Migraine: The importance of early treatment during the prodromal phase

Prodrome is the first phase of a migraine and is also known as the premonitory phase or “pre-headache (Image: Canva)

Migraine attacks: Migraine is a type of headache that can induce excruciating pain along with a pounding sensation, typically on one side of the head. Something that may feel like a construction crew jackhammering away at solid concrete. A neurological condition with recurring headaches, migraine is often accompanied by other symptoms such as nausea, vomiting, and extreme sensitivity to light (or photophobia) and sound (phonophobia). It is described as a thud that sends shockwaves of pain radiating from the temples to the base of the skull, thus causing one to wince with every pulse.

When a migraine hits, even the slightest movement causes the throbbing to intensify, and the gentlest sounds feel like a knife piercing through the eardrums. No matter how hard one tries, the pain only grows stronger, overpowering every other sensation in the body. Migraine episodes can last for hours or sometimes days, and intense pain can interfere with a person's everyday activities.

The most common type of migraine is sans aura. A migraine without aura is a recurrent headache attack of 4 to 72 hours occurring unilaterally with moderate to severe intensity that is aggravated by physical activity and associated with nausea. Generally, migraine has a female preponderance, but a variant called 'Cluster headache' is commonly found in men, characterised by unilateral temporal pain that lasts for 15-180 minutes accompanied by rhinorrhea (running nose), tears, and facial flushing.

Episodic syndromes that may co-occur with migraines include various health conditions such as recurrent gastrointestinal disturbances, which entail repetitive abdominal pain and discomfort resulting in vomiting. Benign paroxysmal vertigo, which causes sudden and brief episodes of vertigo or dizziness, may also accompany an attack. In addition, there is benign paroxysmal torticollis, which is marked by repeated episodes of tilting the head to one side.

During the prodrome phase of a migraine, following the treatment plan diligently can prevent or lessen the headache phase (Image: Canva)

Identifying migraine prodrome

Before the onset of a migraine headache, some people may experience subtle changes that warn of an upcoming attack. These changes are known as the prodrome and can occur hours or days before the headache. The prodrome can include a range of symptoms such as mood swings, food cravings, exhaustion, yawning, irritability, increased thirst and urination, and stiffness in the neck region or the shoulders. As per the American Migraine Foundation, prodrome is the first phase of a migraine and is also known as the premonitory phase or “pre-headache.” Being conscious of this phase and reacting in time to the looming headache can help one lessen the pain before it becomes agonising. Some people may also experience visual disturbances, such as flashing lights or blurred vision.

While not everybody undergoes all four phases of migraine with every episode, recognising the subtle signs of prodrome can be crucial in managing the condition. Maintaining a headache journal is an effective way to monitor migraine patterns, understand unique symptoms, and identify warning signs of an impending attack.

Early treatment during prodromal phase

Prodrome is an indication that a migraine attack is beginning. It's important to know the triggers and symptoms and start treatment as soon as possible to stop or lessen the severity of the attack. It's vital to avoid known triggers during this phase. Keeping hydrated and not skipping meals helps. Taking a nap or relaxing in a quiet, dark room reduces stress and keeps environmental triggers such as intense optical and acoustic stimuli at bay. Wearing earplugs or applying an ice pack to the head, neck, or shoulders to alleviate pain or tension is also useful.

Abstaining from sleeping late and controlling the consumption of oily foods and chocolates is a healthy habit one can adopt to prevent severe effects. Managing stress effectively by practicing pranayam and yoga may prove to be of aid in the long run.

It is crucial to get a treatment plan from a healthcare provider and develop a prodrome action plan together. During the prodrome phase of a migraine, following the treatment plan diligently can prevent or lessen the headache phase. In the case of acute medication for migraine, taking it during prodrome may halt a migraine attack. To maximize the effectiveness of medication, it's essential to take it as early as possible.

A concoction of a healthy lifestyle, a scheduled treatment regimen, and avoidance of triggering factors is often prescribed.