Learn why identifying migraine triggers is not as clear-cut as people often believe, and how “triggers” may actually be signs of migraine prodrome.

Many people managing migraine are hopeful that they can identify specific “triggers” for their attacks so they can better anticipate and manage their symptoms. Some believe that things like food or exposure to certain smells are triggers, but in reality, people may already be experiencing symptoms of the prodrome stage of migraine—meaning some well-known “triggers” may be signs that a migraine attack has already started. 

Dr. Rashmi Halker Singh, neurologist and associate professor at Mayo Clinic Arizona, shares insights on how our understanding of migraine triggers is changing and some common prodrome symptoms that may be mistaken for triggers. She also advocates for shifting our focus away from anticipating “triggers” toward an awareness of prodrome symptoms rooted in personalized care.

What is the prodrome phase of migraine?

The migraine prodrome phase is the first phase of a migraine attack and can signal that a headache is about to start. Also called the “preheadache” or premonitory phase, the prodrome phase often lasts anywhere from a few hours to several days. Symptoms experienced during the prodrome phase may be more subtle than those experienced during the aura or headache phases, and may include things like mood changes, nausea, food craftings, muscle stiffness and fatigue. 

Understanding the timeline of a migraine attack can be helpful for people managing migraine. Since prodrome symptoms can vary, some people may not realize they’re having an attack until they enter the aura or headache phases. However, if you can recognize signs of the prodrome phase, you can begin using acute treatments that much earlier, possibly reducing the severity of the oncoming headache phase. 

“Triggers” May Really Be Signs That a Migraine Attack Has Already Started

Migraine attacks begin during the prodrome phase well before the onset of pain. While many people are more focused on the most obvious, painful and disabling symptoms of an attack, this means there are a range of other symptoms that may go unnoticed. Dr. Halker Singh notes that it’s not uncommon for people who live with migraine to not be fully aware of all of their symptoms—especially those of the prodrome phase.

This means that in many cases, symptoms of the prodrome phase may be mistakenly associated with causing a migraine attack when really the attack has already started. For example, many people with migraine may think their attacks are triggered by specific foods, like chocolate. This is because in the past they have noticed that they start experiencing the headache phase of an attack after eating chocolate, and they associate the food with their pain symptoms. 

So, can food really trigger migraine attacks? The reality is probably more complicated. Migraine prodrome can actually cause food cravings—meaning the craving for chocolate (or another food) might actually be a sign that an attack has already started. In these cases, the migraine attack would have happened whether or not a person satisfied their prodrome craving by eating chocolate. 

This misconception that people with migraine have to avoid certain food triggers is one of the prominent myths about migraine triggers

What are some common migraine prodrome symptoms?

People with migraine may experience a range of symptoms during the prodrome phase. Some of the most common include: 

  • Food cravings
  • Nausea
  • Fatigue
  • Excessive yawning
  • Excessive urination
  • Neck pain
  • Mood changes (including irritability and stress)

These early signs of a migraine attack are easy to miss. Because we tend to focus on painful and more obviously debilitating symptoms of an attack, some prodrome symptoms may be unexpected even for people who have lived with migraine for years. 

“Because these symptoms can be so subtle and a little bit unusual, people might not think about them as being part of migraine,” says Dr. Halker Singh. “But sometimes—when the pain phase hits and we look back to what has been going on the day before—if I list these symptoms, you might say, ‘Oh yeah, maybe that was my prodrome.’”

Reducing Stigma and Prioritizing Self-Care in Migraine Management

Sometimes when people attempt to carefully track and avoid all their triggers, it creates a sense of guilt. When we think about it this way, the burden is on the person with migraine to avoid their triggers, and people may feel that if they experience an attack, it’s because of their own behavior. 

“Many times it is just the disease,” says Dr. Halker Singh. “This is the unpredictable nature of migraine. I think we carry enough on our shoulders as it is without the added stigma or guilt [around triggers].” 

Instead, we can shift to a healthier conversation about awareness in migraine management by learning to recognize prodrome symptoms and early signs of a migraine attack. This puts the focus on a deeper, more personalized understanding of each individual’s own unique experience with migraine. 

“I think making that shift is a little bit freeing and allows us to separate ourselves from migraine,” says Dr. Halker Singh. “My personal relationship with my migraine changes a little bit—I can separate from my own guilt and say, ‘OK, this is happening, what can I do about it?’”

This kind of shift enables someone with migraine to focus more on self-care and addressing what their body needs in the moment during an attack.

Identifying Prodrome Symptoms to Enable Earlier Treatment of an Attack

Doctors and healthcare providers are increasingly focusing on more individualized treatment when it comes to managing migraine. “We’re really thinking about patient-centric care in migraine management and trying to limit the disability associated with migraine as much as possible,” says Dr. Halker Singh. 

While the standard approach to migraine management previously involved providing treatment when pain was mild, new medications look to offer the ability to treat during the prodrome phase, so that people can potentially avoid a migraine attack altogether. 

“If we can recognize the prodrome phase and identify when someone is going into a migraine attack, we may be able to [use acute treatment] in that moment and avoid the pain phase completely,” Dr. Halker Singh says. “Maybe that is the next step in migraine management. Imagine a world where you can take medication…at one of these beginning stages and really eliminate the rest of [a migraine attack]. Wouldn’t that be amazing?”

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.