix, L.; Hemphill, M.; Diamond, M.; Cady, R.
• “Domperidone in the prevention of complete classical migraine” by Waelkins, J.

How to take care of yourself during a migraine prodrome

A migraine prodrome happens before a full attack.

But while it isn’t as severe as an attack, a migraine prodrome does have some unpleasant symptoms that will require you to look after yourself. This is how you can take care of yourself during a migraine prodrome:

Minimise any known triggers you have for a full-blown migraine

If there are any things you’re aware of that can trigger you to have an attack then avoid them. Migraine triggers vary from person to person, ranging from caffeine to coughing.

If you keep a diary of your triggers then you can take appropriate action during the migraine prodrome stage and reduce your chances of having an attack.

Take abortive medications to stop a migraine before it starts

Abortive medications are designed to stop a migraine before it develops and becomes more severe.

A prodrome can be one of the key migraine warning signs, serving as a notice for a full-on attack and it may be appropriate to take abortive medications at this stage.

You should consult a doctor or pharmacist before taking abortive medications during the prodrome phase.

Use behavioural tactics to cut the chances of your migraine developing

Work has been done and studies carried out on the impact of using behavioural tactics (such as mindfulness and cognitive behavioural therapy) to tackle migraines.

The American Headache Society published an interview with Elizabeth Seng, PhD, FAHS in which Dr Seng talks about the use of mindfulness-based CBT interventions to tackle migraines.

In this interview, Dr Seng explains that “we saw large changes in headache-related disability over the course of eight weeks of mindfulness-based cognitive therapy for migraine”.

How to prevent a migraine attack

Preventing a full-blown migraine begins with finding the triggers that cause you to experience an attack.

Once you’ve established your triggers, there are some natural measures you can take to prevent a migraine attack. These are the main natural ways of preventing migraines:

• Limit your intake of caffeine: replace your caffeinated coffee with a decaf choice.
• Control your intake of alcohol: lower the number of units of alcohol you drink.
• Cut down on sugary foods: swap sugary (including fructose) snacks for healthier options.
• Partake in plenty of exercise: have an exercise program, one that works for you.
• Create stress coping strategies: consider relaxation techniques or counselling.
• Have a regular sleeping pattern: sleep at the same time and take away distractions.
• Keep to a regular meal schedule: eat breakfast, lunch and dinner at the same time.

Do I need to go to the doctor after a migraine attack?

The NHS advises that you “should see a GP if you have frequent or severe migraine symptoms”. As an attack is the most severe of the migraine stages, it stands to reason that you should see a doctor if you have frequent attacks.

The NHS expands on its advice for going to a doctor in the event of a migraine by explaining that you should see a GP if you have migraines on more than five days a month.

The NHS also highlights that you should immediately dial 999 and request an ambulance if you or someone of experiences any of the following things:

• Weakness or paralysis in one or both arms or on one side of your/their face
• Garbled or slurred speech
• Unexpected and agonising headaches — severe pain never before experienced
• High temperature, confusion, stiff neck, double vision and seizures alongside a headache

If you or someone you’re with experiences any of these symptoms then it may indicate you/they have a condition that’s more serious than a migraine, like meningitis or a stroke.

Timeline of a migraine attack: the 4 migraine stages

There are four stages in a migraine attack: prodrome, aura, attack and postdrome. Each of these four stages has its own symptoms and we’ve highlighted them below:

Migraine prodrome symptoms

• Anxiety
• Confusion
• Constipation
• Cramp
• Depression
• Diarrhoea
• Difficulty sleeping
• Difficulty speaking
• Dizziness
• Energetic
• Excessive and repetitive yawning
• Excitable
• Fatigue
• Feeling cold
• Food cravings
• Irritability
• Muscle stiffness
• Nausea
• Problems concentrating
• Sensitivity to light (photophobia)
• Sensitivity to smells (hyperosmia)
• Sensitivity to sound (phonophobia)
• Stiff neck
• Thirstiness
• Urinating more frequently
• Vertigo
• Vivid dreams

Migraine aura symptoms

• Visual disturbances
• Temporary loss of sight
• Numbness and tingling on parts of your body

Migraine attack symptoms

• Migraine headaches
• Throbbing pain
• Drilling pain
• Stabbing pain
• Icepick in your head pain
• Burning pain
• Nausea
• Vomiting
• Giddiness
• Insomnia
• Nasal congestion
• Anxiety
• Depression
• Sensitivity to light (photophobia)
• Sensitivity to smells (hyperosmia)
• Sensitivity to sound (phonophobia)
• Neck pain
• Stiffness

Migraine postdrome symptoms

• Lack of comprehension
• Unable to concentrate
• Depression
• Euphoria
• Fatigue

Treatment options for migraine attacks

Migraine attacks can be agonising and there are a number of treatments you can use to relieve your pain. These are the main migraine treatments you can take to help manage an attack:

• Paracetamol
• Ibuprofen
• Vydura 75mg
• Almotriptan 12.5mg tablets
• Imigran Nasal Spray (10mg & 20mg)
• Maxalt Melt 10mg Wafers
• Migard 2.5mg Tablets
• Migraleve Pink Tablets
• Migraleve Yellow Tablets
• Rizatriptan 10mg Orodispersible Tablets
• Sumatriptan Tablets (50mg & 100mg)
• Zolmitriptan 2.5mg Tablets

Complete an online consultation to get prescription migraine treatment

Over-the-counter painkillers can be an effective way of bringing you migraine relief. If you need stronger medication then you can complete an online consultation and get prescription treatment for your migraine. Or you can speak to one of our qualified medical experts, who can offer advice about choosing the most suitable treatment for migraines.