Prodrome: A Prediction of an Impending Migraine Attack

I recently wrote an article about migraine attacks with a focus on aura and the stages of an attack. I never really thought too much about the prodrome stage, though. When I get an attack, I personally never pay too much attention to the warning symptoms. As soon as I feel the first twinge of pain, I always take two Excedrin and hope for the best.

However, now that I did some research on the prodrome phase and its interesting and unique symptoms, I’m starting to think that if I pay better attention and maybe even keep a migraine diary or keep track on an app (like I recommend to others!), I may be able to recognize patterns and catch an attack before it hits.

What is prodrome?

According to the American Migraine Foundation, a prodrome, or “preheadache,” is the beginning of a migraine attack and can last several hours to several days. Although people with migraine may not experience prodrome before EVERY attack, when it does occur, it may give insight into patterns.¹

Migraine woke me from my sleep

Last night, I kept waking up in the middle of the night with excruciating migraine pain (after going to sleep just fine). Half-awake/half asleep, I wasn’t sure if I was dreaming or truly having a migraine attack. Instead of stumbling out of bed and taking two Excedrin, I kept going back to sleep - several times - and in the morning, I woke up with one of my worst migraine attacks ever. By the time I got the medication in me, it was full blast pain, and it took quite a while to feel better. The day was wasted, spent mostly in bed…

Were there warning signs?

BUT… connecting the dots, I started to think about the prodrome phase and its symptoms, some of which you wouldn’t normally associate with a migraine. These include:

• Mood changes, including depression or irritability
• Difficulty concentrating
• Tiredness
• Sensitivity to light and sound
• Insomnia
• Stomach problems like nausea, constipation, or diarrhea
• Muscle stiffness
• Yawning
• Food cravings
• Frequent urination

Sure enough, looking back, I did have some of these symptoms the previous day. Had I connected the dots better, I may have known the migraine attack was coming.

What were my prodrome symptoms?

The day before my migraine attack, I:

• Was tired AND moody: I needed a nap mid-day and was extremely cranky when I woke up, which is unusual. Usually, after a nap, I feel rested and refreshed.
• Had food cravings: I’d been eyeing an Uber Eats place for months which had amazing-looking milkshakes. Although I love ice cream, I’m not a milkshake person, but I absolutely HAD to have a milkshake right away. Sadly, after that milkshake, I also had stomach problems - not sure if it was related to the milkshake or the impending migraine attack, as stomach problems can also come with prodrome symptoms

So right there, that’s three or four prodrome symptoms that could have alerted me to an oncoming attack.

Keeping track

What does this teach us? While prodrome can be unpredictable and not happen with every attack, it’s one of many important factors to keep track of when keeping detailed notes about migraine attacks. Maybe you’ll notice a unique symptom that occurs before most attacks, and you can begin treatment quickly, lessening the pain. Talk to your migraine specialist for more information about prodrome or any of the phases of a migraine attack.