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Can Patients With Migraine Predict an Attack?

Jaime Rosenberg

While headache is the most recognized symptom of migraine, migraine attacks often encompass a wide range of symptoms, including premonitory symptoms prior to the episode. The majority of patients who suffer from migraine experience these premonitory symptoms and are able to predict at least 1 attack, according to a new study.

Premonitory symptoms have been characterized as symptoms that precede and alert patients of a migraine between hours and 2 days in advance, including euphoria, fatigue, depression, increased appetite, or food cravings.

“Studying these symptoms is valuable as they are the first patients report during an attack and can indicate which anatomical regions and neurochemical mechanisms are affected at onset,” wrote the researchers of the study. “Another important factor, suggested in several papers, is the administration of the treatment during this phase with the aim of anticipating and preventing the pain onset.”
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The researchers studied 34 patients who experienced between 1 and 8 migraine attacks per month. Patients used a mobile application to reported baseline data, including sex, age, confirmation of migraine diagnosis with or without aura, age at onset, overall qualities of pain, pain frequency, and current preventive treatments.

Researchers followed the patients for 2 months as they used the mobile application to record what they believed to be premonitory symptoms and onset of pain, if it occurred. When a migraine attack ended, participants completed a form on the characteristics of the episode, including the presence of premonitory symptoms not identified prior to the attack.

A total of 229 migraine attacks were recorded, of which 158 (69%) were accompanied by premonitory symptoms. A total of 29 patients experienced premonitory symptoms during at least 1 episode. The mean number of premonitory symptoms recorded was 4.3 per episode, and the mean time of symptom presence was 10 hours and 38 minutes prior to pain onset. Symptoms identified closest to pain onset were nausea and vomiting, apathy, difficulty concentrating, blurred vision, and neck stiffness.

Twenty-three patients were able to predict an attack at least once, implying that patients have a 67.6% likelihood of predicting attacks on occasion, noted the authors. Of those patients, 12 were considered good predictors and were able to predict more than 50% of attacks. Meanwhile, just 4 (11.8%) were always able to predict attacks when accompanied by premonitory symptoms. Eleven patients never predicted an attack.

The authors noted that good predictors of migraine attacks could not be characterized by any specific profile. “An analysis of whether any baseline characteristics increased patients’ likelihood of being able to predict some attack or being a good predictor revealed no statistically significant differences, including sex, age, years form onset headache, and cognitive reserve and associated preventive treatment,” they wrote.

Reference:
Gago-Veiga A, Pagán J, Henares K, et al. To what extent are patients with migraine able to predict attacks? [Published September 27, 2018]. J Pain Res. doi: https://doi.org/10.2147/JPR.S175602.
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