Migraine and Mental Health: Those Prodrome Mood Swings

Patient Expert & Health Professional
Medically Reviewed

Migraine is frequently comorbid with bipolar disorder. Yet Migraine itself can present some intense psychological symptoms. The prodrome can begin up to 48 hours before the headache phase. It is during this early warning period that many people report intense emotions. To the untrained eye, these dramatic mood swings may look like a manic episode. Prodrome mood swings may be intense enough to make you wonder if you need to seek counseling or psychiatric help.

Common psychological symptoms that can occur during prodrome:

  • Depressed mood
  • Irritability
  • Anxiety
  • Elevated mood
  • Increased energy
  • Inability to concentrate
  • Insomnia

A true manic episode is quite different. For starters, it lasts for at least a week, regardless of Migraine. Next, it is often followed by weeks or months of a major depressive episode. A manic episode takes over, making it difficult to function in daily life. The mood changes are observable by other people. However, the affected person may not realize what is happening at all.

Common symptoms of mania include:

  • Expansive mood
    This is more than just feeling happy or self-confident. It is a feeling of invincibility and overwhelming positivity in the face of proof to the contrary. When challenged, the person either ignores the challenge or becomes combative.
  • Inflated sense of self
    These are grandiose, irrational self-perceptions of one’s ability.
  • Decreased need for sleep
    A person can go days without sleep and still feel alert and refreshed.
  • Racing thoughts
    Thoughts are coming so fast that they cannot be processed or communicated.
  • Pressured speech
    This rapid, loud speech is often unrelated to the situation and the urge to speak is overwhelming.
  • Difficulty concentrating
    Due to racing thoughts, the person cannot slow down enough to focus.
  • Increase in goal-directed activity
    These mood changes compel the person to act. They may spend days working on a project without stopping to sleep, eat, or use the bathroom.
  • Psychomotor agitation
    Feelings of restlessness are so great that the person involuntarily moves excessively and more rapidly. They can often be observed pacing about and talking to themselves.
  • Excessive involvement in pleasurable activities
    Gambling, drinking, recreational drug use, sex, shopping are common activities during a manic episode. Patients are likely to engage in these activities to the detriment of finances or close relationships. They will even persist despite serious injury or law enforcement involvement.

It is possible to have both Migraine and bipolar disorder. A true manic episode will occur independent from a Migraine attack, last much longer, and will often be followed by a major depressive episode lasting more than two weeks. If the symptoms only occurred during a Migraine prodrome and disappeared as the attack subsided, it would be inappropriate to diagnose bipolar disorder. There’s simply no evidence to support a diagnosis of mania if the mood changes are limited only to the prodrome phase of Migraine.

If you are concerned about mood swings, then document these symptoms in your Migraine diary. Use the results to discuss your concerns with your doctor. If mood swings interfere with your daily activities or cause significant distress, please talk to your doctor, psychiatrist, or therapist.