Premonitory Symptoms: Predicting a Migraine

Premonitory symptoms, which occur during the prodromal phase of a migraine, are the first indications of an impending migraine episode. These can occur a few hours or several days before a migraine reaches its peak. About 60% to 80% of people who have recurrent migraines experience premonitory prodromal symptoms at least sometimes, and they tend to be associated with more severe attacks. When these symptoms do occur, they are followed by a migraine aura (if you have one) or by the migraine itself.

If you learn how to recognize your premonitory symptoms, you can use home remedies or take medications in an effort to stop your migraine from progressing.

Recognizing Premonitory Symptoms

A migraine generally consists of four sequential stages and can be a prolonged episode. You may routinely experience one, two, three, or all of these phases, or your migraines may differ in this regard each time they occur.

If you have premonitory signs and symptoms before your migraines, then you realize that a migraine isn't just a headache—it can involve your whole body as well.

Premonitory symptoms are variable, but the most common include:

• Fatigue
• Mood changes (depression or irritability)
• Gastrointestinal symptoms (like a change in bowel habits or nausea)

Other common symptoms include:

• Muscle stiffness/aching/pain, especially in the neck, back and face
• Food cravings or a loss of appetite
• Difficulty concentrating
• Confusion
• Feeling cold
• Sensitivity to light, sound, or smells
• Excessive yawning
• Vivid dreams

Prodrome vs. Migraine Aura

The terms prodrome, premonitory symptoms, and aura are frequently confused. A prodrome is the first migraine phase and is characterized by premonitory symptoms, while an aura is a different phase characterized by neurological symptoms.

A migraine aura typically does not last more than 60 minutes, whereas premonitory symptoms last hours to days.

Premonitory symptoms are also different biologically from an aura. Premonitory symptoms are believed to involve the neurotransmitters dopamine and serotonin, which modulate pain and mood. Research also suggests that this phase may involve the hypothalamus, which controls hormones in the body.

An aura is characterized by electroencephalogram (EEG) changes described as cortical spreading depression, which is diminished nerve activity that sweeps across the outer layer of the brain.

When Premonitory Symptoms Strike

If you notice that you have premonitory migraine symptoms, you can try to make your next few days more comfortable by taking steps to reduce the severity, and possibly even avert, a migraine.

Keep in mind that since premonitory symptoms are associated with more severe migraines, it is a good idea to pay attention to them. They could indicate that an intense migraine is on the horizon, which you may need to prepare for.

• Lifestyle: Important migraine prevention strategies include staying hydrated, relaxing, exercising, and avoiding your usual migraine triggers (e.g., such as bright lights, sleep deprivation, and alcohol). Incorporating a yoga practice, mindfulness routine and good sleep hygiene can also help.
• Medication: If you have had success with a migraine treatment, such a nonsteroidal anti-inflammatory drug (NSAID) or a prescription medication, taking it during your prodrome can minimize your migraine before it peaks. However, be cautious not to take medication both during your premonitory phase and then during the headache phase, as this may contribute to medication overuse headaches.
• Social: Let your loved ones know that you are experiencing prodromal symptoms to set up expectations. Now is also a good time to ask for support with things like errands and childcare. Be aware that you may be more sensitive or easily angered. It may be best to avoid addressing emotional issues until you are physically more comfortable.

A Word From Verywell

If you experience recurrent migraines, you need to try to recognize the patterns of your episodes, including the triggers, the earliest symptoms, and how often they occur. Recognizing premonitory symptoms is an important aspect of migraine management that can give you more control over the outcome and overall severity of your migraines. Researchers are studying this migraine phase to identify the earliest biological changes in migraine attacks, as well as how migraines can be treated before they reach their maximal intensity.