I’ve lived with episodic migraine for most of my life, until about six years ago when my migraine attacks became chronic. As a child and into most of my adult life, I experienced a visual aura for 20 minutes before a full-blown migraine attack hits. The sparkling zigzag lines that impeded my vision gave me an immediate warning to drop everything, take my meds, and curl up in a quiet room.
What I didn’t know was that my body had been telling me for days prior to the aura that I should brace myself for a monster of an attack.
Phases of a migraine attack
I have stacks of headache and food diaries I’ve used to analyze causes and patterns of my migraine attacks over the years. It wasn’t until I started focusing on the days before an attack that I realized there were recurrent themes I had overlooked, assuming certain symptoms were just quirks of my body.
A migraine attack typically occurs in four phases:
- prodrome or premonition
- migraine attack
- postdrome or recovery
In the prodrome stage, weird symptoms like mine can appear 12 to 72 hours before a migraine attack. For years, I had missed these signals, only focusing on the aura stage, which occurs roughly 20 minutes to a few hours in advance of an attack.
Next, the headache or attack phase is well, exactly what it sounds like. This phase can cause a range of disability for 4 to 72 hours.
When the worst has past, it can still take days to recover during the postdrome phase.
In one migraine study, up to 87 percent of participants experienced prodromal symptoms. Another study found that proactive measures taken during that prodromal phase were effective in reducing symptoms of a migraine attack.
The jury is still out as to whether or not you’ll be able to prevent an attack entirely, but learning to recognize these early warning signs can help people with migraine act quickly at the first sign of a pending attack.
My 8 weirdest prodrome symptoms
While a person may experience a variety of strange symptoms during the prodromal stage, below are a few that I’ve learned to identify days ahead of my own migraine attacks.
Like many things with migraine, the cause behind these symptoms isn’t completely known. Migraine is considered a neurological disorder, so it may be that some symptoms are associated with reduced electrical activity in part of the brain affected by migraine.
Migraine is a genetic, neurological disease. For people like me living with it, our brains don’t process sensory disturbances the same way as those who live without migraine, which triggers debilitating attacks. The oddities on this list just reinforce how complicated migraine is.
I have never been the most graceful person — I can trip over a blade of grass. However, in the days leading up to a migraine attack I’ve found that I tend to drop things more often or feel that my depth perception increasingly fails me.
I’m a pleasant person most of the time, and so it was strange when I started getting short with my boss. When this happened, he recognized right away that a migraine attack might be coming my way soon. He was usually right.
I feel fatigued most of the time, so yawning is normal. However, excessive, uncontrollable yawning lets me know that I may be in the prodrome phase.
Allodynia makes you feel pain from sensations and stimuli that don’t normally cause pain. Sometimes, in the days leading up to an attack, my hair hurts. Other areas of my body become sensitive or tender, too — the slightest touch can cause significant, short-term discomfort. A recent study showed that those who experience allodynia with their migraine attacks have “significantly worse outcomes” than those who don’t.
Don’t all women have small bladders? Sure, but going to the bathroom 6 to 10 times in an hour isn’t normal. The American Migraine Foundation lists frequent urination as a symptom found in the prodrome phase.
“Alice in Wonderland” syndrome
During Lewis Carroll’s fictional story, Alice is stuck in a house because she had grown large enough to fill a room. While rare, this very disorienting sensation — seeing objects growing or shrinking — also known as macropsia and micropsia — is a form of aura that can occur along with migraine.
Sure, we all lose our keys, miss an appointment, or forget a name from time to time, but increased memory loss can occur before the attack phase begins. For me, that means my extreme multitasking skills begin to fail me, and I completely blank on important conversations. Now I always carry a notebook with me.
Olfactory, gustatory, and auditory hallucinations happen to a small percentage of those with migraine. I have smelled burning rubber or tobacco when none was present (olfactory), and occasionally, food has a metallic taste (gustatory). Though I haven’t experienced them, some research shows that auditory hallucinations not associated with psychosis can cause voices or even songs to repeat in your head for short periods of time.
Recognizing the warning signs
A cardinal rule of migraine is to treat an attack at the first sign. I used to think that this meant the visual aura, but now I know that waiting until that phase may be too late. And remember: Not everyone with migraine experiences an aura — the American Headache Society estimates that only 20 to 25 percent of people do.
Learning to recognize the signs of the prodrome phase and taking quick action to mitigate your symptoms can significantly impact the severity of an attack.
Now when I find myself rudely yawning during an engaging conversation or snapping at a friend, I realize I could have a horrible migraine attack very soon. That’s my cue to treat early and rest.
It can take some trial and error, but it’s worth the effort to try to figure out what, if any, migraine warning signs you might be experiencing ahead of an attack. Keeping a journal to log symptoms and behaviors is a good place to start, and may help you to identify patterns you might have otherwise missed.
With migraine, often knowing —your triggers, your treatments, your type — is half the battle. While you may not be able to prevent an attack entirely, understanding and identifying your prodrome symptoms could make a huge difference in how you manage your migraine attacks.
NPS-US-NP-00314 JULY 2018