Migraine is far more than pain, with headache itself being just one of the symptoms. To non-migraine sufferers, migraine is simply a bad headache and this perception has freely percolated society causing confusion and misunderstanding. Newly diagnosed sufferers often struggle to make the connection between their mood swings and associated symptoms, not fully understanding how closely the two are related.

Migraine Phases

Because migraine involves far more than headache, the start and finish of the migraine attack shouldn’t be measured by the duration of pain.

The entire cycle of a migraine episode has distinct phases, and while symptoms and duration vary between sufferers, most learn to recognize these phases and use them to understand and manage their migraine.

There are four distinct phases, and mood swings can happen during any of them:

• Prodromal Phase: During this phase, sufferers will experience early warning signs that a migraine is on the way. Symptoms vary, and you may feel more thirsty or have unusual food cravings, you may need to visit the bathroom more often, have more energy than usual or experience mood swings such as feeling more irritable and short tempered.
• Aura Phase: Not everyone has migraine with aura, but for those who do symptoms are most typically in vision, tingling in the skin, or a sensation of confusion with possible difficulty in speaking or concentrating.
• The Pain Phase: This is the one everyone is familiar with, sufferers and non-sufferers alike. It can be agonizing and become worse if you’re physically active, which is why many sufferers find the only answer is to retreat to their beds until it subsides.
• Postdromal Phase:  The pain subsides, but this is not the end. Many sufferers will continue to feel unwell for several hours to a day or more. Symptoms during the postdromal phase can include feeling very tired, feeling confused or experiencing a sudden flare of pain if you move quickly or bend over.

With so much going on in the body during the cycle of a migraine attack, it’s hardly surprising that mood swings are a common accompaniment. Around 75% say the majority of mood swing symptoms occur during the prodromal and postdromal phases - immediately before and after the pain phase.

Brain Chemicals

During a migraine attack, serotonin levels in the body are affected, increasing immediately before the onset of the migraine and then decreasing as the pain phase passes. Whilst serotonin isn’t totally to blame, the fluctuating levels play a part in mood swings.

Serotonin is a neurotransmitter, carrying signals along and between nerves. It regulates bodily cycles and contributes to feelings of happiness or well-being. When levels become too high or too low, the outward symptoms are mood changes and they can be extreme, ranging from elation to the depths of depression.

Commonly prescribed medications such as triptans are ineffective against these symptoms. In fact, no medications effectively deal with these short-term mood swings.

Coping and Management Strategies

It’s important to recognize that changing mood patterns are, for many sufferers, a normal part of the migraine cycle. Practicing detachment from feelings can help.

That’s not to say you should deny the way you are feeling but, instead, recognize that feelings or emotions don’t necessarily dictate the reality of your life. The notion of positive thinking has a bad reputation in certain sections of society; the implication being the denial that anything is amiss.

What positive thinking really means however, is that you dig deep to find the good in a situation, reframing your thinking to help with feelings of guilt, anger, fear, depression or even hyper excitability. Migraine mood swings may be difficult to deal with, but:

• You survive them and should celebrate that fact
• You have a unique understanding of human frailty and can use your knowledge to help others
• The dark times heighten your ability to appreciate good times.

Adding changes in mood to your migraine diary can also help you pinpoint exactly when mood changes start, how long they last, and how you feel such as whether you’re happier or more depressed or fearful than normal. With practice and over time, some sufferers find their mood swings are a reliable indication that migraine is on the way. This early window of opportunity can then be a positive they can use to treat the approaching symptoms, either preventing or reducing the impact of the headache when it descends.

Mood swings are one of the hidden migraine symptoms that non-sufferers find hardest to understand, as well as being disturbing for newly diagnosed migraineurs who are at the beginning of their journey to understand their condition.

In discussions of your symptoms with either loved ones or colleagues, don't forget to include how mood swings affect you so their understanding grows along with your own.