Migraines can be debilitating and often come without warning. But for many migraine sufferers, identifying pre-migraine symptoms can provide critical time to take abortive medication and avoid a full-blown attack. Recognizing the earliest signs of an oncoming migraine is key to effective migraine management.
What are the phases of a migraine?
A migraine episode typically progresses through four phases:
- Prodrome – Early warning signs
- Aura – Mostly visual disturbances
- Headache – Throbbing pain on one or both sides of the head
- Postdrome – Aftereffects like fatigue and mood changes
Not every person experiences every phase with every migraine. But paying close attention to your body’s signals can help identify your own unique pre-migraine symptoms.
Prodrome phase – subtle changes emerge
For up to 60% of migraine sufferers, the earliest indications of an impending migraine take place during the prodrome phase, which can begin hours to days before other symptoms set in.
Some common prodrome phase symptoms include:
- Mood changes – depression, irritability, giddiness, euphoria
- Food cravings
- Thirst and frequent urination
- Neck stiffness
- Sensitivity to light or sound
- Fatigue and low energy
- Nausea
- Difficulty concentrating
- Frequent yawning
The prodrome phase offers a critical window for abortive migraine treatment. Taking medications at the first signs of prodrome symptoms can stop a migraine before it ever gains full force.
Aura phase brings visual and sensory changes
Up to 30% of migraine sufferers experience temporary neurological disturbances known as auras. These fully sensory hallucinations signal that a migraine will soon occur.
The most common auras include:
- Visual disturbances – flickering lights, spots, zigzag lines, temporary vision loss
- Sensory numbness or tingling – often starting in the fingers and spreading to the arm and face
- Speech problems
- Confusion
- Weakness or paralyzed feeling on one side of the body
Auras develop gradually over 5 to 20 minutes and last less than an hour. The migraine headache phase begins soon after the aura phase ends.
Headache phase brings the pain
This is the phase most people associate with migraines – throbbing pain on one or both sides of the head.
Migraine headaches also tend to have these key features:
- Pulsating or throbbing sensation, often described as feeling like a pounding inside the head
- Pain level ranges from moderate to severe
- Pain worsens with physical activity
- Nausea and sensitivity to light and sound
- Lasting 4 to 72 hours if untreated
Additional migraine headache symptoms may include:
- Watery eyes
- Congested, runny nose
- Frequent urination
- Diarrhea
- Sensitivity to smells
- Lightheadedness or dizziness
The pain phase is when over-the-counter and prescription medications are most helpful for relieving migraine symptoms.
Postdrome brings migraine hangovers
After a migraine attack, many people feel hungover and drained. This postdrome or migraine hangover phase can last another 24 hours.
Typical postdrome symptoms include:
- Fatigue
- Difficulty concentrating
- Mood changes – depression, irritability
- Weakness and dizziness
- Neck pain
Understanding postdrome effects can explain cognitive difficulties and mood changes following migraines. Be patient with yourself and allow time for full recovery.
Keep careful records to identify pre-migraine patterns
The best way to determine your unique pre-migraine symptoms is to keep detailed headache diaries or use a migraine tracking app. Note specifics like:
- Date, time and length of migraine episodes
- Triggers – foods, lack of sleep, hormonal changes
- Exactly how you felt in the hours and days leading up to the headache phase
- Any relief measures that helped ease symptoms
Review your records regularly for any early warning sign patterns. Then share your findings with your doctor to inform effective treatment plans.
Treatment options for pre-migraine phases
Catching a migraine early opens up more treatment possibilities for avoiding a full-blown attack. Treatment options for each phase include:
Prodrome phase treatments
- Over-the-counter pain relievers like aspirin, acetaminophen or ibuprofen
- Triptans – prescription medications like sumatriptan that constrict blood vessels
- Anti-nausea medications
- Applying hot or cold therapy to the head and neck
Aura phase treatments
- Find a quiet, dark room to rest
- Triptans to constrict blood vessels and inhibit pain pathways
- Inhale essential oils like lavender or peppermint
Headache phase treatments
- Prescription-strength pain relievers
- Triptans
- Antinausea medications
- Muscle relaxers
- Nerve blocks – injections that temporarily block pain signals from reaching the brain
Postdrome phase treatments
- Over-the-counter pain medication
- Rest and sleep
- Hydration and light, easily digestible foods
- Gentle yoga stretches
Talk to your doctor to develop an abortive migraine treatment plan tailored for each phase of your attacks.
Lifestyle changes to reduce migraine frequency
While you can’t always prevent migraines entirely, making certain lifestyle changes can significantly reduce your risk of episodes and minimize pre-migraine symptoms when they do strike.
Helpful lifestyle adjustments include:
- Get enough sleep – aim for 7 to 9 hours per night
- Eat regular meals – avoid skipping meals or fasting
- Stay hydrated – drink water throughout the day
- Limit caffeine – consume no more than 200mg daily
- Manage stress – try yoga, meditation, massage
- Exercise regularly – aim for 150 minutes per week
- Keep a consistent daily routine
Making healthy lifestyle choices goes hand-in-hand with keeping careful migraine records to better prevent and manage your migraine attacks.
When to seek emergency migraine treatment
Most migraine episodes can be managed at home by taking medication at the earliest pre-migraine stages. But be sure to seek emergency care if you experience:
- Sudden, severe headache unlike your usual migraines
- Fever and stiff neck along with your headache
- Confusion, difficulty speaking or understanding
- Vision loss, double vision, weakness or numbness
- Headache after a head injury
These signs may indicate a medical emergency like stroke, meningitis or hemorrhage. It’s always better to err on the side of caution and seek immediate medical attention when concerned.
Pre-migraine symptoms offer opportunities for treatment
Paying close attention to subtle changes in your mood, digestion, sleep patterns, and perceptions in the hours to days before migraine pain starts can unlock effective ways to prevent attacks from developing.
While you can’t always stop migraines before they start, recognizing individual pre-migraine symptoms provides a valuable window of opportunity to minimize your pain and discomfort. Keeping detailed headache records, identifying your triggers, and working with your doctor on an abortive treatment plan helps take advantage of your migraine early warning signs.
With diligent tracking and tailored treatment strategies for each phase, you can hopefully keep more migraine episodes confined to the early stages and reduce the number of full-blown debilitating attacks you suffer overall.