You Feel the Oncoming Migraine. Now What?
You’re driving home from work and suddenly, you notice that you’re feeling a little off. It seems to take more mental energy than it should to follow the road signs, you find yourself yawning a lot, and you need to pull over to use the bathroom. As you do, you feel a little bit unstable in a way that is hard to describe, and you notice tension in your neck.
And then you know: A migraine is on its way. If you don’t get it under control fast, by the time you get home, it will probably be in full swing, and there’s a good chance that it will ruin the rest of your night.
Situations like these can be frustrating. If your migraines are intense enough, they can even be frightening.
But if you act fast when you detect the first sign of a migraine, in some cases, you can ward off a full migraine attack, or at least reduce its severity when it strikes.
So, what should you do when you feel a migraine coming on? In this article, we’ll go over some suggestions.
But first, let’s talk about how you can recognize when migraine headaches are potentially on their way.
Signs of an Impending Migraine: How To Recognize When a Migraine is Coming On
While some migraine patients experience an attack immediately without warning, for most, there is a lead-in phase referred to as the “prodrome.”
Migraine.com defines the prodrome as, “the first part of an attack when the ‘normal’ equilibrium of the central nervous system has been disrupted. It occurs in about 80% of Migraine patients and usually lasts from between 24 – 48 hrs.”
How obvious the symptoms of prodrome are can vary significantly from one person to another. For some, certain giveaway signs may be obvious, while for others, they may be almost undetectable or impossible to define.
Indeed, the same link describes cases where the “patient may begin to feel the ‘premonition’ that something is not right.”
If you do notice distinct signs and symptoms, some of them might include:
- Excessive yawning or deep intakes of air (experienced as a compulsion—it can be hard to stop even after you become conscious that you are doing it). This can be accompanied by an urge to stretch compulsively as well.
- Having to urinate frequently.
- Losing your appetite.
- Conversely, becoming very hungry, particularly for certain foods (craving for chocolate are common).
- Loss of visual focus (things getting “fuzzy”). Attempting to pull focus can be painful.
- Mood changes are possible (i.e. heightened anxiety). Some people report feelings of excitement or irritability.
- Hands and feet may become cold.
- It can become difficult to cognitively focus or think clearly. Some people experience problems with memory.
- You might feel more fatigued than usual.
- Weakness or dizziness are possible.
- You might experience muscle tension or pain, especially if have an associated myofascial disorder.
- You could experience a wave of nausea or other digestive symptoms.
For a very long time, I did not think that I had any distinguishable symptoms leading up to an attack. I would just suddenly become aware that something was wrong, and then I would be in severe pain.
But since learning more about migraines (and discovering that I have them), I have become better at noticing some of the signs that lead up to my attacks.
The earliest sign for me is usually a compulsion to stretch and yawn, even though doing so is bad for my muscular problems. Even once I become aware of this, it is very difficult to stop myself from yawning and stretching.
I also might notice myself compulsively taking deep gasps of air, as if this is somehow going to stop something bad from unfolding.
I may find myself running to the bathroom every five minutes. But for me, this symptom is more likely to occur once an attack is in full swing than it is to proceed one.
Likewise, chocolate cravings are common for me, but usually once the pain is already becoming severe.
Bright light (like from the sun) will become unpleasant, and I will feel an instinctual urge to shut my eyes or turn away from it whereas I might not if not in danger of a migraine attack.
I may notice if I bend over to pick something up off the floor, I feel a brief pulsating pain in my temple. This might also occur if I get up too quickly and move across the room.
Another possible sign of an oncoming attack is simply a worsening of the low-level migraine pain that is often present with me even outside of a full-blown attack.
Often, I will feel a kind of “unstable pain” in both temples and a sense of all-around tension.
The pain will then pick a side, and launch a unilateral attack.
That “unstable pain” sensation gives me no more than 5-30 minutes of warning before an attack is in full progress.
Sometimes, that “both sides unstable” sensation won’t be “painful” either—it will just be “unstable.”
But for me, the signs of an attack are usually most detectable through changes in my psychological frame of mind, and fall under that “premonition” umbrella.
There will be an increased sense that something is accelerating which is no longer within my grasp of partial control
Imagine, for example, that my chronic pain is a set of horses pulling a carriage. The horses, being their own entities, are never 100% within my control, but I’ve learned to tame them to some degree.
But when they spook, I can lose control of them completely.
When that “runaway carriage” sensation starts, that usually means that a migraine attack is ramping up.
In most cases, there will be nothing I can do at that point to stop the horses from trying to run me off a cliff, but I can at least try to avoid activities that will make them worse.
One more psychological sign I sometimes get that a migraine attack is on the way is a detectable increase in agitation.
I can sometimes pick up on this before the “runaway carriage” phase commences.
I monitor my agitation levels pretty consistently throughout the day because I am autistic, and do so to try and spot meltdowns ramping up before they can get the better of me.
I have noticed that my agitation levels will often increase and I will be more meltdown-prone when I am in the prodrome phase leading up to a migraine attack, even if I do not have other obvious symptoms.
This makes sense, because a meltdown is usually the result of feeling as if my last vestige of control in the universe has just gone away.
So, if a migraine is building up in the background, I will have that decreased sense of personal agency which can contribute to a meltdown tipping state.
My partner, like me, has chronic migraines. He describes a typical set of warning signs preceding an attack as follows:
First, it will become difficult for him to pull focus visually, even painful to do so. The next symptom that he might notice is an increased sense of overall fatigue, and possibly feeling a bit sick. There may then be a sensation of excitement similar to cresting the top of a roller coaster. The last sign is often a tightness in the temples preceding the full-on attack, which usually picks a unilateral side.
Key Point: Migraine warning signs during the prodrome phase can vary considerably from person to person, or even from episode to episode for just one migraine sufferer.
Learning to Identify Your Own Migraine Warning Signs
It can take time and experience to become familiar with your own early warning signs for migraine attacks.
They can vary considerably from one attack to another.
So, the best thing to do it is to turn self-monitoring into a regular, ongoing practice.
Consider taking notes when you think you have noticed a pattern of warning signs or symptoms across multiple attacks.
You can also ask people who live or work with you to share their observations with you as well.
Someone else might notice, for example, that you yawn a lot before getting a migraine, but you might not be aware of the fact.
Or, somebody might note that you snap at them impatiently more often in the hours leading up to an attack, but you might have no idea that you are even doing it.
The more skilled you become in recognizing your own warning signs for migraine headaches, the earlier you will be able to catch impending attacks and take abortive measures.
Key Point: Regular self-monitoring can help you learn to identify your personal migraine warning signs. Once you do, you will get better at spotting oncoming attacks and taking evasive action.
Steps to Take When You Feel a Migraine Coming On
Let’s say that you do become aware that you have migraine pain ramping up and an attack may be on the way. What can you do when you spot the first migraine symptoms to try and get your situation back under control?
1. Your Environment
When a migraine state increases your sensitivity to certain stimuli (i.e. bright light, loud noise), it seems that the stimuli can worsen pain, nausea, and other unwanted symptoms.
So, the first thing to do if at all possible is to try and make your environment as inoffensive as possible to your compromised system.
Because bright light is a problem for many migraine sufferers, a good first step is to try and make your environment darker.
If there are blinds or curtains you can pull over your windows to shut out the bright sun, do so.
If there are bright light fixtures on, switch them off. You can also consider reducing the brightness settings on monitors temporarily.
Should you have the luxury of moving to a completely dark room, think about doing so.
Sensitive to loud noises when you have migraine pain? Look for ways to reduce your exposure to loud sounds.
If you are work, close your office door. If you are at home, close your windows, ask other people in your home to be quiet, and avoid rooms where people are doing noisy chores like vacuuming.
If there are other sensory problems which become overwhelming during a migraine attack (for me, movement and general chaos can get to be pretty bad), do what you can to avoid those sensory triggers.
Heat and cold can be issues too. If you are excessively hot, that will almost certainly make your pain, fatigue, dizziness, weakness and nausea worse. Try and move to a cooler room.
If you are excessively cold, that can make you shiver and tense up your muscles, which may also become a problem. If that is your situation, try layering up or getting a blanket.
Key Point: When a migraine attack is on the horizon, sensory issues can develop as symptoms. They may worsen an attack. Try and get to a dark, quiet room which will not assault your senses. Make sure you are not too hot or too cold.
2. Medications or Supplements
Something else that you should consider doing at the first sign of a migraine attack is to take abortive medications and/or supplements.
In many cases, this might involve taking over-the-counter medications such as Excedrin, ibuprofen or acetaminophen.
If you take sumatriptan (Imitrex) or a similar prescription medication, this also is to be taken at the first sign of migraine.
If you wait to take it until later, it may be significantly less effective.
There are also some supplements which you might take in an abortive capacity, although most are to be used on a daily basis as preventative measures.
One example is ginger. You can take ginger daily as a preventative treatment, but you also can take it as an abortive supplement at the start of an attack.
I recommend taking a look at this research study, which found, “Two hours after using either drug, mean headaches severity decreased significantly. Efficacy of ginger powder and sumatriptan was similar. Clinical adverse effects of ginger powder were less than sumatriptan. Patients’ satisfaction and willingness to continue did not differ. The effectiveness of ginger powder in the treatment of common migraine attacks is statistically comparable to sumatriptan. Ginger also poses a better side effect profile than sumatriptan.”
The participants in the study took the ginger the same way they would sumatriptan, at the first sign of an attack.
Should you hold off and see if your migraine goes away on its own before taking medication or supplements to prevent a full-on attack?
That is up to you. Migraine warning signs do not always point toward an attack, and in some cases, taking some of the other steps discussed in these sections is enough to prevent one.
You might want to base your decision on the frequency of your attacks as well as other factors which might make you more or less attack-prone at any given point of time.
Since I have chronic migraines, I will almost always go for ibuprofen at the first sign of an impending attack. But I may hold off on stronger medications unless I know that an attack is a near certainty—such as, for example, during certain times of the month when hormonal shifts make attacks nearly inevitable for me.
Key Point: If you have a strong chance of getting a migraine attack, you should strongly consider taking your medications and supplements right away. They will be most effective if you are swift.
3. Food and Water
This is a great moment to asses your nutritional and hydration status. When is the last time you had something to eat or drink?
If it has been a few hours since you had something to eat, you should think about grabbing a bite, even if you don’t feel like it.
It could be that you are low on magnesium and other nutrients. In some cases, this could even be what triggered your migraine in the first place. But even if that is not your situation, getting the nutrition you need might be enough to stave off a headache or prevent it from being worse.
Getting dehydrated may also be a migraine trigger and exacerbating factor.
So, if you have not been drinking a lot of water, you should probably see to that as well.
This can be unpleasant if you happen to have excessive urination as one of your migraine symptoms. But, you should do what you can to replenish your liquids.
If you want to learn more about how water and minerals can help prevent or treat migraines, see this article.
Key Point: If you get dehydrated or are running low on certain nutrients, that can trigger a migraine or make one worse. So if you feel a headache coming on, getting some food and water in your system may be a smart move.
You should think not only about your environment, but also what activities you are engaged in when you feel a migraine coming on.
It could be that if you continue with those activities, in some cases, that could feed into the development of a migraine attack.
There are also situations where continuing with an activity could be unsafe.
Here are a few examples:
- Let’s say you have been sitting in the same position all day working. Sometimes, that can produce tension in your muscles. If that tension is a migraine trigger for you, you could end up making your situation worse if you continue to sit in that position working. It might serve well to get up and move into a different position and stop working for a while so that you can give your body a break. While migraines do not always respond as quickly and effectively as you might like to rest, you probably have noticed that they can respond quite adversely to attempts to “power through.”
- If you get an attack while driving or operating machinery, consider stopping what you were doing for a while. You probably can tell for yourself whether you are functional enough or not to continue. But it is not worth it to endanger yourself or others, even if that means you have to pull over on the side of the road for a while.
- For some people, working out can prompt a migraine or make one worse (some people are the opposite). If exercise makes you worse, try to avoid anything too strenuous if you think a migraine could be on the way. Conversely, if exercise tends to help you, think about doing a brief, light workout if you feel the threat of a headache approaching.
- Sex can also make a headache better for some people and worse for others (and in some, it can even trigger one). As with the exercise, listen to your body and do or don’t do what makes sense for you.
- Any activity which is stressful should be avoided if possible if you think that you have a migraine coming on. The more stressed you are, the more likely an attack is, and the more intense the attack is likely to be.
- Think an injury may be involved in your migraine? If so, avoid doing anything which might provoke your injury. Note that old injuries, not just recent ones, can be involved in migraine pain.
Key Point: Some activities can worsen migraines or trigger them. If you detect the first signs of a migraine, staying away from such activities is a good idea if you can.
5. Home Remedies
There are some simple home remedies which may be able to help you counter a migraine attack. As with medications, the more rapidly you act, the more likely you are to stop the attack before it gets and feel swing.
Some examples include:
- Cold therapy. Sometimes, applying a cold pack or ice to the head or face can help prevent or treat an attack. You can read all about this in this post. In my experience, it is best to hold the cold pack in place for around half an hour. Just a few minutes often won’t do the trick.
- Heat. Sometimes, heat can actually help too, though in many situations, it can make you feel much worse. But you can try standing in a hot shower to see if it makes a difference. If tight muscles are exacerbating the problem, warming them up may help. If the heat seems to be making the pain worse, make sure that you stop right away.
- TENS unit. A TENS unit probably won’t prevent a migraine attack, but it can stave one off for a while or help to dampen the sensation of pain.
- Massage, gua sha, or other techniques to loosen muscle knots. Note that these techniques are only relevant if muscle tension is involved in your migraine pain.
- Sleep. Sometimes, catching a quick nap is enough to put an end to a migraine before it enters the attack phase, or end it once it does. For whatever reason, this seems to work most consistently for younger migraine sufferers.
Key Point: Some home remedies may be able to help ward off an attack.
I already touched on this briefly, but a migraine is an overload of sorts. You will only make matters worse if you allow anything else to unnecessarily overload your system.
So, if you feel a migraine on the way, trying to remove as many stressors from your environment as you can. This is a time to withdraw, not engage. In some situations, this might also mean putting social situations on hold.
Key Point: Stress will not help a migraine. Avoid engaging in stressors where possible.
Sample Game Plan
Putting it all together, you should come up with a plan for evasive action at the first sign of a migraine.
For example, here’s what I do if I feel a migraine coming on:
- If bright light is problematic, I pull the curtains or turn off light fixtures.
- I take NSAIDs.
- If I can take an Imitrex (i.e. haven’t already taken all the ones I am allotted for the week), I do.
- If I can’t take Imitrex, I may take ginger.
- I may put ice on my face for 10-30 minutes (depending on whether or not I am working).
- If I am stuck working, I use my TENS unit.
- If I am not working or can’t work, I take a shower in a dark room.
- I try not to interact with anyone.
Key Point: You need a game plan for when you detect a migraine coming on. Having this plan structured in advance can help, because it can be very difficult when you are experiencing a migraine to think clearly and make decisions.
Migraine Prevention is Key
How successful abortive measures like those we have gone over above actually are depends on a variety of factors.
Some people may find that they can easily stave off most migraines if they are swift to action.
But others may find that success is unpredictable. Still others may discover that they cannot prevent an attack at all once they pick up their first warning signs.
If you fall into that latter category and you have frequent migraine attacks, you are probably a candidate for preventative treatments.
According to the Migraine Research Foundation, “Although 25% of sufferers would benefit from preventive treatment, only 12% of all sufferers receive it.”
Preventative treatment options include a range of medications and supplements as well as Botox.
Alas, the vast majority of preventative migraine medications carry significant adverse side effects or long-term health consequences.
For that reason, many migraine patients opt to try out supplements instead.
As we talked about earlier, ginger can be used as either an abortive or preventative treatment.
Other natural supplements which you might try to support brain health include butterbur, boswellia, Vitex, and feverfew.
These supplements may help to prevent the conditions in your body which are conducive to the neurologically imbalanced state that leads to a migraine attack.
If you find one or more that work for you, that should mean that you enter prodrome less frequently to begin with.
Key Point: Since abortive measures frequently are not enough, even if you act fast, preventative care may be worth considering. If you’re a chronic migraine sufferer, this may be a necessary course of action. Even if medications like Imitrex can help you out, you cannot use them every day.
Conclusion: Act Quickly at the First Sign of a Migraine
Based on what you have read above, you should be able to put together a game plan to deal with a migraine at the first signs.
Hopefully, if you act quickly, you can prevent at least a few migraines from turning into full-blown attacks each month.
But you also now understand why preventative treatments such as supplements are important when you have frequent migraine attacks.
To learn more about the supplements that we discussed above as well as the other ideas and techniques in this guide, continue to explore our blog posts.