Patient-Reported Study Identifies Common Symptoms and Timing During Migraine Prodrome

Richard B. Lipton, MD

(Credit: American Headache Society)

In a newly published qualitative study in Headache, researchers identified patients who frequently reported prodromal symptoms, often noting that a migraine headache followed their prodrome in a 1- to 6-hour window. These findings suggest that characterizing the prodrome experience could improve strategies for measuring migraine burden and offer opportunities to initiate treatment during the prodromal phase to prevent moderate or severe headache.¹

Using 20 patient interviews from March 2022 to May 2022, participants reported 36 unique prodromal symptoms, and each patient had a mean of 13 symptoms (SD, 6.6) and a median of 11 symptoms (IQR, 7.8-17.0) during the prodrome phase. Most of the commonly reported prodromal symptoms included nausea (85%), fatigue/tiredness (80%), sensitivity to light (65%), neck pain/stiffness (60%), and dizziness/vertigo/light-headedness (50%).

‘This study is one of the first to assess the humanistic burden of migraine prodrome from the patient perspective. Findings related to symptom timing contribute to the distinction between migraine phases as well as the progression of prodromal symptoms. Specifically, people with migraine are often uncertain about when to take medication; currently, we instruct patients to treat early, while pain is mild, but not too often. This study sets the stage for assessing the benefits of treating in the prodrome phase, when initial symptoms that signal impending headache develop,” lead author Richard B. Lipton, MD, director of the Montefiore Headache Center at Albert Einstein College of Medicine, and colleagues wrote.¹

For the current study, investigators included patients who had a clinician-confirmed diagnosis of migraine and at least 1 prodromal symptom; participants were consented, screened, and then completed 60-minute interviews. During the interviews, researchers asked participants open-ended questions to capture spontaneous reports, along with specific probes based on a clinician-established list of prodromal symptoms. Utilizing a theory approach², authors analyzed the qualitative data gathered from each of the interviews to uncover key themes and retrieve insights.

READ MORE: Analyzing Eptinezumab’s Ability to Extend Interictal Periods and Reduce Migraine Burden

Among symptoms reported by at least 4 participants (20%), patients rated neck pain/stiffness as the most bothersome (8.9/10), whereas sensitivity to light was rated as the most severe (8.5/10). Authors noted that nearly 40% of all reported symptoms by patients appeared in 2 hours of migraine onset. Of the commonly reported symptoms, nausea (0.8 h), sensitivity to light (1.0 h), and dizziness/vertigo/light-headedness (2.0 h) occurred closest to headache onset, whereas fatigue/tiredness (4.0 h) and neck pain/stiffness (4.8 h) appeared earlier.

Migraine attacks typically progress through 4 stages, including the prodrome or premonitory phase, aura, headache, and postdrome. However, authors noted that qualitative data on the variety of symptoms experienced during the prodrome and their timing relative to headache onset have been limited. Therefore, investigators recommended that understanding these early symptoms could help predict when a migraine headache will occur and offer a clinically useful window to begin treatment before pain develops.

“Prodrome symptom identification could encourage early treatment intervention, possibly resulting in improved efficacy and better patient outcomes. The findings herein can be used to inform future studies exploring this potential benefit,” Lipton et al noted.¹ “Specifically, more research is needed to explore the incidence of migraine prodrome across a larger patient population, including whether early intervention with acute migraine medication leads to the reduction of migraine headache pain, or prevents its onset altogether. This future research will aid the effort to mitigate the incidence and humanistic burden of migraine attacks.”

REFERENCES
1. Lipton RB, Stokes J, Evans CJ, et al. Characterizing the patient experience during the prodrome phase of migraine: A qualitative study of symptoms and their timing. Headache. Published online September 1, 2025. doi:10.1111/head.15024
2. Glaser BG, Strauss AL. The constant comparative method of qualitative analysis. In: Glaser BG, Strauss AL, eds. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine de Gruyter; 1967:101-115.