Prodromes and auras are both warning signs that a migraine is coming, but they happen at different times and feel very different. Prodromes are the early, subtle signs that can occur hours or even a day or two before your headache starts. Auras, on the other hand, usually occur much closer to the headache phase, usually 5 to 60 minutes before or even during the migraines and are more specific neurological changes.
Migraine prodromes are like your body’s early “heads-up” that a migraine is coming. They are a collection of subtle warning signs that can start anywhere from a few hours up to a day or two before the actual headache begins. In simple terms, think of them as the “pre-migraine” phase.
Many people notice that before their migraine hits, they might feel unusually tired, irritable, or even a bit depressed, or sometimes unusually happy. You might also have unexpected food cravings, find yourself yawning more than usual, feel extra thirsty, or notice a slight stiffness in your neck. These signs are not the migraine pain itself but are early changes in your mood, energy, or body that suggest your body is about to enter a full migraine attack.
The migraine prodrome is thought to be the result of early changes in brain function that occur well before the headache itself begins. Although the full picture is not completely understood. Functional imaging studies have shown that areas in the hypothalamus and brainstem become active several hours, and sometimes even a day or two, before the migraine headache. The hypothalamus, which is involved in regulating sleep, hunger, thirst, and mood, appears to “turn on” abnormally. This early activation likely triggers the release of several key neurotransmitters and neuropeptides, such as dopamine, serotonin, and calcitonin gene-related peptide (CGRP). For example, altered dopaminergic activity has been linked with symptoms like yawning, mood changes, and fatigue that many patients report during their prodrome. These chemical messengers begin to disturb the normal balance of brain function even before the pain phase starts.These changes in brain activity and chemistry are thought to “prime” the brain, making it more sensitive and setting off a cascade of events. This cascade eventually leads to more dramatic changes—like the cortical spreading depression seen in auras, which then trigger the headache phase of the migraine. Essentially, the prodrome reflects the early, subtler signs of a migraine attack as the brain’s networks, especially those involved in regulating our autonomic functions and emotional state, start to become dysregulated.
In summary, the migraine prodrome is not just a random collection of symptoms. it is the clinical manifestation of early neuronal dysfunction in key brain regions. These early changes in activity and neurochemistry are what eventually lead to the full-blown migraine.
Like migraine auras, while prodromes may be different for different people, each individual’s prodromes tend to stay the same. Recognizing your early symptoms can sometimes help you take action sooner, like taking your prescribed medication or avoiding a known trigger, which might lessen the intensity of the upcoming migraine.