manager@migrainespecialist.com.au – Migraine Specialist

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Recognising the Early Warning Signs of Migraine

For many people, a migraine attack begins before the headache itself. This early stage, known as the prodrome or premonitory phase, may occur hours before pain develops and can provide important warning signs that an attack is underway.

In the PRODROME trial screening period, researchers analysed 4,802 prodrome events reported by people with migraine. The most common symptoms were sensitivity to light, fatigue, neck pain, sensitivity to sound, dizziness, irritability, nausea, and difficulty concentrating.^1 Fatigue and neck pain were particularly burdensome, with more than half of these symptoms rated as moderate or severe when they occurred.^1

These warning signs were also reasonably predictive. Overall, 81.5% of qualifying prodrome events were followed by a headache within one to six hours. More than three-quarters of participants were able to identify prodrome events that predicted headache within this timeframe at least 75% of the time.^1

Recognising the prodrome may create an opportunity for earlier treatment. In the treatment phase of the wider PRODROME trial, taking an oral calcitonin gene-related peptide receptor antagonist, a medicine from the gepant class, during the prodrome reduced the likelihood of developing a moderate or severe headache compared with placebo.^2 Early treatment also improved outcomes related to headache severity and the ability to function normally.^2

These findings suggest that migraine management may not always need to wait until headache pain is established. Tracking symptoms such as unusual fatigue, neck discomfort, difficulty concentrating, or increased sensitivity to light may help some people identify their personal warning pattern and discuss appropriate early-treatment strategies with a healthcare professional.

The findings may not apply to everyone with migraine, because the study enrolled people who already believed they could recognise prodromal symptoms that reliably predicted headache. Even so, the research highlights the prodrome as a potentially valuable window for reducing the impact of a migraine attack.

References

Schwedt TJ, Lipton RB, Goadsby PJ, et al. Characterizing prodrome (premonitory phase) in migraine: results from the PRODROME trial screening period. Neurol Clin Pract. 2025;15(1):e200359. doi:10.1212/CPJ.0000000000200359.
Dodick DW, Goadsby PJ, Schwedt TJ, et al. Ubrogepant for the treatment of migraine attacks during the prodrome: a phase 3, multicentre, randomised, double-blind, placebo-controlled, crossover trial in the USA. Lancet. 2023;402(10419):2307-2316. doi:10.1016/S0140-6736(23)01683-5.

New Australian Research Highlights the Need for Better Migraine Recognition

Migraine affects millions of people worldwide, yet it is still frequently under-recognised and undertreated. A new Australian study, co-authored by our very own, Dr Nicole Limberg and published in The Journal of Headache and Pain, sheds light on how migraine is diagnosed and managed in general practice—and where improvements can be made.

What the Research Found
The study analysed 14 years of de-identified health records from more than 3.4 million patients attending Australian general practices, making it one of the largest studies of migraine care in Australia.

Some of the key findings included:

Migraine appears to be underdiagnosed. Fewer than 1% of patients had a recorded migraine diagnosis, despite migraine affecting an estimated 15% of Australians during their lifetime.

Mental health conditions are common. People with migraine were much more likely to also have anxiety or depression.

Migraine-specific treatments may be underused. Opioids were prescribed more often than expected, while migraine-specific medications such as triptans appeared to be used less frequently.

Neck pain may contribute to delayed diagnosis. Many patients were referred to physiotherapists, highlighting that neck pain—a common symptom of migraine—can sometimes be mistaken as the cause rather than part of the migraine itself.

Why It Matters
Migraine is much more than a headache. It is a complex neurological condition that can significantly affect work, family life, and overall wellbeing.

Earlier diagnosis and evidence-based treatment can help people better manage their symptoms, reduce disability, and improve quality of life.

This important Australian research highlights the need for greater awareness of migraine among both healthcare professionals and the community, helping ensure more people receive timely diagnosis and appropriate care.

Click here to read the full research paper

Situational Prophylaxis for Migraines: Stay One Step Ahead of Your Triggers

For many people living with migraines, the hardest part isn’t just the pain—it’s the uncertainty. Will it hit during a big meeting? A long-awaited holiday? A special event, like a wedding? If your migraines seem to strike at the worst possible moments, you might benefit from a proactive approach called situational prophylaxis.
This short-term strategy can help reduce the risk of migraines during known high-risk situations—so you can stay focused on the things that matter most.

What Is Situational Prophylaxis?
Situational prophylaxis involves taking preventive migraine medication for a limited period of time, before a known trigger. Unlike daily preventive treatments, which are taken continuously, situational prophylaxis is more targeted and often better suited for people who:

🟢 Experience infrequent migraines
🟢 Have predictable triggers (like menstruation, travel, or stress)
🟢 Want to avoid daily medication

Think of it as a “just-in-case” strategy that can reduce the likelihood of a migraine before it starts.

When Might It Be Useful?
Situational prophylaxis can be helpful in many common scenarios, including:

🔵 Menstrual migraines – Hormonal changes before your period are a common and predictable migraine trigger.
🔵 Air travel or altitude changes – Pressure changes, disrupted sleep, and stress can all increase your risk.
🔵 Big events or special occasions – Weddings, exams, or important presentations may bring on stress-related attacks.
🔵 Shift work or jet lag – Changes to your sleep schedule or routine can set off migraines.

If you’ve noticed a pattern, you may be a good candidate for this approach.

Medication Options
There are several types of medication your neurologist might recommend for situational prevention:
🟢 NSAIDs (e.g., Naproxen)
Often used for menstrual migraines. Taken once or twice daily during the trigger window to reduce inflammation and pain.
🔵 Triptans (e.g., Naratriptan)
Naratriptan is a long-acting triptan that can be taken for a few days around the trigger period. It is often used in predictable migraine patterns like menstrual migraine.
🟡 Gepants (e.g., Rimegepant)
These newer medications block a key protein (CGRP) involved in migraine attacks. Gepants are well-tolerated, non-sedating, and a great option for people who can’t use triptans—especially those with heart or blood pressure issues.

Importantly, gepants do not appear to be associated with medication overuse headaches (MOHs), making them suitable for intermittent use even in people who need frequent situational coverage.

Is It Safe?
When used under medical supervision, situational prophylaxis is safe and effective. It allows you to manage migraines more flexibly, with fewer side effects than daily medication. Your neurologist with a special interest in headache and migraine will consider your medical history, the frequency and severity of your migraines, and your personal triggers to create a plan that suits you.

Let’s Personalise Your Plan
At Migraine Specialist, we understand how disruptive migraines can be—especially when they interfere with travel, work, or special life events. If you think you could benefit from a situational approach to migraine prevention, we’re here to help.

👉 Ask your GP for a referral to one of our neurologists with a special interest in headache and migraine to discuss your triggers and create a personalised prevention plan.

When Neck Pain Is Actually a Migraine: Understanding the Neurological Connection

Many people associate migraines with severe headaches – the throbbing, one-sided pain often accompanied by nausea or light sensitivity. But what’s less commonly known is that migraines can also present with neck pain, sometimes even before the headache begins, or in place of a traditional headache altogether.

This overlap can be confusing. Patients often seek help for what feels like a neck or muscular issue, only to discover the root cause is neurological. Understanding this connection is crucial for effective diagnosis and treatment.

Neck Pain and Migraines: What’s the Link? 🔗

It’s common for migraine sufferers to experience pain or stiffness in the neck, particularly at the base of the skull. This neck discomfort can:

Occur before the headache phase as part of the prodrome or early warning signs
Happen during a migraine attack as referred pain
Be present without a typical headache, especially in chronic migraine

This happens because of how the trigeminal nerve system and cervical nerves interact. In a migraine, pain signals can radiate and be perceived in areas like the neck and shoulders. While it might feel muscular, this pain is often part of the migraine process itself – not a result of poor posture or a spinal issue.

A Common Misdiagnosis ❌

Due to the prominent neck symptoms, migraines are sometimes mistaken for:

Cervicogenic headaches (originating from the neck)
Muscle tension or strain
Arthritis or disc issues in the cervical spine

As a result, patients may undergo unnecessary imaging, physiotherapy, or other treatments targeting the neck – without improvement.

Migraines Are a Neurological Condition 🧠

Migraines arise from dysfunction in the brain and nervous system, not the neck. They involve a complex cascade of events, including changes in brain activity, nerve excitability, blood vessel changes, and inflammation. Because of this, they require neurologist assessment and targeted neurological treatment.

Simply treating neck pain won’t resolve a migraine. Effective management requires identifying migraine triggers, understanding the full spectrum of symptoms, and often using preventative or acute migraine-specific medications.

When to See a Neurologist? 🧑🏻‍⚕️

If you have recurring neck pain especially with any of the following a migraine could be the cause:

Sensitivity to light or sound
Nausea or visual disturbances
Headache that follows or accompanies the neck pain
A family history of migraine
Pain that is one-sided or throbbing in nature

At Migraine Specialist, we help patients make sense of complex symptoms and get to the true cause of their pain. Migraines are treatable but only when they’re correctly diagnosed as the neurological condition they are.

Still wondering if your neck pain could be a migraine? 🤔

To book an appointment with our Neurology team, or to find out more, speak to a member of our team on (07) 3831 1611.

Published by Migraine Specialist
15th April 2025

This post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider.
This content was created as a collaboration with Neurologist Dr Nicole Limberg, in conjunction with the use of AI.