Prodrome: Signs A Migraine's On The Way

Prodrome is the first of four potential phases of a migraine attack. Up to 80% migraineurs (people who experience migraine) experience a prodrome phase, which lasts anywhere from 2 to 48 hours before the onset of the headache and other symptoms, such as light and sound sensitivity and extreme nausea.

If you can learn to recognise your prodrome symptoms, it might be possible to abort your migraines before they reach the attack phase.

Sorry. Don't believe you.

Luciani and colleagues studied 20 migraineurs. In the initial phase, they were asked to record their migraines and any prodrome but not to treat their migraine until the headache began. 100% of the prodromes developed into a migraine attack. In the treatment phase of the study, the 20 patients were treated with naratriptan, and told to use it when they had prodrome symptoms and felt a migraine was "inevitable". The prodrome developed into a migraine only 40% of the time.

A study of 19 migraineurs by Waelkens found that treating patients during the prodrome phase decreased the amount of migraines by 65%.

Although you shouldn't treat yourself in the prodrome phase, if you have reliable and recognisable prodrome symptoms, you could discuss this option with your doctor at your next appointment.

Possible prodrome symptoms

Here are fourteen possible symptoms of prodrome, which can predict your migraine attack. If you're unsure about whether you are experiencing prodrome, try keeping a headache diary. Identifying your migraine pattern could help you nip it in the bud as soon as it starts.

Symptom 1: Speech problems

Aphasia (problems with the production, comprehension or selection of the right word; it causes a problem with both speaking and writing) is a common, early prodrome symptom. Reading and speaking are problematic.

Symptom 2: Low Mood

Depression often occurs in prodrome, even in people who normally don't experience depression. That's because serotonin - the cheering, sleep-promoting neurotransmitter - drops when we get a migraine. Serotonin is an important mood-regulator.

Symptom 3: Irritability

If you're in the prodrome phase, you may snap at the people closest to you. This can make the migraineur in the prodrome phase quite difficult to live with. If people are asking you why you're so moody all of a sudden, consider that you may have a migraine on the way.

Symptom 4: Poor Concentration

Not only can this be a serious irritation for migraineurs, making it hard to work during the prodrome phase, it can also be dangerous if migraineurs are required to drive or operate machinery while their concentration is impaired.

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Symptom 5: Fatigue

When you have a prodrome, you are not merely "tired", you can be so exhausted and weak that all you want to do is creep off to bed in a dark and cool room and sleep.

Symptom 6: Constipation or Diarrhoea

Both are possible during the prodromal phase of a migraine attack. Children are more likely to experience diarrhoea than adults. However, many migraineurs find it risky to venture that far from their bathroom during the prodrome phase.

More Prodrome Symptoms

Symptom 7: Sensitivity to sound

If you frequently want to wear earphones, or crawl away and cover your ears with pillows, you may be suffering with phonophobia (sensitivity to sound). Phonophobia is one of the longer-lasting symptoms that frequently starts with prodrome and continues through the aura and attack phase.

Symptom 8: Light sensitivity

Photophobia (sensitivity to light) is one of the most common symptoms. As with phonophobia, the symptom generally continues throughout the attack. Light makes migraines more painful and may cause sensitivity in migraineurs even between attacks.

Symptom 9: Thirst

Needing to drink a lot more before a migraine is a lesser-acknowledged migraine symptom. People rarely spot it, especially if they have other medical conditions (such as diabetes), or take medications that may cause a dry mouth.

Symptom 10: Yawning

If you're yawning so much that people have asked, "Am I boring you?", it could be a lesser-noticed sign of prodrome. It's quite common, although we rarely notice we're doing it. It is thought that it may be due to changes in dopamine levels. However, further research is needed.

Symptom 11: Insomnia

Migraineurs are a bit stuck. Insomnia, or not getting rest, can act as a trigger for your migraine. It is also a symptom of prodrome and the migraine itself, with many sufferers experiencing insomnia or broken sleep until the attack has passed. This insomnia can continue to worsen the attack. And thus the cycle continues.

Symptom 12: Stiff neck

If you only have a stiff neck before your migraine, it's a symptom of prodrome. If your neck remains stiff after your migraine has passed, see your doctor as it could be a sign of something requiring treatment.

Symptom 13: Nausea

Did you know that nausea can begin in the prodrome phase, up to two days before your migraine? If you're feeling sick without other migraine symptoms, you may not be in the migraine phase.

Symptom 14: Food cravings

Many migraineurs have cravings for particular types of food in the prodrome phase: salty, sweet, crisp, carbs, or any mix of the above. While it's fine to indulge your craving, there's no evidence that there's any biological need behind them.

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But what's this mean?

A 2016 study by Nicola Giffin, published in the journal Neurology, revealed that patients who monitor prodrome symptoms could predict a migraine with a 93% success rate up to 24 hours before the attack phase strikes. As discussed earlier, this could be invaluable for preventing the debilitating pain and other symptoms of migraine.

By working with a neurologist or migraine clinic, chronic migraineurs could find the perfect time to take their abortive medication (when they know a migraine is imminent, but before it has become completely incapacitating) and so prevent migraines from taking hold and devastating the migraineur's life.

Watch your Triggers

We all know that prevention is better than cure. While you're monitoring your prodromes, try seeing if your migraines seem to have any particular triggers.

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Common triggers include:

• Flashing or strobe lights; florescent or harsh lights.
• Strong odours
• High altitude
• Lack of sleep (occasional, or during a prolonged bout of insomnia), or sleeping too much
• High and/or prolonged stress
• Skipping meals (irregular blood sugars are a big cause - you should eat little and often); excessive caffeine or alcohol; consuming red wine (which contains tyramine and has been linked to migraine); large amounts of camembert and brie (tyramine again).
• Additives, particularly: monosodium glutamate (MSG), nitrates and nitrites, Sunset Yellow (also known as Yellow Dye Number 6 and E110) and aspartame.
• Dehydration: Dehydration leads to migraine, so drink 8 glasses of water a day. Also avoid diet drinks with aspartame (see above).
• Looking at screens for hours on end. If you work with a screen, take regular breaks to do other tasks, and make sure you sit comfortably with your neck supported (neck strain is thought to contribute to migraine). No-one's saying that - if screen time is a trigger - you have to stay off your computer, but by being sensible and avoiding looking at your computer from breakfast until dinner (perhaps instituting a self-curfew), you can get everything that you need done, and may reduce your number of migraines.