When it comes to migraine, most people think of head pain, nausea or migraine aura, but there are actually five distinct stages of a migraine attack. The very first part of an attack is known as the premonitory stage or prodrome. In this blog, we answer commonly asked questions about this stage of migraine.

What is migraine prodrome (the premonitory stage)?

The premonitory stage, sometimes called the migraine prodrome, is the very first stage of a migraine attack. The symptoms can be physical changes and/or mental changes, and you might not even notice them. They can include:

• Feeling tired
• Yawning more than usual
• Food cravings
• Changes in your mood such as feeling down or irritable (high or low)
• Feeling thirsty
• Neck stiffness
• Passing more urine (wee) than usual

If you notice any of these symptoms, it could be a sign that you are experiencing the beginnings of a migraine attack and the more severe symptoms are on their way. Keeping a migraine diary where you write down how you’ve been feeling and what you’ve been doing each day will help you and your doctor work out your migraine patterns and your premonitory symptoms.

Many people assume that certain foods trigger their migraine because, for example, they always seem to have an attack after eating chocolate. However, it is thought that these patterns are actually the result of food cravings in the premonitory stage rather than the food itself triggering the attack.

The premonitory stage can actually be helpful to us as it can signal that it is time to treat the migraine attack before the worst symptoms set in, reducing the severity of the attack overall.

While research suggests the majority of people with migraine experience premonitory symptoms, not everyone does.

How long does the premonitory stage last?

The premonitory stage tends to last anywhere up to 24 hours. It might be difficult to gauge exactly how long it lasts as its symptoms can be subtle. Everyone’s experience of migraine is different so you might find that your prodrome stage lasts longer than 24 hours.

How is the premonitory stage different from migraine aura?

About a third of people with migraine experience migraine aura and it is an entirely different stage of a migraine attack from the premonitory stage.

Aura happens after the premonitory stage and before the main attack stage, which often involves head pain, nausea and vomiting, and fatigue, but can include a wide array of symptoms. Aura tends to last no more than an hour and involves sensory changes like changes to your vision or hearing. Many people see bright spots, flashes or wavy lines, or experience blurry vision or blind spots. You may also feel confused and struggle to speak as you normally would. You can also feel dizzy or weak.

While aura might feel alarming, particularly the first few times you experience it, it is a very normal part of a migraine attack. If you are experiencing aura for the first time or your migraine symptoms suddenly change, it is worth speaking to your doctor.

Should I treat my migraine attack during the premonitory stage?

The premonitory stage can act as a helpful warning sign that the main attack stage of migraine is on its way, so treating your attack in this early stage may help to ease the symptoms later on.

When you notice premonitory symptoms, it may help you to rest if you can. If you are at home, you could lie down in a dark room or take a nap which could help stave off the full migraine attack. If you are not at home, you may want to make your way there so that you do not have to deal with the main attack stage at work or while you are out. Using non-drug options may help, such as using an electronic migraine device if you have one or doing some gentle stretches.

If you take triptans, such as sumatriptan, this can be a good time to take one as these drugs work best when taken at the first signs of a migraine attack. If you find painkillers like paracetamol or ibuprofen effective, it may also be helpful to take them during the premonitory stage. As with any medication, you should speak to your doctor or consult the instruction leaflet in the packet to ensure you are taking it safely and correctly.

You should also make sure you are aware of the risks of medication overuse headache when it comes to taking medication and avoid taking acute migraine treatments too frequently.

For more information on the stages of a migraine attack, click here. To learn about the final stage of migraine, known as the postdrome or migraine hangover, click here.