Two non-obvious signs of an approaching debilitating migraine have been named

The main finding of this study was that changes in sleep quality and energy the previous day were associated with headaches the next day,” said Dr. Kathleen Merikangas, principal investigator of the study published Wednesday in the journal Neurology.

As CNN notes, you shouldn’t shake your head when you have a migraine, and it’s certainly not just a nasty headache. According to a February 2018 study, chronic migraines are the leading cause of disability in people under 50.

Kathleen Merikangas, director of the Genetic Epidemiology Research Unit at the National Institute of Mental Health’s Intramural Research Program, and her colleagues used electronic diaries to track the behaviors and symptoms of 477 people over a two-week period, according to the study.

The research team found that sleep quality and energy were important predictors of a migraine attack the next day.

The data showed that those who had poor sleep quality and low energy one day were more likely to experience a migraine the next morning. Higher-than-average energy and stress typically predicted the onset of a migraine later in the day.

“This is a very exciting study because of how well it was done, how detailed it was, and how large it was,” says Dr. Stuart Tepper, vice president of the New England Neuroscience and Headache Institute in Stamford, Connecticut. Tepper was not involved in the study.

The differences point to the importance of your circadian rhythm, which regulates your sleep-wake cycles, in the manifestation of headaches. The results obtained may serve as the basis for the treatment and prevention of migraine attacks, CNN notes.

Knowing when migraines start can be critical, especially given the growing interest in treating migraines before they start, Dr. Tepper says.

“If we can identify things in the environment that people can change, then we’d like to be able to prevent an attack in the first place,” emphasizes Kathleen Merikangas. “If we can do that through behavioral interventions… then they might be able to prevent it, either by going to sleep to compensate or some other intervention that would eliminate the need for us to take medication to prevent an attack.”

Dr. Tepper, however, said he is not sure whether behavioral changes can always prevent a migraine attack.

A migraine attack is more than just a headache. And warning signs such as fatigue, neck pain and sleep disturbances may be early symptoms of an attack, not just its trigger, he added.

Instead, Tepper advises taking medications before a headache starts in hopes of preventing it in the first place.

It makes sense that people might be conservative about using migraine medications, Tepper said.

An older class of drugs called triptans were associated with more migraines and, as a result, chronic migraine conditions if they were used more than 10 days a month, he said.

Your doctor may recommend pain medications to treat migraines, but it also helps to recognize the signs of an upcoming attack, Tepper says.

In addition to monitoring your sleep, exercise, and diet, Dr. Merikangas suggests finding a way to manage stress so you can watch for signs of migraines.

According to Tepper, there are five typical signs of an oncoming migraine. These include light sensitivity, fatigue, neck pain, as well as noise sensitivity and dizziness, he said.

Cognitive behavioral therapy is often useful to help manage stress, which can trigger migraine attacks. What’s more, taking vitamins and supplements such as magnesium and riboflavin may be effective in reducing the frequency of migraines, Kylie Petrarca, a registered nurse and director of education programs for the Migraine Disorders Association, said in a previous CNN article.

It’s not just about avoiding pain, Merikangas says. “It’s really important to think about the full context of our health,” she said. “By being able to characterize not just headaches, but all these other systems, we could then get to the bottom of the causes of negative health events.”