Warning Signs Of Headaches

The Sneaky Warning Signs a Migraine Is Coming—and How to Stop Them

Catching a migraine early is key to fending off a full-blown attack. Here are the surprising symptoms to watch for—and what to do when they hit.

A migraine is more than a bad headache

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We’ve all been sidelined at some point by a tension headache, but only about 12 percent of Americans get migraines, says the National Institutes of Health. (Check out 16 signs that your headache could be something much worse.) Thought to be at least partially genetic, migraines are an episodic headache that can involve severe, throbbing pain. “When we think of migraine, it’s the level of disability that really sets it apart from other headaches,” says Susan Hutchinson, MD, a southern California headache specialist and medical advisor at MigraineX. “And it’s much more than just the headache. What comes with it is an extreme sensitivity to the environment and a resulting inability to function.”

The phases of a migraine

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Although the experience can vary from one sufferer to the next, migraines tend to involve four phases: The prodrome phase, which lasts 24-72 hours, has many distinct symptoms that don’t include head pain; the aura phase (flashing lights or stars); the actual headache, and finally the postdrome phase, or migraine hangover. “Prodromal symptoms can vary from patient to patient, and even from migraine attack to migraine attack for the same patient,” Dr. Hutchinson points out, adding that some people may not experience all phases. And be sure to watch out for these potential migraine triggers.

Be wary

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What brain changes are thought to cause a migraine? Simply put, an external trigger (like a change in barometric pressure) or internal trigger (like the estrogen drop of menstruation) sparks a release of neuro-inflammatory compounds known as peptides; these sensitize and inflame blood vessels in the brain. “Think about it as an inflammatory cascade that moves from the lower brain centers to the higher brain centers,” says Dr. Hutchinson. “You could get to a point where the attack has progressed so much, it’s hard to turn around.” That’s why it’s so important to anticipate triggers—here’s a guide to predicting a migraine—so you can treat it before the real pain kicks in, which also happens to be when treatments are most effective. “My patients who recognize prodromal symptoms are better off because they can be proactive,” she says.

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The prodrome phase—also called the premonitory phase—could involve yawning, mood changes, nausea, light and sound sensitivity, and neck pain. “Functional brain scans performed during this phase show activation of different brain regions corresponding with different symptoms,” says neurology professor Andrew Charles, MD, director of the UCLA Goldberg Migraine Program, and member of the American Headache Society board of directors. For example, activation of the hypothalamus, a small region deep in the brain that is involved in the regulation of appetite, sleep, and metabolism, could play a part in the prodrome symptom of food cravings.

Dr. Hutchinson says food cravings—especially for chocolate—is the top prodromal symptom her patients report: “Many women say, ‘I think chocolate causes my migraine.’ But we’ve found that chocolate is not a trigger. It’s more that the headache process has already started, and as part of that initial phase, they’re craving chocolate.” Discover 11 more possible reasons for your food cravings.

Feel sleepy?

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The activation of the brain’s hypothalamus region may also play a part in the sleep difficulties some patients experience, according to Dr. Charles. In a study published by The Journal of Headache and Pain, excessive daytime sleepiness was linked to an exacerbation of migraine symptoms. Check out these six tricks for improving sleep.

Neck pain

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Neck pain is a common prodromal symptom, says Dr. Charles, and it seems related to migraines due to the nerve impulses that go back and forth between the lower part of the brainstem and upper spinal cord, he explains. Consider these five exercises to reduce neck pain.

Upset stomach

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In patients with nausea, brain scans reveal activity at the base of the brain, where the queasy sensations originate, says Dr. Charles. What’s more, migraines may be genetically linked to irritable bowel syndrome (IBS), according to 2016 research from Istanbul University in Turkey. Seek some relief by trying these natural stomachache remedies.

Light sensitivity

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While light sensitivity can signal other eye problems such as this potential issue, it is also a symptom of the prodrome phase. It may be caused by the activation of the occipital cortex, which is the region at the back of the brain that processes vision, explains Dr. Charles.


Stroke-like symptoms

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Patients who experience the aura phase may suffer from symptoms that seem like a stroke, says Dr. Hutchinson. “It’s during the aura that you might get numbness on one side of your body or notice spots in front of your eyes.” Patients may also experience other visual disturbances—such as flashing lights or shimmering lines—as well as tingling sensations, difficulty speaking, or dizziness, says Dr. Charles, explaining such symptoms are caused by slowly spreading waves of abnormal activity that cross the surface of the brain, usually beginning in the part of the brain that processes vision, the occipital cortex. And by the way, make sure you know the silent signs of an actual stroke—just in case.

Activate your treatment plan

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New research into the brain mechanisms behind migraines has led to a number of new treatments that not only minimize the attack, but prevent it altogether. “It’s a pretty exciting time in the headache world,” Dr. Hutchinson says. The key is to have your doctor help you establish a treatment plan ahead of time and to recognize the warning signs that should prompt you to activate it. “Your plan might vary from attack to attack depending on what you think the trigger is,” Dr. Hutchinson explains. “If you’re at your sensitive time in your menstrual cycle, for example, your approach might be different than if your headache was brought on by stress or lack of sleep.” Try these tips for reducing stress.

Take advantage of new meds

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Migraine sufferers have lots of options for treatment—check out these ten. For patients who need to relieve the pain of an attack that’s already begun, there are a number of good prescription drugs available, including triptans, which work by constricting blood vessels in the affected area of the brain and inhibiting the release of neuroinflammatory peptides. Anti-inflammatory medications such as Naproxen and Ibuprofen can also be helpful, says Dr. Hutchinson. Patients who experience frequent attacks may take a regular, preventive prescription to keep the migraine process from starting in the first place.

Beyond drugs

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Therapies you could use in combination with your medications include MigraineX, a specially designed earplug you insert when symptoms start. It can limit a migraine triggered by weather-related pressure changes. Home remedies may also help. “Maybe one person needs to get in a dark room and lay down with an ice pack,” says Dr. Hutchinson. “Somebody else might need to eat something if a skipped meal triggered their attack.” Another approach is a combination of meditation and yoga known as mindfulness-based stress reduction (MBSR), which was found to make migraines shorter and less disabling in 2015 research from Wake Forest Baptist Medical Center.

Keep pushing for treatments that work

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If your plan isn’t doing the trick, try another approach—or even another doctor—until you find a strategy that eases your pain. “Years ago people had to go home from work because their migraines were so debilitating,” says Dr. Hutchinson. “But today there are so many more options. If you get your treatment on board as soon as symptoms start, it’s possible to return to full activity and not feel like you’re missing out on life.”

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