Recognizing the Migraine Prodrome

Patient Expert
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A Migraine attack can have up to four phases. The first is the prodrome or premonitory phase. The prodrome is symptoms preceding and forewarning of a Migraine attack by two - 48 hours, occurring before the aura in _ Migraine with aura_, and before the onset of pain in _** Migraine without aura** _.

The prodrome is often overlooked. Many patients don't know about it. According to Dr. Peter Goadsby, the prodrome is "common if you ask about it, but patients often don't think to tell about those symptoms." Several studies have shown that some Migraineurs are able to very accurately tell that a Migraine attack is beginning from their prodrome symptoms. In one study of patients who were aware of having prodrome symptoms (Giffen et al.), participants correctly predicted a Migraine following prodrome symptoms 93% of the time.

Prodrome symptoms can vary from one Migraine to the next. Some Migraineurs have even found that which prodrome symptoms they experience is a good indicator or how severe their Migraine is going to be because they have different prodrome symptoms with mild, moderate, and severe Migraines. Possible prodrome symptoms include:

  • concentration problems,
  • depression,
  • difficulty reading (aphasia),
  • difficulty speaking (aphasia),
  • diarrhea
  • fatigue,
  • food cravings,
  • hyperactivity,
  • hypoactivity,
  • increased thirst,
  • increased urination,
  • irritability,
  • nausea,
  • _phonophobia _,
  • _photophobia _,
  • repetitive yawning,
  • sleep problems, and
  • stiff neck.

How long before the aura or headache phases the prodrome symptoms begin varies from one person to the next. For most Migraineurs, they begin one to two hours before the aura or headache, but for some, they can precede the aura or headache phase by 24 hours or more.

The prodrome can be beneficial for us. Knowing a Migraine is coming can allow us to be better prepared. If we're out and know a Migraine is coming, it can give us a chance to get home or someplace else safe and comfortable.

Do you know if you experience prodrome symptoms? Many doctors believe that most Migraineurs do, but that they aren't aware of them because they've never been asked about them. I've prepared a prodrome tracker to help determine if you have prodrome symptoms. To use it, mark any potential prodrome symptoms you experience. Then, after a Migraine, refer back to your prodrome tracker to see if you had prodrome symptoms. Using the tracker can help you become more aware of your body and any prodrome symptoms you may experience. _Download the free Migraine prodrome tracker _.

Given this information about prodrome would it be helpful to treat a Migraine during prodrome? For the answer see _Should we Treat a Migraine During Prodrome? _


Resources:

  • Goadsby, Peter J., MD PhD. "Premonitory Phase of Migraine - Biology and Clinical Characteristics." Platform Presentation. 53rd Annual Scientific Meeting of the American Headache Society. Washington, DC. June 4, 2011.
  • Sprenger, Till, MD. "Premonitory Phase of Migraine - Insights into Primary Headaches from Functional Imaging." Platform Presentation. 53rd Annual Scientific Meeting of the American Headache Society. Washington, DC. June 4, 2011.
  • Becker, Werner J., MD PhD. "Premonitory Phase of Migraine - Treatment of premonitory Phase of Migraine: What is the Evidence?" Platform Presentation. 53rd Annual Scientific Meeting of the American Headache Society. Washington, DC. June 4, 2011.

Medical review by John Claude Krusz, PhD, MD

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