Triggers versus Prodrome
Over the past 40 years, a lot has been learned about Migraine. One of the things we’ve learned is that attacks can start hours before the onset of pain. This prodrome can last for up to two days before the pain and nausea set in. Some of the symptoms of prodrome can easily be mistaken as triggers. So how do you tell the difference? It's certainly not easy. Maybe my experiences will give you some ideas.
There are a few things my parents and I thought were triggers that turned out to be prodrome symptoms. Of course, back in 1975 not even the experts knew that migraine attacks came in 4 phases. We all made the mistake of blaming the migraine attack on whatever occurred less than an hour before the attack started. We believed that migraine attacks started when the pain began.
For a few days before an attack, I have lots of energy and grandiose thoughts about how much I can accomplish. I’m also impatient when I feel held back. This hypomania can start as much as 2 days before an attack and continue until just a few hours before the pain starts. During this time I have a lot of energy, can’t sleep, and don’t feel hungry. After about 8 hours of this, I start to realize that my plans are not realistic and get irritable. Then the crying starts along with a pity party.
As a young child, my parents observed that every time I had an emotional meltdown I would also get a migraine attack. They concluded that the mood swings and crying were triggers and encouraged me to stay calm. To this day my mom still thinks I can “give myself a migraine” when I am upset. But mood swings and crying are not my triggers. They’re prodrome – uncontrollable, unstoppable signals that migraine is about to attack.
For at least a day or more before an attack I crave carbohydrates, especially chocolate. After decades of trial and error, I have concluded that this is definitely a prodrome symptom. Whether I give in to the cravings or not, the migraine attack still comes. Giving in to the cravings does soften the blow of mood swings.
For years I tried to resist these cravings with sheer willpower. Successful or not, migraine attacks still happened. Many times the attacks were far worse if I fought against the cravings. At least for me, carbohydrates (while not good for me in excess) do not trigger migraine attacks.
It can start as much as 24 hours before the attack begins. I never yawn unless I am about to have a migraine, and then I can’t stop. Many people joke that yawning is contagious. It wasn’t until I learned about prodrome that I made the connection between non-drowsy, uncontrollable yawning and migraine.
Before learning about prodrome, I believed that yawning was a sign that I was not well-rested. Sleep disruptions can certainly trigger migraine attacks. However, the yawning itself is not a reliable indicator that I am over-tired.
Neck and shoulder pain
My shoulders, upper back, and neck get stiff and sore a few hours before an attack starts. It is one of the last prodrome symptoms to appear. When it arrives, I know I have limited time to get prepared because I have passed the point of no return. This signals that it’s time to double-check my supply of medicine, gather my comfort measures, and settle in to my Migraine Cave.
Long ago I tried to prevent neck and shoulder stiffness in an effort to prevent migraine attacks. I was convinced (as were many chiropractors) that muscle tension was a trigger. After 26 years of chiropractic care, thousands of dollars in ergonomic office furniture, countless massages, and months of physical therapy, I still get neck and back pain before every single migraine attack.
Photophobia & Phonophobia
When whispers sound like shouting and even dim lights burn my eyes, the pain is imminent. If I take an abortive at this moment, I can occasionally stop the process. Taking medicine any earlier will not help. It must be at this point in order to work. This is one symptom that hangs on from prodrome all the way through the postdrome hangover.
Sure, bright lights and loud noises are triggers. But photophobia and phonophobia happen even in their absence. My family will attest to being snapped at all too often to turn off a light or lower the volume on the television. Just because I am sensitive to light doesn’t mean that the light triggered an attack.
There are many other prodrome symptoms, so please check out our complete list. This is just an example of how I’ve learned to separate trigger from prodrome. What symptoms do you experience during prodrome? Are there any that you used to think were triggers?
It starts sooner than you think
What I finally realized is that the Migraine attack started the minute I started getting mood swings and food cravings. Avoiding, resisting, or controlling these symptoms made absolutely no impact on the likelihood that I would soon be blinded by pain. The experts say that the headache phase of a migraine can last for up to 72 hours. Those three headache days are often preceded by two days of prodrome symptoms. The chemical processes in the brain begin two full days before we ever feel the pain.
Preparing for the storm
Learning to identify those early warning signals can make a big difference in our sense of control. If we can see it coming, then we don’t feel quite so helpless when it hits. It’s a lot like preparing for severe weather. We can’t stop it. We know it will cause damage. But preparing for it helps soften the blow. How much better off are we if we stock up on supplies and take shelter from the storm instead of standing outside unprotected from the elements?
Do you know the early warning signs? What do you do to prepare for an attack? Do you feel more in control when you can prepare ahead of time?
How much has your migraine disease changed or evolved over time?