Migraine Prodrome: Symptoms and Treatment

Migraine prodrome, or the premonitory phase, symptoms include difficulty sleeping, mood changes, and trouble focusing. Prodrome, which is the first phase of a migraine, can occur 24 to 48 hours before the headache phase and lasts 72 hours.

A migraine is a severe type of recurring headache. The attacks can come with other severe symptoms, including light sensitivity, nausea, and vomiting. There are four phases of a migraine: prodrome, aura, headache, and postdrome phases. Aura, or visual disturbances, 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 what a migraine prodrome feels like and how long it can last.

Symptoms usually develop 24 to 48 hours before the headache phase. The average prodrome attack lasts four to 72 hours if untreated.

Migraine prodrome symptoms include:

  • Cravings: 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. 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. You may develop excessive thirst before a migraine, which causes increased urination.
  • Mood changes: Mood changes begin in the prodrome phase. 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.
  • 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. Research has found that sleep disturbances are one of the most common migraine triggers. You might be lethargic, another early sign of a migraine attack, if you do not get enough sleep.
  • Sensitivity to light and sound: 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: Some people may have trouble focusing their vision during the prodrome phase. This causes blurry vision.
  • Yawning: You may excessively and uncontrollably yawn every few minutes. Research has found that 45% of people with chronic migraine report yawning, both in the prodrome and headache phases.

Prodrome and aura both come before the headache phase. Only 30% of people with chronic migraine, for example, go through the aura phase. Aura includes visual changes, such as flickering lights, zigzag lines, and blind spots.

Other aura symptoms include:

  • Hearing disturbances, such as tinnitus (ringing in your ears), music, or noises
  • Language changes, such as trouble understanding or finding words
  • Motor auras, such as weakness on one side of the face or body

Aura typically lasts between five minutes to one hour. 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 to 48 hours before the headache phase.

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

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

Prodrome is the first phase of a migraine attack, which may occur 24 to 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.


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