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Triggers versus Prodrome

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.

Mistaken identity

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.

Mood changes

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.

Food cravings

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.

Yawning

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?

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

Comments

  • Ellifane
    1 year ago

    Thank you for this. I’m still learning the definitions but I had the food cravings as a warning sign of an impending migraine. I could never resist the carbs and thought maybe it was a hormone thing (aka a trigger). You are right though, no matter how much I have, or little, it made very little difference with the migraine. You also brought up another good point that I didn’t realize, I too yawn. At least with this migraine, I did yawn before the mother of all migraines attacked. Thank you again, I appreciate the information and again that I’m not the only one.

  • UKuser
    2 years ago

    This has been really helpful for me Tammy ♡ I will try to differentiate with my own symptoms. The moods like you, I thought we’re a trigger but maybe it is prodrome. I also am bipolar so this complicates things a bit

  • Anne
    2 years ago

    btw – carbs and chocolate create serotonin – migraines correspond to drops in serotonin levels so makes sense that this is a good indicator that a migraine is coming

  • Anne
    2 years ago

    what a great article!!!! This is so right on the money and what I tell fellow migraine sufferers (and doctors). I have the boundless energy before my migraine – I feel like a healthy person and then I know it’s coming and it always does. I get the cravings, too, and I know it’s coming. The light sensitivity always means migraine’s on it’s way.

  • DonnaFA moderator
    2 years ago

    Hi Anne! We’re so glad you enjoyed the article, thanks for taking the time to let us know. I thought you might be interested in reading other members experience with food cravings. Thanks for being part of the community, we’re glad you’re here! -Warmly, Donna (Migraine.com team)

  • Tory
    3 years ago

    Has anyone ever suffered from debilitating fatigue prior to migraines? I’m talking can not get out of bed, sleeping for 48 straight hours on zero meds, along with no appetite and lower GI pain. My migraines are chronic, resulting from two head traumas, the last of which was 7 months ago. I’ve always been on the low energy side, but I couldn’t sleep this much as a teenager if I’d tried and I’m in my 40s now. I’m not depressed, I just get extreme vertigo, zero appetite though I force myself to eat, and it feels like I’m walking through quicksand when I try to move. Also I get really really pale. It’s happened before and I’ve been like this since Monday (today’s Thursday). Head is throbbing but no extreme pain. I’ve spoken with Stanford about this crippling fatigue before but they don’t seem alarmed by it. But it’s so frustrating, on top of the 15+ migraines per month I’m also sleeping the rest of my life away.

  • Anne
    2 years ago

    yes – I get extreme fatigue. I also found out I was low vitamin D, so my doctor is making me go in the sun and take supplements (just what a migraine sufferer wants – more sun). But I sleep a lot. Being in pain wears you out.

  • kirstinab
    3 years ago

    I too, experience debilitating fatigue prior to a migraine. Often, this unbelievable exhaustion is worse than the actual pain of migraine. To make matters worse, I often do not take my abortive medicine in a timely manner when this type of fatigue sets in (too tired to walk to the kitchen, tired!)
    I’ve been to numerous doctors/specialists, most do not address the fatigue. One doctor, a cardiologist, thought it might be narcolepsy. I Had various tests done, but they were inconclusive. Thanks to him, I am taking some medications that help with General fatigue, but they don’t seem to help the debilitating fatigue before a bad migraine.
    I experienced a head trauma in my teens and wonder if this is a contributing factor.

  • Ina
    3 years ago

    Thank you so much for this! It is exactly what I have been thinking for a while now. The mood swings, the hunger, the neck pain, and extreme yawning…all there. Another one for me is thirst. I will often be ravenously thirsty the day before a migraine. I used to think that the thirst was the trigger (I must not be hydrated enough), but I am coming to realize that it happens even when I have had enough water, so it might be a prodrome. Experienced it again yesterday, and today woke up with a migraine.

  • katsock
    3 years ago

    I don’t know if it is carbs or chocolate but it is usually one of those 2 items that I start to crave. I will go open the door on the refrigerator not see anything that looks appealing (remember nausea coming on) and go back 10-15 minutes later and look again. I know that nothing has changed but something is still making me go and look for anything to satisfy this craving. I don’t even have to have something big as it can literally be 2 bites of chocolate (fun size bars or smaller) and the craving calms down and the nausea does not strike to bad. But if I don’t find something to take that few bites of I will make that trip multiple times until I try something. I am tired of my brain telling me what to eat or to hide in the dark or to ruin another family day because it is in a mood. I really wish that someone could figure this out so that we could all get our lives back.

  • Joxie
    4 years ago

    I have never analyzed physical and mental occurrences prior to a migraine. Maybe I should. I do know that the stiff, sore neck happens immediately before a full – blown migraine. Extreme fatigue and depression happen before, during, and after each migraine episode. The fatigue leaves me rather worthless. I have always thought that these events were part of the migraine.

  • Kiddy
    4 years ago

    I have very frequent urination as a
    prodrome.

  • SReeves
    4 years ago

    Oh my gosh! I had no idea this chronic neck pain was part of the prodrome. It’s almost always there (and right under my shoulder blade on the left side). I’ve seen five neurologists and two pain management doctors and none of them has mentioned this. No wonder the chiropractors, massage therapists, physical therapists and acupuncturists haven’t helped with long-term relief. I’m not sure what I need to do with this new information, but at least I know the neck pain isn’t a trigger and is part of the migraine. Thank you!!

  • maankigo
    4 years ago

    I get neck pain too. I sometimes even think of it as migraine with out head pain because I will have acute neck pain on one side for a day or so. The problem is that my neck pain never seems to go away. (I have been diagnosed chronic for 11 years; migraines for over 20.) It may not feel as bad, but I always seem to have a stiff sore neck with knots in my shoulders. So I wondered, Tammy, if when you say the pain goes away if that is the case entirely or just the pain diminishes?

    I ask this because I too have been doing Chiropractic and massage for years without improvements. I have thought that my sore neck was an aggravating factor, maybe not a trigger but contributing, now I am wondering if I should rethink that perspective.

  • Tammy Rome author
    4 years ago

    It used to get worse before an attack, but I did have baseline pain. That was a comorbid condition called Cervicogenic Headache that was caused by degenerative disc in my cervical spine and a bulging disc between C6 and C7. My headache specialist referred me to a physical therapist who did Myofascial Release Therapy and to a pain management clinic for an epidural between the vertebrae. After about 20 weeks of physical therapy, the baseline pain disappeared. Now I only get neck pain as a prodrome symptom.

  • Jules2dl
    4 years ago

    I often get terribly hungry before a migraine, and since hunger is also a trigger for me, I always thought that I was getting the headache in response to the hunger. I know now that this is not always the case. When I get hungry as part of the prodromal phase of a migraine, it’s a sick kind of hunger…I get shaky, break out in a cold sweat, and feel as though I’ve got to eat or I’ll pass out. As soon as I’ve eaten, no matter what I’ve eaten, the headache starts. If I skip a meal, I’ll often get a migraine, but the hunger is not the same compelling type as I get from a prodromal hunger. I don’t feel sick, I just feel hungry and if I eat, I generally feel better, not worse.

  • Kathy
    4 years ago

    One of my prodromes is clumsiness. I drop things and bump into things. I think my eyesight is slightly affected and that’s why I get clumsy. not sure about that though. I also get neck pain and yawn a lot. I was chronic for 15 years and its finally improving since I stopped eating processed food. who would have guessed?! Down to about 2 a month!

  • Garangwyn
    4 years ago

    Wow…this really gives me a whole new perspective. My last migraine (yesterday & even today) I “thought” was triggered by that pain in my back, shoulder & neck. But now that you mention it, it is gone…and the migraine lingers. I had been doing a lot of sewing so I just thought I’d been bending over the sewing machine too long. It never occurred to me that it might be a symptom of the prodrome and not a trigger! I have had chronic migraines for “only” 4 years, but have learned a lot about them from this site and the bountiful information shared by those of you who have suffered with migraine disease all your lives.

    I am currently titrating off of Topamax, and now that I am down to 100 mg a day, I am much more in tune with my body and able to catch those subtle changes during the prodrome. When I was at high doses, I was so out of it, the migraine would hit before I knew what was happening. The pain is worse without the Topamax, but I am functioning much better in between migraines on the lower doses than I was on the higher ones. It has not seemed to increase the frequency much.

    Now I have a lot more to think about and be aware of! Always something new to learn, but all the better to learn to manage this disease that I will apparently be living with for a long time! Thank you so much for this article!

  • Laura
    4 years ago

    I thought for years that my neck pain triggered my migraines until I found this site. I understand my migraines so much better now.

  • JanetH
    4 years ago

    Tammy, thanks for sharing. I’ve noticed often before a migraine hits, I get really irritated about little things. Since I’m close to menopause, I attributed it to that, and it COULD be playing into the equation, but yep, mood swings. Also carb cravings, but again, I am still having periods, and also dealt with that with those. However, the hormonal issues couldn’t always be explained by the frequency of the symptoms. I also get the neck and shoulder pain/discomfort. Like you; money into chiropractic (I stopped); massage (nice when you can afford it, but doesn’t heal the problem). Best thing is my rice pack and heating pad. I do yawn sometimes prior to an attack; but more likely I feel just REALLY tired. It doesn’t have to do with how much sleep I got the night before.

  • Garangwyn
    4 years ago

    I also have the carb cravings and the fatigue. I have always wondered if the carb cravings is my body trying to increase my energy level, to counteract the fatigue? And like Tammy, I have tried resisting, but the migraine comes anyway. It is at least some comfort to give in to the carbs. Perhaps my body does need the extra carbs to prepare for what is coming.

    I am currently trying cranio-sacral therapy, which is quite costly and not covered by my insurance. It does seem to help, and the cranio-sacral therapist (also a reiki practitioner) can stop a migraine flat while I am on her table. But it almost always returns on the drive home, whether it is due to the sun (even though I have Theraspecs OVER my glasses, which get dark outside)…or whether it would happen anyway. There is so much to learn! And I’m not sure my brain will hold that much any longer! I’m already 60 years old!!

  • zippy36
    4 years ago

    I too always get the neck pain/tension. I thought that it was a trigger for many years but now realize that it is part of the prodrome. I appreciate the article.

  • Jill M.
    4 years ago

    Excellent article, Tammy! Thanks for sharing.

  • Christine S.
    4 years ago

    I hope, someday, to figure out what a predrome and a postdrome look like in my life. I went chronic almost a year ago without ever being diagnosed with migraine disorder. My “headaches”, often days long, and the neck and shoulder pain were allergies, work related problems, stress. I needed to see the chiropractor, I was out of alignment, I needed to relax. I went last year for a cervical mri because I KNEW I must have some injury. I stopped listening to my body a long time ago when I got sick of people telling me suck it up and quit being such a hypochondriac. So hearing my body again, even under these circumstances, will be good.

  • Tammy Rome author
    4 years ago

    I’m so sorry that your first experiences with migraine were with chronic migraine. I’ve been there and it does seem like all the symptoms run together and almost anything can set off an attack. There’s really not any quality of life when you’re chronic. I do hope you can find some relief very soon.

    I wonder…have you been able to see a headache specialist? That’s what made all the difference for me and finally broke that nasty cycle of never-ending pain. Please take a look at our list of specialists. It’s not a complete list, but it will get you started. If you need help finding a good one or knowing how to spot a good one, then please write back.

    http://migraine.com/blog/how-are-migraine-specialists-different/
    http://migraine.com/blog/the-mrf-directory-of-headache-and-migraine-specialists/

    Best wishes for many migraine-free days.

    Tammy

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