A recent study identifies the most common symptoms of the prodrome phase of a migraine attack. Learn how research into migraine prodrome symptoms may pave the way for earlier and more effective treatments.

In the first phase of a migraine attack, referred to as the prodrome phase, people often experience a range of symptoms that indicate a headache is on the horizon. A new study found that while the majority of people with migraine are aware of prodrome symptoms, only around half recognize these symptoms as warning signs that an attack has started. 

We spoke with one of the study’s researchers, Dr. Richard B. Lipton, Edwin S. Lowe Professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, about the results of the study and what it means for people who live with migraine. Dr. Lipton also discussed how increasing awareness of migraine prodrome symptoms can aid in migraine management.

What is migraine prodrome?

When people think of migraine, they usually think of symptoms like head pain, nausea, vomiting and sensitivity to light. These often debilitating symptoms are commonly associated with the headache phase of an attack. However, there are a range of other symptoms that a person may experience throughout the other phases of a migraine attack.

The earliest stage of a migraine attack is called the prodrome phase (or the premonitory phase). How long does the prodrome phase last? It varies from one attack to another, but it typically lasts a few hours.

“The most prominent symptom of migraine is headache, but headache is never the sole symptom,” says Dr. Lipton. One of the most important takeaways of the study is that prodrome symptoms can be debilitating in and of themselves. “There is substantial temporary disability during the pre-headache phase, even before pain begins, and also in the post-headache phase,” he says.

Identifying the Most Common Symptoms of the Prodrome Phase 

The CaMEO study was a web-based study which asked respondents meeting diagnostic criteria for migraine to report symptoms and warning signs they believed meant a migraine was coming. Respondents were given a list of possible symptoms and asked to identify any that matched their experience. Slightly more than 84% of respondents experienced at least one pre-headache symptom. However, only 56% believed their symptoms acted as a warming sign that the headache was coming.

Dr. Lipton and his fellow researchers found that the most common symptoms of the prodrome phase included:

  • Neck pain and stiffness
  • Vision changes
  • Dizziness and feeling lightheaded
  • Foggy thinking
  • Trouble concentrating
  • Moodiness and irritability
  • Fatigue

Other common signs of the prodrome phase include excessive yawning and cravings for certain foods.

How does recognizing prodrome symptoms impact migraine treatment? 

The researchers also found another significant feature of the prodrome phase: Although symptoms may be different from one person to the next, an individual person tends to have similar symptoms from one attack to another. This means that if a person can track and recognize their specific prodrome symptoms, this can be an important tool in their overall migraine management plan.

Reducing Migraine Anxiety

“A big part of the burden of migraine is its lack of predictability,” says Dr. Lipton. People are afraid to make plans or worried about missing upcoming events, such as a work presentation or a wedding. If a person can more accurately identify their prodrome symptoms, this can help them be more aware of the start of an attack and use migraine treatments earlier. This in turn can reduce migraine anxiety.

“There are many people who worry about the next attack,” Dr. Lipton says. “To the extent that you can render attacks more predictable, you reduce that burden.” 

Using Medication in the Prodrome Phase

Dr. Lipton also points to research led by Dr. David Dodick and presented by Dr. Peter Goadsby at a recent American Academy of Neurology meeting. Dr. Goadsby’s research—based on a study called the PRODROME Trial—found that treatment with the acute migraine medication Ubrogepant during the prodrome phase of an attack can actually reduce pain and other symptoms during the headache phase. 

Additional research is needed to determine if these findings also apply to other types of acute migraine medications, but Dr. Lipton notes that this has the potential to signal a “paradigm shift” in migraine treatment strategy. More accurate and widespread knowledge of prodrome symptoms is helpful here as well.

“In the old [model of migraine treatment], if you know a headache is coming, you can plan, you can be sure you bring your migraine medicine with you and you can think twice about traveling,” Dr. Lipton says. “But in the new [model], you can actually treat when you get prodrome symptoms and know a headache is coming. That can be a considerable benefit.”

Migraine Prodrome Treatment 

People who experience migraine often have intense, incapacitating symptoms during the prodrome phase. Dr. Lipton hopes that in the future, migraine treatments will be able to target these specific symptoms of prodrome in addition to the more well-known symptoms of the headache phase. 

“The real implication [of the study] is that if you treat your prodrome—if you can identify prodrome and reliably predict your headaches—then you can treat during prodrome and shorten the prodrome phase, [a phase that] is disabling in its own right,” Dr. Lipton says. 

The Future of Migraine Management

Dr. Lipton’s study shows that while many people are generally aware of their prodrome symptoms, people differ in their ability to recognize these symptoms as signs of an oncoming migraine attack. 

Some people are highly aware of their bodily sensations, such as feelings of fatigue, changes in mood, tension and appetite. However, people with less bodily awareness—called interoceptive awareness—may not reliably notice the same signs and symptoms happening regularly before their attacks. This means that some people are likely naturally better at predicting an oncoming headache than others.  

“The limitation of my study is that people could have robust warnings that never made it into their conscious awareness,” Dr. Lipman says. “So a next step is to use smartphones and have people record their symptoms in real time, and then record whether they get a headache.” 

Researchers could then further analyze which non-headache symptoms are more predictive of headache than others. The better we can document and understand prodrome symptoms, the greater the chance that people with migraine and their doctors will be able to effectively manage symptoms, prevent attacks and improve quality of life.

For more of the latest news and information on migraine and migraine treatment and management, visit the American Migraine Foundation’s doctor-verified resource library. For help finding a healthcare provider, check out our Find a Doctor tool.