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Understanding the Migraine Prodrome Phase 

Migraine is a complex neurological condition that affects everyone differently. Marked by intense headaches and painful throbbing in one side of the head, migraine can be debilitating and incredibly difficult to deal with regularly. Although there is currently no cure for this brain disease, understanding the phases of migraine and utilizing specific tools can help individuals manage their symptoms and find freedom from pain. 

The four distinct phases of migraine are prodrome, aura, attack, and postdrome [1]. While not every person will always experience all four phases, it is helpful to understand that each phase has its unique symptoms. Recognizing and treating the warning signs before the attack can prevent the migraine from progressing to the next stage. 

What is the Prodrome Phase of a Migraine? 

The prodrome phase, also known as the premonitory phase, is the first stage of a migraine. This initial phase can last anywhere from a few hours to several days. During this time, individuals may experience non-headache symptoms like neck stiffness, fatigue, sensitivity to light, sensitivity to sound, irritability, mood swings [2]. Other symptoms may include cognitive impairment, sensitivity to smell, nausea or vomiting, yawning, dizziness or vertigo, or food cravings. 

 Since the prodrome phase does not include headache or throbbing pain, individuals are not always aware that these early symptoms are part of the migraine cycle. Keeping a migraine diary allows for tracking early warning signs to help with recognizing the prodrome phase. Identifying warning signs allows patients to begin treating symptoms before the headache starts [3]. 

What is the Difference Between Prodrome and Aura Migraine Phases? 

Prodrome and aura are two separate stages of a migraine. After the initial prodrome phase, some individuals may experience an aura. During the aura stage, one might see flashes of light that look like stars or lighting. Other signs of the aura phase may include temporary loss of vision, numbness in the body, visual disturbances, or increased sensitivity to sensory stimulation. The aura stage is much shorter than the prodrome phase and may only last for a few minutes or up to an hour [4].  

Sometimes the symptoms between the first two stages overlap, so individuals experiencing aura may also exhibit neck stiffness, fatigue, sensitivity to light, sensitivity to sound, irritability, mood swings that are common to the prodromal phase [2]. The prodrome and aura stages occur before the headache or “attack” phase. They offer warning signs to help you treat before the pain begins. 

Prodromal Phase Symptoms:

Quick Reference 

The prodrome migraine phase may include these non-headache symptoms: 

  • Neck stiffness or pain 
  • Fatigue or extreme weakness
  • Sensitivity to light and sound 
  • Irritability
  • Mood swings 
  • Cognitive impairment
  • Sensitivity to smell
  • Nausea, vomiting, or constipation 
  • Yawning 
  • Dizziness or vertigo
  • Food cravings 
  • Difficulty sleeping 
  • Slurred speech 

Nerivio’s Quick Q&A Guide on Navigating A Migraine  

“Can I treat migraine in the prodrome phase?”

Individuals experiencing the prodrome phase can treat their symptoms effectively. When you see the early warning signs of the prodrome phase, that is the best time to begin your treatment plan [5].

Treating a migraine in the prodrome phase can help prevent the migraine from progressing to the later, more painful headache stage. If you use Nerivio to treat migraine, you can start treatment at the prodrome phase. For effective results, start within 60 minutes of the onset of a migraine attack and treat for the full 45 minutes treatment. 

“How do I reduce a migraine in the prodrome phase?”

Many individuals find it helpful to take a nap or practice relaxation techniques, such as deep breathing or meditation during the prodrome phase. Resting in a dark room may help the symptoms pass.  Exercise and physical activity can also help ease migraine symptoms [6]. 

Although not everyone has clear triggers, some find that hormonal fluctuations, such as menstrual periods, foods, environmental factors, or high-stress situations, may trigger migraine [7]. Try to avoid any triggers you think might result in a migraine. Caffeine, wine, and chocolate are common triggers. COVID-19 and the vaccine have also triggered migraine in some individuals who already manage migraine pain [8]. 

 If you experience migraine attacks regularly, one of the best things you can do is start tracking them in a diary. Keeping a detailed record of your experiences will help you recognize patterns as your symptoms develop. For example, if you regularly experience nausea or muscle stiffness a day or two before a severe headache, those symptoms let you know that a headache is coming. The Nerivio app acts as a complete migraine diary helping track not only treatments but also daily symptoms and triggers to help manage your migraine. The Nerivio migraine diary entries can be shared with physicians or caregivers.

By recording any symptoms that develop, either in a physical journal or in Nerivio’s app, you will begin to see the patterns that lead to your headache so you can treat them early.  

A migraine diary should include the day and time your symptoms begin, how long they last, which symptoms you experience, how you feel, perhaps any triggers such as hormonal changes or food, and any treatment you use. This journal will be your best friend when you want to find the right tools to treat your migraine. Be sure to share the journal with a primary care provider or nurse practitioner so they can assist with developing a customized treatment plan. 

 “Can my doctor prescribe a migraine treatment?”

Physicians may prescribe drugs or abortive migraine medicines like Cafergot, triptans, Maxalt, Frova, Relpax, Imitrex, Amerge, or other NSAIDs to treat symptoms for a patient [9]. Many drugs are considered safe but often have side effects associated with them. These side effects may include dizziness, weight gain, nausea, hair loss, confusion, or diarrhea. Over-the-counter (OTC) medications, like aspirin, acetaminophen, and other pain medications, can help treat migraine symptoms in the short-term. 

Due to concern for side effects and drug-to-drug interactions, many individuals who experience migraine prefer a safer approach. Nerivio is a drug-free therapy for acute and preventive treatment of episodic and chronic migraine with or without aura, in patients age 12 and up. 

Nerivio is a prescription use, self-administered device for use at the onset of migraine headache or aura and for prevention. Whether you have a Nerivio yet or not, Nerivio’s app also includes a diary to help accurately journal your symptoms. If you’re interested in asking your doctor about if Nerivio is right for you, visit our step-by-step guide for more information about getting the Nerivio drug-free migraine treatment.

Whether your treatment plan includes medicine or drug-free alternatives, treating your migraine in the prodrome phase may help you avoid the more painful symptoms of the headache phase. It’s very important to contact your healthcare provider to get a proper diagnosis and find the best treatment for your migraine.


  1. The Migraine Trust. (n.d.c). Stages of a migraine attack. https://migrainetrust.org/understand-migraine/stages-of-a-migraine-attack/
  2. American Migraine Foundation. (2022, March 17). Migraine Prodrome: Symptoms and Prevention. https://americanmigrainefoundation.org/resource-library/migraine-prodrome-symptoms-prevention/
  3. The Migraine Trust. (n.d.a). Keeping a headache diary. https://migrainetrust.org/live-with-migraine/self-management/keeping-a-migraine-diary/
  4. American Migraine Foundation. (2023, March 01). Understanding Migraine With Aura. https://americanmigrainefoundation.org/resource-library/understanding-migraine-aura/
  5. Mayo Clinic. (2021, July 02). Migraine. https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207
  6. American Migraine Foundation. (2022, August 4). Migraine Home Remedies. https://americanmigrainefoundation.org/resource-library/migraine-home-remedies/
  7. American Migraine Foundation. (2017, July 27). Top 10 Migraine Triggers And How to Deal With Them. https://americanmigrainefoundation.org/resource-library/top-10-migraine-triggers/
  8. Silvestro, M., Tessitore, A., Orologio, I., Sozio, P., Napolitano, G., Siciliano, M., Tedeschi, G., & Russo, A. (2021). Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine. Journal of clinical medicine, 10(24), 5914. https://doi.org/10.3390/jcm10245914
  9. Annette (Gbemudu) Ogbru, P. D. (2021, November 2). Migraine medications: Types, side effects, list, Prevention & Safety. RxList. https://www.rxlist.com/migraine_medications/drugs-condition.htm

Safety Information

It is highly recommended that you consult your doctor before taking any action based on the information above. This content does not constitute medical advice or a recommendation.

Nerivio is an FDA-cleared, drug-free therapy for acute and preventive treatment of migraine with or without aura in patients 12 years and up. It is a prescription use, a self-administered device for use in the home environment at the onset of migraine headache or aura for acute treatment, or every other day for preventive treatment.

Nerivio should not be used by people with uncontrolled epilepsy, an active implantable medical device, such as a pacemaker, hearing aid implant, or any implanted electronic device. Such use could cause electric shock, electrical interference or serious injuries or medical conditions.”

For full user instructions and safety information, please see the Nerivio User Manual.
Talk to your doctor to see if Nerivio is right for you.