By recognizing your pre-migraine symptoms, you’re more likely to prevent a migraine attack from occurring.

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Migraine is more than headaches. It’s a neurological condition that affects more than 39 million people in the United States, according to the American Migraine Foundation. Migraine can cause severe pain and interfere with your daily activities.

Pre-migraine is one of the four stages of a migraine attack. Pre-migraine symptoms may occur before a migraine attack begins. And if you can recognize the pre-migraine stage, you may be able to take steps to avoid a painful migraine attack.

Migraine has four distinct stages.

Pre-migraine (also called the prodrome stage or premonitory phase) involves one or more symptoms that let you know a migraine attack is coming. These symptoms can begin anywhere from a few hours to several days before a migraine attack occurs.

The prodrome stage does not occur before every migraine attack, but learning to recognize pre-migraine symptoms can help you take preventive action.

It’s also important to know that not everyone who experiences a prodrome stage will have the same symptoms.

Possible pre-migraine symptoms include:

  • Mood changes: You might feel depressed, anxious, or irritable with no apparent cause for those feelings.
  • Muscle pain: Stiffness and cramping in your neck and shoulders are common pre-migraine symptoms.
  • Food cravings: You might have strong cravings, especially for sweet foods.
  • Difficulty concentrating: You might have trouble focusing and feel foggy or confused.
  • Fatigue: Even if you had a good night’s sleep, you may feel extra tired before a migraine attack.
  • Excessive yawning: Yawning frequently throughout the day can be a pre-migraine symptom.
  • Digestion trouble: You might experience constipation or diarrhea before a migraine attack begins.
  • More frequent urination: Needing to use the bathroom more often than usual is a common prodrome symptom.
  • Sensitivity to light and sound: You might have a low tolerance for bright lights and loud sounds before and during a migraine attack.

You can start to take action if you recognize pre-migraine symptoms. If you’re being treated by a doctor for migraine, they can help you come up with a pre-migraine management plan that could prevent a full migraine attack from occurring.

Try these common steps that can help during the prodrome stage:

  • Take pain-relieving medication: You may find it helpful to take pain relievers before a migraine attack begins. You can use over-the-counter (OTC) options such as Excedrin or prescription options. Follow your doctor’s instructions carefully when taking prescription medication for migraine.
  • Take any prevention medications as usual: If you’re having prodrome symptoms, be careful not to skip a dose of any prevention medications you’ve been prescribed.
  • Avoid any known migraine triggers: It’s always a good idea to avoid anything that triggers your migraine symptoms. But by taking extra care to avoid triggers when you notice pre-migraine symptoms, you may help prevent a full migraine attack.
  • Rest and relax: Taking time to rest and relax can help you prevent a full migraine attack. If you can, try to take a nap or go to bed early. Meditation or other relaxation techniques can be especially useful.
  • Find a dark room: It’s best to avoid loud, bright, and stressful situations while you’re experiencing pre-migraine symptoms. Relaxing in a dark, quiet room can help prevent a migraine attack.
  • Take a hot shower or bath: A hot shower or bath can help relax your muscles. You can also try warm compresses.
  • Try ice packs: Ice packs are a good way to numb your pain and help you rest.
  • Drink a caffeinated beverage: Small amounts of caffeine may help relieve pain and can enhance the effects of some OTC pain relief medications. But it’s best to stick to a small amount, such as a single cup of coffee or one can of soda. Consuming too much caffeine can lead to withdrawal headaches and make it difficult to sleep.

When to call a doctor

You might be able to treat migraine attacks with over-the-counter (OTC) medication and rest. But if your migraine attacks are frequent and interfere with your daily activities, it’s a good idea to talk with a doctor.

Contact a doctor if:

  • your OTC medications don’t help stop your migraine attacks
  • you need to take OTC medications more than twice per week
  • your migraine attacks have become more frequent than in the past
  • your migraine attacks become more severe when you move or change positions
  • your migraine attacks are new or more painful than in the past
  • your head seems to hurt all the time
  • you start to experience headaches after a head injury or trauma
  • you experience an increase in symptoms such as dizziness and numbness
  • your headaches are triggered by exercise or sexual activity

Aside from the prodrome stage, migraine involves three other stages. Not everyone will experience every stage during every migraine attack.

Aura stage

About one-third of people with migraine experience aura. If you experience aura, it will usually occur about an hour before a migraine attack.

Aura symptoms can vary but often include blurry vision, flashing lights in your vision, visual hallucinations, vision loss, numbness, dizziness, and changes in hearing and speech.

Headache or attack stage

During the headache stage, you’ll typically experience moderate to severe pain that’s concentrated on one side of your head. The pain is often throbbing and can become more severe when you move.

The attack stage can last anywhere from a few hours to 3 days and also includes migraine symptoms such as nausea, vomiting, trouble sleeping, and sensitivity to light, sound, and smells.

Postdrome or resolution stage

This stage occurs once the migraine attack has faded and can last for a few hours to a few days. Symptoms at this stage often include feeling drained, fatigued, dizzy, and achy. It’s best to continue to avoid triggers and rest as much as you need during this stage.

Questions to ask your doctor

Understanding your migraine attacks can help you manage them. Don’t be afraid to ask your doctor questions during your appointment, such as:

  • Could an underlying health concern be causing my migraine attacks?
  • Could alcohol, smoking, or stress be causing my migraine attacks?
  • Could changes such as getting more exercise help prevent migraine attacks?
  • Are there foods I should avoid?
  • Are there foods I should eat more of?
  • What medications can I take to prevent migraine attacks or to stop an attack?
  • What medications can treat secondary symptoms such as nausea and dizziness?
  • What are the side effects of the medications?
  • What are signs or symptoms that my migraine could be related to something more concerning?

The pre-migraine stage can start anywhere from a few days to a few hours before you have a migraine attack. Symptoms can vary but often include:

  • confusion
  • fatigue
  • more frequent urination
  • sensitivity to light and sound
  • mood changes
  • neck pain
  • food cravings

Learning to recognize your pre-migraine symptoms can help you manage migraine and possibly avoid an attack.

Talk with a doctor if you’re having migraine attacks frequently. They can help you identify your pre-migraine symptoms and the steps you can take during pre-migraine to avoid an attack.