The hours before a migraine attack: which early signs can appear, what you record, and what the notes show you and your doctor.

A migraine attack often has an early phase called the prodrome. It can begin hours, and for some people up to two days, before the headache. Many people feel tired, yawn a lot, notice mood shifts or crave certain foods. Recording those early signs lets you see later what came before an attack. Do it on paper or in the migraine diary in Sam, where sleep and heart rate variability from Apple Health sit a few taps from the entry. The text explains what the prodrome is, what you log, and what that logging can and cannot do.

What is the prodrome and which early signs appear?

The prodrome is also called the premonitory phase. It is the first part of an attack, before the pain. The Migraine Trust lists typical signs: feeling tired, yawning more than usual, food cravings, mood changes, feeling thirsty, neck stiffness and passing urine more often. MedlinePlus adds fluid retention and says the phase starts up to 24 hours before the headache.

Not every sign appears for every person. The sources stress that people with migraine experience it very differently. Sensitivity to light and sound can come early too. About a third of people have aura, which is a different phase, usually closer to the head pain. How aura, prodrome and the other phases fit together is explained in migraine symptoms: aura and phases.

One set of numbers helps. The CaMEO study, reported by the American Migraine Foundation, found that just over 84 in 100 respondents felt at least one sign before the head pain. Only 56 in 100 recognised that sign as a pointer to an oncoming attack. What a single sign means for you is for your practice to judge, not you alone.

What you record before and during the attack

Two details take the least effort: the time the attack starts and the first sign you noticed. You can put both into the attack entry. If you noticed that something felt different before, make a short note, such as "yawned a lot" or "felt irritable". That note becomes part of the entry.

The time of the attack matters, not the time of your note. That way you can later see how far ahead a sign came. Also record days without headache. Otherwise you cannot tell whether a gap means free or forgotten. What belongs in a calendar overall is covered in Headache calendar: what to include.

Enter on the same day, not backdated at the weekend. In Sam you can note the early signs in the symptom diary right by the attack entry. After a few weeks the short notes turn into a pattern you and your practice can see over time.

What recording can and cannot do

Recording is documentation, not prediction. Over time you can see which signs came before your own attacks. Reading the pattern is a human job: yours and your doctor's. A diary does not promise to predict every attack. The signs change and can skip a time.

Recording also does not stop an attack on its own. A US trial called PRODROME looked at whether one prescription medicine, taken during the early phase, could ease the following head pain. It was run under study instructions, not by an app, and it included only people who could reliably identify their early signs. What makes sense for you at which point is for your practice to decide.

Recording has a clear benefit. It gives you material and a basis for your practice. Over weeks it shows which signs are common for you. Many signs, such as tiredness or food cravings, are common in everyday life. Their closeness in time to the attack is what the record makes visible.

What Apple Health adds next to your entry

For today's entry Sam shows sleep, resting heart rate and heart rate variability from Apple Health beside it. That is neutral context, not a finding and not a warning. You may notice that before some attacks sleep was short or the resting heart rate high. You may also see no link. Both are a result.

These values appear only for entries made today, and only when Apple Health supplies data. The link between sleep, pulse and migraine is its own question. It is explored in sleep, resting heart rate and migraine. You enter only what you know yourself, and you bring it all to the appointment. If you are newly diagnosed, migraine diagnosis: what now walks you through the first weeks.

How you prepare the conversation with your doctor

The longer you record, the more concrete the appointment becomes. Show your early signs, the time of the attacks and the headache-free days. The MIDAS questionnaire counts in five questions on how many days migraine limited you in the last three months. You can fill it in with the MIDAS migraine score. The score is not a diagnosis, just a number for the conversation.

A clear boundary: the early signs are not a substitute for a medical opinion. New or unfamiliar symptoms belong with a doctor. The early signs are an observation, and your care team decides what they mean for you.

When it cannot wait

A sudden, extremely severe headache counts as an emergency. First-time severe vision, speech or weakness symptoms can point to a stroke and need help at once. Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). You do not have to decide whether it is aura or something else. Sam does not predict anything and does not diagnose. This text does not replace a medical assessment.

Log your prodrome in Sam and take the report along

You bring more than loose notes. You bring the course from the program for migraine, a diary of its own with a doctor report and a monthly questionnaire.

• Instead of paper or a notes app: each attack is one entry in about 30 seconds, and sleep, resting heart rate and heart rate variability come from Apple Health for today's entries.
• Instead of memory: the doctor report as a PDF shows your migraine days for the period you choose.
• Instead of answering MIDAS from head: the questionnaire comes once a month as a short check-in, and the result sits in the report.

Sam does not predict, detect or diagnose an attack. Sam only shows what you enter and what comes from Apple Health.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Migraine triggers: sleep, stress and tracking
• Sleep, resting heart rate and migraine
• Migraine symptoms: aura and phases
• Migraine diagnosis: what now

Sources

Updated: October 2026

• The Migraine Trust: Prodrome: spotting the first signs of a migraine attack (blog, 7 October 2022)
• MedlinePlus: Migraine (last updated 20 November 2025)
• American Migraine Foundation: Characterizing pre-headache (prodrome) features of migraine attacks: results from the CaMEO study (13 September 2023)
• NHS: Migraine and Headaches (last reviewed 17 April 2024)
• Dodick DW et al.: Ubrogepant for the treatment of migraine attacks during the prodrome (PRODROME trial). Lancet 2023