What are the Premonitory Symptoms of a Migraine?

Learn how premonitory symptoms are different from a migraine aura.

woman yawning
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Premonitory symptoms begin hours to days (usually one to two days) before a migraine attack. More specifically, they occur before the "aura" of a migraine with aura and before the "headache" of a migraine without aura. The phase of a migraine attack in which premonitory symptoms occur is called the prodrome phase, and its the first phase, followed by aura, headache, and postdrome. 

Premonitory symptoms are unique in that they allow a person to predict a migraine attack about 72 percent of the time, according to an older study in Neurology.

This prediction allows a window for migraine preparation before the aura or pain of a migraine occurs. 

What are Examples of Premonitory Symptoms?

Premonitory symptoms are variable but the most common ones include fatigue, mood changes (depression or irritability) and gastrointestinal symptoms (like a change in bowel habits or nausea). Other potential symptoms include:

  • muscle stiffness/aching/pain, especially in the neck, back and face
  • food cravings or a loss of appetite
  • difficulty concentrating
  • confusion
  • feeling cold
  • sensitivity to light or sound
  • excessive yawning

What Percentage of People Experience Premonitory Symptoms?

In a study in Headache of nearly 900 patients with migraines, approximately one third of patients reported experiencing premonitory symptoms. That being said, the prevalence of premonitory symptoms has ranged widely based on other studies -- from 7 percent to 88 percent -- so it's really difficult to tell.

As you can imagine, many people may not even realize they are experiencing premonitory symptoms, as they can be quite subtle.

How Can I Distinguish Premonitory Symptoms from a Migraine Aura?

A migraine aura lasts no more than 60 minutes whereas premonitory symptoms last hours to days. In addition, an aura is characterized by short-lived, localized neurological abnormalities (like numbness and tingling on one side of the body or vision changes in both eyes) whereas premonitory symptoms are more generalized and tend to be behavioral.

Premonitory symptoms are also different biologically from an aura. An aura is characterized by cortical spreading depression -- a wave of depressed nerve activity that sweeps across the outer layer of the brain. Premonitory symptoms are believed to involve the neurotransmitters dopamine and serotonin

Bottom Line

Premonitory symptoms can serve as a warning sign that a migraine attack is about to occur, but they can also be difficult to recognize. If you do happen to notice them, you can prepare by hydrating, relaxing, and avoiding usual migraine triggers (like leaving a room with bright lights).

Sources:

Buzzi, M.G., Cologno, D., Formisano, R., & Rossi, P. (2005). Prodromes and the early phase of the migraine attack: therapeutic relevance. Functional Neurology, Oct-Dec;20(4):179-83.

Giffin, N.J., et al. (2003). Premonitory symptoms in migraine: an electronic diary study. Neurology, Mar 25;60(6):935-40.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Kelman, L. (2004). The premonitory symptoms (prodrome): a tertiary care study of 893 migraineuers. Oct;44(9):865-72.

Tepper, D. American Headache Society: Aura With Headache

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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