Pre-migraine Symptoms: When to Call a Doctor?

According to a study conducted by the Neurological Society of India, migraine is a neurological illness that affects one in every four to one in every eight people in India. In India, over 213 million people reportedly had migraines in 2019. Among these cases, women reported 60% of the cases. Migraine can cause severe pain and interfere with your day-to-day activities. WHO estimates that migraine onset often starts at puberty, and those aged between 35 and 45 years are most affected.

There are 4 types of migraine headaches. One of the phases of a migraine attack is the Pre-migraine stage. Pre-migraine signs are visible even before the actual migraine attack occurs. To avoid a painful migraine episode, make some lifestyle changes and recognise the pre-migraine symptoms. 

Pre-migraine symptoms 

Pre-migraine, also called the prodrome stage, indicates the upcoming migraine attack. It can stay anywhere from a few hours to several days before a migraine attack occurs.

The prodrome stage or the pre-headache not necessarily occurs before every migraine attack. However, recognising migraine warning signs can help you avert the discomfort caused by it. It’s also vital to understand that not everyone with a prodrome stage will have the same symptoms.

Pre-migraine symptoms may range as follows:

1. Extreme changes in Mood 

Feeling depressed, anxious, or euphoric, and intense excitement without a precise cause. A person may find it difficult to concentrate or focus.

2. Soreness in Muscle 

Stiffness and cramps in your neck and shoulders 

3. Food cravings  

Intense cravings, especially for chocolates.

4. Too much sleep

Excessive sleep may be a characteristic of a migraine episode or a premonitory period before the onset. Sleep can also be beneficial during a migraine episode and can often help stop it, especially in children.

5. Excessive yawning 

Yawning is one of the common pre-migraine symptoms in patients, and a person who frequently yawns throughout the day may offer an opportunity for early migraine treatment.

6. Gastrointestinal changes

You may have digestive trouble like constipation or diarrhoea before a migraine attack begins.

7. Increased urge to urinate

The increased frequency of urination may be a sign of an impending migraine. Frequent urge for urination is one of the several symptoms people encounter throughout the prodrome phase.

8. Photophobia, phonophobia and the strong odour

38% of those who identify triggers also claim that exposure to light can cause migraines. About 40% of episodes in persons who report triggers may be brought on by odours like spirits, perfume and strong incense sticks. According to a study, loud noises trigger a migraine attack in patients.

Phases of migraine

Not all individuals will experience every phase of a migraine attack. The remaining three other migraine stages are:

1. Aura stage  

For those who have an aura with migraine, symptoms normally appear approximately an hour before the attack. Auras symptoms include blurry vision, flashing lights, visual delusions, vision loss, numbness, dizziness, and changes in hearing and speech. These symptoms may vary. About one-third of people who suffer from migraine will experience the aura phase of migraine. 

2. Headache or attack stage.  

A person is said to have the headache stage when they have moderate-to-severe head pain. The headache stage symptoms include nausea, vomiting, difficulty sleeping, photophobia, phonophobia, and osmophobia. Pain is often pulsating type and intensity increases within no time. The attack stage can remain anywhere from a few hours to days.

3. The postdrome or resolution stage 

Postdrome migraine occurs once the migraine attack has disappeared. Migraine attack stages can vary depending on the person’s physical health. However, symptoms of postdrome migraine include fatigue, dizziness, difficulty concentrating, and exhaustion.

When to Consult a Doctor

People affected by migraines may be able to prevent them by resting and taking over-the-counter medications. If the migraine attacks become more frequent and interfere with your daily activities, you should contact a doctor. Visit a doctor:

• When OTC medications are not effective anymore in stopping your migraine attacks.
• When you may require to take OTC medications more than twice a week, make an appointment with the doctor.
• The frequency of migraine attacks is more than in the past.
• Change in positions increases the severity of migraine attacks.
• If migraine attacks are new or more painful than in the past.
• Headaches that have begun after a head injury or trauma.
• The intensity of symptoms causes dizziness or numbness.

What to Ask Your Doctor

Monitoring your pre-migraine symptoms might aid in their control and management. Don’t hesitate to ask your doctor doubts during your appointment. Questions you should ask include:

• Could an underlying health concern cause my migraine attacks?
• Is alcohol consumption, smoking, or work-related stress responsible for migraine?
• Will regular exercise help prevent migraine?
• What food items should I avoid?
• Which food item should I include in my diet?
• Are there medications that I can take to prevent migraine or stop an attack?
• Can any medication treat symptoms such as nausea or dizziness?
• Are there any side effects of the medications?

Instant Migraine relief tips 

It is important for a person to recognize pre-migraine symptoms. Here are some tips that can provide you with immediate migraine relief.

1. Identify and avoid migraine triggers 

A person who has suffered a migraine attack previously should be able to recognise the migraine warning signs causing it. Doing so can prevent a full migraine attack in the future. 

2. Dim the lights 

Bright and loud lights contribute to pre-migraine symptoms. One should find a quiet and dark room to avoid migraine attacks.

3. Take a lot of rest

Meditation, taking a nap, going to bed early or following relaxation techniques provide some relief. 

4. A hot shower can help

A hot shower can act as a hot compress and give some relief from stress, which is a reason for a migraine attack. 

5. Try using a cold pack

Ice packs are a helpful technique for relieving discomfort and promoting sleep.

In short

Symptoms can vary but often include confusion, fatigue and dizziness, frequent urination, photophobia and phonophobia, mood swing, stiffness in the neck and food cravings.

The pre-migraine symptoms appear anywhere from a few hours to days before you have an actual migraine attack. One should learn to recognise pre-migraine symptoms. Early diagnosis can help you manage migraine and avoid an attack. Visit your doctor if the intensity and frequency of your migraine attacks have increased. Expert medical help can analyse your pre-migraine symptoms.

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Disclaimer: This content, including advice and medications, provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your doctor for more details.

References:

• Journal of the Association of Physicians of India – JAPI
• Headache disorders (who.int)
• Migraine Prodrome: Symptoms and Prevention | AMF (americanmigrainefoundation.org)