What to Know About Prodrome Symptoms, the Earliest Stage of Migraine

They can help signal an attack before the pain fully hits.

Medically reviewed by Alina Masters-Israilov, MD

July 14, 2023

If you have migraine, you probably know the signs of an attack all too well: A throbbing headache, nausea, and sensitivity to certain lights and sounds can be hell. But you might also notice that you feel off in the days or hours leading up to an attack. Maybe you’re uncharacteristically irritable, guzzling more water than usual, or feeling extra stiffness in certain parts of your body. Weird as they might seem, those “off” feelings are actually part of migraine: the prodrome phase.

According to the American Migraine Foundation, prodrome is the first stage of a migraine attack—and most people with the neurological disease will experience it. It can happen hours or days before the throbbing head pain strikes, and it’s one of four phases of the condition. Aura, a phase that may follow prodrome for some people, can occur before or during the pain phase, and often includes vision changes. Next, the headache phase sinks in, typically lasting a few hours to a few days. Finally, postdrome, known as a “migraine hangover,” might leave you feeling pretty spent for a day or two. (It’s important to note, though, that you might not experience all of these stages with migraine.)

During prodrome you might be irritable or super tired, have mood swings, or feel hungrier or thirstier than you normally do. Those symptoms can be just as intrusive as the attack itself, says Lauren Aymen, DO, a neurologist who oversees the Headache, Migraine, and Facial Pain Center at the Michigan Institute of Neurological Disorders. “When I ask patients about migraine and how many days they’re affected, I count the prodrome as a migraine day because they are symptoms that can be just as disabling,” she tells SELF.

By understanding how—and when—your prodrome symptoms manifest, you can take steps to ease uncomfortable premonitory (a.k.a. pre-headache) issues and potentially prevent an attack from happening entirely. Here’s why the prodrome phase of a migraine happens and what you can do about it.

In the prodrome phase, your brain is warning you an attack is on the horizon.

When an attack is nearing, your brain becomes hypersensitive, particularly in the hypothalamus, thalamus, and cortex.¹ “Various areas light up or activate during this period before the full-blown migraine attack occurs,” Mia T. Minen, MD, MPH, the chief of headache research in the Department of Neurology at NYU Langone Health, tells SELF. As a result, body functions associated with those brain parts—like body temperature, hunger, mood, sex drive, sleep, and thirst—perform differently than normal. This dysfunction can lead to intense cravings, fatigue and constant yawning, frequent urination, neck stiffness or jaw pain, and mood changes, among other signs—which are often warning flags for what’s on the horizon.² “Patients will say, ‘I always get these symptoms, and I know a migraine is coming,’” says Dr. Aymen.

The exact symptoms of migraine differ from person to person, and that includes the prodrome phase. On average, it’ll kick in about 12 hours before an attack, says Dr. Minen, but some people won’t experience it until a few hours before the migraine actually starts. Additionally, Dr. Aymen notes that she has a handful of patients who experience prodrome symptoms three days before an attack. “There’s a big window [in timing],” she says.

What to do when prodrome symptoms hit

During the prodrome phase, there’s typically no sharp, wincing pain (like there is an attack), outside of some potential stiffness in your muscles. That doesn’t mean your symptoms aren’t frustrating and sometimes disruptive, says Dr. Aymen. You may find it hard to focus at work if you’re fried, for example, or have trouble showing up for family members if you’re peeved. But being in this phase has its benefits, Dr. Aymen points out: You can potentially prevent a full-blown attack from occurring with the right care.

The first step, Dr. Aymen says, is to recognize your unique prodrome symptoms. When you look back at prior attacks, how did you feel in the hours or days leading up to it? Jot down any particular patterns—especially those you could potentially mix up with other issues. For example, in the past, you could have mistaken a food craving caused by prodrome for one spurred by a nutritional deficiency or boredom, or assumed your constant yawning was caused by restless sleep when it actually signaled an attack on its way. If you’re not sure how to approach this, a doctor can definitely help guide you about what to look for, says Dr. Aymen.

Once prodrome symptoms appear, take it easy and try to avoid your known migraine triggers, says Dr. Minen. Here’s how to take action:

Slow down and pay attention to your body. Generally trying to keep your routine consistent and well accounted for is key here. “Try to eat on schedule, hydrate, and work to manage stress,” Dr. Minen says.
Try to nap. Poor sleep often precedes migraine attacks, and snoozing can be restorative for the brain (and help you recover sooner or thwart an attack), says Dr. Aymen.
Guzzle H2O. Drinking lots of water and beverages with electrolytes can also help, as dehydration might worsen the frequency and intensity of a migraine attack.³
Steer clear of coffee and sweet drinks. Caffeine and sugar are common migraine triggers. The trick, of course, is that the prodrome phase might intensify those cravings. Just try to limit or skip sweet stuff until your symptoms pass.⁴
Try gentle head and neck stretches. Dr. Aymen recommends the chin tuck: Flex your head so you’re looking down and touch your chin to your upper chest. This can help stretch the muscles in the back of your neck that may be tensing up during prodrome.
Take “rescue medication.” According to Dr. Aymen, this might include things like acetaminophen, an anti-inflammatory medication, or triptan drugs—whatever a health care provider recommends, or that you know works for you. Taking these meds early can sometimes shorten the prodrome phase and even prevent a migraine from developing.

The prodrome phase is part of your migraine, and it deserves the same TLC you’d give your body if you were experiencing an attack. Even though it sucks, this stage can be helpful—if you can identify it early, you just might be able to feel better—not worse—more quickly.

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