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Is It a Trigger, a Warning, or Both? Understanding Migraine Stages

Managing Migraine

December 23, 2024

Photography by Giada Canu/Stocksy United

Photography by Giada Canu/Stocksy United

by Nia G.

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Medically Reviewed by:

Susan W. Lee, DO

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by Nia G.

•••••

Medically Reviewed by:

Susan W. Lee, DO

•••••

Migraine is a complex neurological disease with a variety of contributing factors, triggers, and symptoms. Because of this, understanding the stages of a migraine attack can be difficult.

The first stage of a migraine attack is referred to as the premonitory stage or the prodrome. This refers to warning signs of an impending migraine, which manifests as a variety of different symptoms.

Some symptoms may overlap with triggers such as a sensitivity to bright lights. There’s also the aura stage of a migraine attack, which around 1 in 4 of those with migraine will experience, including several visual and sensory symptoms.

With the unique presentation of migraine, it can be difficult to distinguish between warning signs and migraine triggers.

So what’s the difference between them? How can you tell them apart? And how can you deal with your specific symptoms?

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What are migraine triggers?

A migraine trigger is anything that leads to or contributes to the start of a migraine attack. A trigger usually occurs anywhere between 6 to 72 hours before a migraine begins.

Some common migraine triggers include

  • stress
  • hormonal changes
  • changes to your sleep schedule
  • caffeine
  • alcohol
  • bright lights or strong smells
  • medication overuse (of acute medication for migraine)
  • dehydration
  • certain foods like cheese
  • changes in the weather

Everyone’s migraine triggers will be different, so keeping a diary to track when you get migraine attacks may help you to identify yours. For instance, you might be able to recognize that you had a migraine shortly after eating that cheesy pizza, the day before your period started, or after that late night out.

This will help you avoid triggers in the future. But it’s also important to be realistic about the fact that not ALL triggers are easily removable from your life and that if you live with chronic migraine, seeking a migraine prevention medication (also called prophylactic therapy) is important, considering that triggers may be much more difficult to pinpoint!

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What are migraine warning signs?

Migraine warning signs, also referred to as prodrome or the premonitory phase of a migraine attack, are symptoms that indicate that a migraine headache is coming soon.

They can begin hours to several days before your migraine begins and can include:

  • changes in mood such as feeling more irritable or depressed
  • yawning
  • fatigue
  • difficulty sleeping
  • increased need to urinate
  • craving certain foods
  • nausea
  • sensitivity to light and sound
  • difficulty concentrating, speaking, or reading
  • neck pain or stiff muscles
  • hyperactivity

The next stage of a migraine attack, which affects around a fourth of people with migraine (myself included!) is the “aura” stage. This usually occurs from 5 to 60 minutes before a migraine begins.

Migraine auras are temporary focal neurological symptoms. These are most often visual (in over 90% of people with aura) but can also be sensory, language, brainstem, and retinal in origin.

Examples of auras are:

  • blind spots
  • seeing colored spots or lines
  • seeing flashing or flickering lights
  • seeing zig-zag patterns
  • temporary blindness
  • numbness or tingling sensations
  • muscle weakness
  • feeling dizzy or off balance

The relationship between triggers and warning signs

If we think about migraine in a series of stages, then it would look something like this:

  1. trigger
  2. premonitory/prodrome phase
  3. aura
  4. migraine attack
  5. postdrome

The trigger is the initial event that causes the onset of warning signs and the migraine attack itself. However, the trigger may not be identifiable, so the first stage may not be something you can track.

Since there are so many migraine triggers, the way in which they cause migraine attacks is often different. However, many do this by causing changes to the neurotransmitter balance inside the brain.

It is this imbalance that starts the cascade of prodrome and aura symptoms.

Being able to recognize your migraine triggers will help you to avoid attacks where possible. Plus, being able to identify prodrome symptoms will give you time to prepare for an upcoming attack and have abortive meds and strategies at the ready.

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Management strategies

When it comes to migraine, avoiding triggers is a very important part of management strategy. These can include:

  • avoiding foods that may trigger your migraine (For me it’s very sugary food, cheese, and processed meats!)
  • limiting stress where possible
  • staying well dehydrated
  • eating regularly
  • avoiding excess caffeine
  • getting a good night’s sleep — not too long or too short!
  • limiting screen time or exposure to intense bright lights, strong smells, or loud noises

Keeping a personal diary of when your migraine episodes occur is a great tool to help you discover what your triggers are. They might also give you clues about the timeline of your migraine attacks and help you understand the different stages better.

As well as identifying your triggers, noticing warning signs is also a big help. Intervening and taking action early in a migraine attack makes the strategies more likely to be effective. If you notice any prodrome signs, it’s good to:

  • have your medication to hand, you may need to take it soon
  • try relaxation techniques, perhaps lie down in a dark room when possible

Takeaway

Migraine is a complex neurological disorder defined by many different triggers, symptoms, and stages.

It can be confusing to try and figure all of these out as a migraine patient, but understanding the way that migraine works and how that may apply to your own experiences is a great way to get a better handle on your attacks.

Triggers and warning signs may overlap and can sometimes be extremely similar. Learning more about them, as well as keeping a diary of your migraine attacks, is a good idea and, hopefully, something that will help you feel more empowered when it comes to living with this condition.

Medically reviewed on December 23, 2024

5 Sources

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Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

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About the author

Nia G.

Nia is a chronic illness and disability advocate from the United Kingdom. Living with many conditions herself, Nia founded The Chronic Notebook platform on Instagram in 2019, now with 18K followers and growing. Since then, she has used The Chronic Notebook across online channels to spread awareness and educate others on issues around chronic illness and disability. In 2020, Nia won the ASUS Enter Your Voice Competition, receiving a grant to fund projects related to her work. Nia continues to work with charities and companies with illness and disability as their core focus. You can find her on Instagram and Twitter.

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