How to recognise pre-migraine symptoms before the onset of a painful attack

Pre-migraine symptoms may occur before a migraine attack begins. You may be able to take steps to avoid a painful migraine attack if you can recognise some of these pre-migraine symptoms.

What is a migraine?

A migraine is usually thought of as a particularly severe headache, but migraines can extend to a whole range of symptoms beyond head pain.

Migraines usually only affect one side of the head, but the pain may radiate across the head and sometimes to the neck and shoulders.

Migraines are often accompanied by other symptoms like nausea and vision disturbances, and tend to follow a pattern of pre- and post-migraine symptoms.

It's not completely clear why some people get migraines and others don't, but the underlying cause is a complex mechanism of changes in activity, chemicals, nerve signals and blood vessels in the brain.

Some people experience a range of migraine symptoms in a classic migraine pattern but do not develop the head pain that most people associate with migraine.

Others, particularly children, may have purely abdominal migraines , where the symptoms are focused around a severe stomach upset, often related to stress or with identifiable triggers.

The four stages of migraine

A migraine will often develop in a distinct pattern with four main stages, however not all migraines follow this pattern. It isn't always possible to identify each stage, and the stages may seem to overlap at times.

The classic symptoms of the four stages of a migraine can include:

Prodrome

Some people experience symptoms in the hours and even days before a migraine.

They can include:

• Stomach problems like general abdominal pain, indigestion, diarrhoea and vomiting.
• Sleeplessness, with difficulty falling asleep or waking up more often through the night.
• Fatigue, sometimes needing to nap in the daytime.
• Poor concentration, finding it difficult to work, study, or even continue pleasurable activities that require concentration.
• Needing to urinate more frequently - it's not clear why this is linked to a migraine, but is quite common.
• Yawning more than usual.
• Experiencing food cravings.

Some symptoms which could indicate a prodrome period of a migraine may also be linked to an underlying cause of a migraine - for example, disturbed sleep can be a sign that a migraine is coming, but it can also be an independent trigger for a migraine.

Aura

A migraine aura typically affects sight and sensation. The symptoms of a migraine aura include:

• Sensitivity to light or sound.
• Changes in vision, sometimes even temporary partial sight loss.
• Seeing lights, patterns and colours in front of the eyes - this can occur when they are open, closed, or both. These patterns may change, but are often described as geometric shapes, bright lights, flashing lights and rings.
• Tingling sensations in the head and sometimes other areas of the body.

Occasionally, people experience difficulty in speaking, which may be slurred or confused, and some people collapse. Some of the symptoms of a migraine could indicate other serious acute medical conditions.

Unless you have experienced these symptoms before, had them assessed by a doctor, and are sure that these are your usual migraine symptoms, any potentially serious signs should be urgently assessed.

Migraine aura symptoms can happen before and during the active migraine stage.

Migraine

A migraine usually takes the form of a severe headache, and may include some other symptoms, such as:

• Head pain which may be throbbing, drilling, pounding, or otherwise severe.
• Nausea, sometimes with vomiting.
• Sensitivity to light and sound.
• Pain that usually only affects one side of the head, though not always.
• Diarrhoea.
• Stomach pain.
• Inability to focus or concentrate.

Postdrome

Many people continue to have some symptoms and changes in mood in the aftermath of a migraine. The postdrome phase may be accompanied by:

• Fatigue, sometimes with sleep disturbance.
• Mood changes which can range from depression to a heightened, almost euphoric state.
• Poor concentration and even feelings of confusion or "brain fog".

The fatigue and changes in mood can mean it takes a few days for someone to fully recover from a bad migraine, even to the point that they're missing time at work or study, or finding it difficult to cope within the household, family and social settings.

What are pre-migraine symptoms?

Pre-migraine symptoms describe the prodrome or aura stage of a migraine. It is useful to be able to recognise symptoms of an impending migraine, as taking steps to manage the symptoms early can help avoid a full-scale migraine.

No two people experience exactly the same migraine symptoms, so it isn't always easy to spot a migraine, especially the first time it happens. People who have had migraines before can learn to identify their own individual pre-migraine symptoms.

What's the difference between migraine and headaches?

A migraine can cause extreme headaches, but not all severe headaches are migraines. A migraine is usually identified as a broader set of symptoms, particularly when they include visual disturbances and nausea.

Migraines tend to be more severe than headaches, to the point where they can be quite debilitating. Some migraines occur without any significant headache symptoms at all.

There isn't a specific test for migraines, so a diagnosis is usually made based on reported symptoms.

A GP may recommend some investigations to make sure there isn't another reason for repeated migraines and headaches. This might include blood tests and medical imaging such as CT or MRI scans.

What to do if you have pre-migraine symptoms

Being able to spot the signs of an impending migraine is a really good way to help reduce the effect of migraines. If you know when a migraine is coming, just taking some simple steps to manage it can help.

This could include taking a simple painkiller or medication that may have been prescribed for migraines. Just going to a darkened room to rest for a short while might help to keep the migraine at bay.

If you're able to identify triggers and you feel a migraine is coming on, just limiting or removing those triggers might be enough to stop a migraine in its tracks.

Some people find that keeping a diary can help identify patterns in migraine symptoms and possible triggers. It can be helpful to note down food, activity, mood and sleep patterns to try and correlate them to the beginnings of migraines.

Managing a migraine

It isn't always possible to avoid a migraine, but there are a few simple techniques to try at home to reduce the pain and other effects of a migraine.

• A cold compress or well-wrapped ice pack on the painful part of the head.
• Simple painkillers like paracetamol can help with migraine symptoms. Stronger medications designed for migraines may be available over the counter at pharmacies, and GPs may be able to prescribe medication to use when you feel a migraine coming on.
• Lie down in a darkened room. Bright lights and loud noises can make migraines worse, so finding a cool, comfortable place to rest can really help.
• Get some sleep. Rest is important, and if you can manage your symptoms enough to get some sleep, that can help speed up recovery.
• Relaxation techniques such as breathing management therapies and meditation can help improve a person's experience of a migraine.
• Alternative therapies are available, including acupuncture and herbal medicines. It's important to only go to accredited clinicians, and if you're in any doubt at all, ask a GP for advice.
• Stay hydrated, and eat healthy, regular meals. Dehydration can trigger migraines, and can cause severe headaches and other health problems too.

There are lots of different medications designed to help with migraines, but many of them are only available on prescription.

That's just one of the reasons why it's important to report problematic migraine symptoms to your GP - they may also want to arrange for some investigations to rule out any underlying causes like high blood pressure.

Managing the specific symptoms associated with a migraine can help make them easier to cope with - this can include medications or simple home remedies for nausea and sickness - some people find ginger biscuits, peppermint tea, or sucking on ice chips helps reduce nausea. If light sensitivity is a problem, lying in a darkened room can help.

When to get help

If you're having severe or frequent migraines which aren't eased by over-the-counter medications, it's important to consult a GP. They can help you with a management plan which may include effective medication to take to prevent or improve migraine symptoms.

If you've already got a treatment plan and medications from your doctor and they aren't helping or they've stopped helping, the GP may be able to suggest alternatives or consider other options or causes.

A medication delivery service can help ensure that you always have a supply of the medications you need.

Occasionally, some people get migraines which cause changes in movement and sensation on one side of the body. Although these may be simple migraine symptoms, it could also be a sign of a very serious condition affecting the brain, like a stroke.

New one-sided weakness could indicate a medical emergency and should be assessed immediately.

A severe, persistent headache that begins after trauma to the head should also be assessed urgently.

More tips on preventing a migraine

Migraines aren't always predictable, but it may be possible to identify and manage some triggers. The triggers for migraines are extremely personal and varied, and there is a huge and diverse range of factors.

Some common triggers include:

Environmental triggers

• Bright lights - looking at a phone or computer screen too long can sometimes be a problem.
• Smoky places.
• Some strong smells can trigger migraine - and people may also become more sensitive to smells during a migraine or pre-migraine phase.
• Changes in air pressure - some people find that they get severe headaches or migraines when there's a storm coming, or in certain sorts of weather.

Physical triggers

• Hormonal changes - some people find that migraines are more common at certain points of the menstrual cycle. Some find that migraines reduce or stop completely after menopause, whereas others find that migraines begin around the time of menopausal hormone changes.
• Migraines may also accompany pregnancy, during which time some treatment options can be limited. Pregnancy-related migraines should always be assessed by a medical professional.
• Tiredness - disturbed sleep or fatigue can act as both triggers and symptoms of migraine.
• Back or neck pain - particularly from extended periods in an uncomfortable position - after a long flight or in an uncomfortable office chair.
• Some medications, particularly hormonal contraceptives can be associated with migraines. It's important to consult a doctor before making any changes to medications.
• Some allergies can trigger migraines, and migraines can coincide with hay fever season for some people.

Dietary triggers

• Some foods can trigger migraines. Chocolate, cheese and citrus fruit are common triggers for some people.
• Foods that contain a substance called tyramine are particular culprits for triggering migraines; these include cured meats, pickled and smoked fish, yeast extracts, and some cheeses.
• Missing meals, irregular eating patterns, and crash diets can be a problem.
• Low blood sugar - perhaps due to missing meals or certain medications - can be a trigger.
• Alcohol - some people find that they get migraines after drinking alcohol, or within a few days of a period of heavy drinking. It's important to stay with the guidelines for recommended alcohol intake. People who find that alcohol frequently triggers migraines may find that they have to avoid it altogether.
• Caffeine - caffeinated soft drinks, tea and coffee may trigger migraines in some people. On the other hand, people who are used to taking a lot of caffeine might find that suddenly stopping can trigger very severe withdrawal headaches. There is also some evidence that a little caffeine can reduce the symptoms of migraines.

Emotional triggers

Stress - while it might not be possible to avoid normal stressors in life, learning stress management techniques and taking time for active relaxation can help reduce the risk of stress-related migraines.

Depression or other emotional and mood disturbances can trigger migraines or make them more frequent.

Managing migraines

Knowing your triggers might be able to help you manage or prevent migraines. If you have any concerns about your symptoms, if your migraines are hard to manage or affect your day-to-day life, your GP will be happy to help.

A home call GP may be helpful if you're already feeling unwell.

ALSO READ: Migraine and high blood pressure: Are they related?

This article was first published in Homage.