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

  1. 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.
  2. 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.