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Migraine Attack Prediction: Premonitory Symptoms

Despite the frequent focus on the pain and other symptoms people with Migraine experience during the attack itself, there are actually other phases of a Migraine in addition to the attack phase.

One of these, the premonitory phase, comes before the attack. Once you are armed with knowledge about symptoms associated with the premonitory phase, in time you’ll be amazed at your ability to predict an attack before it starts.

Some of the most common symptoms experienced by Migraine patients in the premonitory phase are:

Being able to predict a Migraine attack in advance has a number of advantages, some obvious, some not so obvious.

(1) You can take your treatment medications right away. We know from research that the earlier a Migraine patient takes a triptan and/or other acute treatment medications, the more likely it is the patient will get relief.

(2) You can make adjustments in your plans in advance instead of having to scramble at the last minute in the midst of an attack.

(3) You can start utilizing your complementary coping strategies right away instead of waiting until you’re in excruciating pain and/or vomiting to try to gear up to ride the wave of that Migraine attack. For example, I rely on mindfulness and relaxation techniques as one way of coping. They’re more useful for me during the attack if I can get my mind right in advance.

It’s one thing to suggest we as Migraine patients frequently experience these symptoms before an attack, but another altogether to realize we’re actually quite good at recognizing and using them to predict our attacks in advance.

At the recent joint meeting of the International Headache Society and American Headache Society, researchers presented exciting data from a study about premonitory symptoms. They learned that Migraine patients as a group are moderately successful in predicting their next Migraine attack. These patients were able to predict their next attack within three days by paying attention to their premonitory symptoms. A subgroup of Migraine patients (10.8% of the study population) were very good at predicting their next Migraine attack. These patients were able to use their premonitory symptoms to predict an attack occurring the next day and very accurately predict an attack starting in the next three days.

Sometimes just reviewing the list of frequent premonitory symptoms is enough for us to realize we experience one or more of them. But beyond that, you can also keep a Migraine diary and record the details of what you experience each day. This allows you to go back through the entries and look for associations and patterns.

Which premonitory symptoms do you experience?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. W.P.J. van Oosterhout, G.G. Schoonman, T. Stijnen, et al. "Premonitory Symptoms as a Predictor for Migraine Attacks; a Cross-Sectional and Prospective Study." P90. International Headache Congress 2013.


  • Janine Parkinson
    6 years ago

    The yawning, neck/shoulder stiffness, irritability and gastrointestinal are all classics for me but not necessarily all at same time – occasionally difficult for me to predict my migraines as I always wake with them but this article has given me another weapon in my personal battle with them to notice on days if I am suffering excessively with more than one of these ‘premonitory symptoms ‘ – I can prepare myself for what may be about to hit me when I next wake!

  • merrie
    6 years ago

    Yawning, extreme fatigue and irritability, although since I have migraines every day now, these are less useful predictors bc I am always exhausted and irritated 🙁

  • Janet
    6 years ago

    I concur…when you’re plagued with daily chronic migraines you don’t get that break …

  • Krissygirl333
    6 years ago

    Neck pain and stiffness for sure

  • Diana-Lee author
    6 years ago

    Yes, that’s definitely something I can relate to!

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