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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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For
many Migraineurs, Symptoms foretell onset of
Headache |
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BY ALEC O’NEILL
Contributing Writer |
BOSTON — By listening to their bodies and
tuning in to their emotional states, patients with
migraine may be able to get a jump on the next attack
and either prevent it or ameliorate it with prophylactic
medications, reported investigators on June 28 at the
50th Annual Meeting of the American Headache Society.
Four out of five patients who took part in an open-ended
survey said they could estimate the timing of migraines
based on the occurrence of prodromal symptoms such as
irritability and fatigue, reported Dr. Allan L.
Bernstein of Kaiser Permanente Santa Rosa Medical Center
in Santa Rosa, California, in a poster session.
(Migraine Prodromes: Creating a Clinical Tool for
Patients and Practitioners. Abstract S59.)
Dr. Bernstein and colleagues reported results of the
survey, which they developed and administered as part of
an ongoing effort to design an intake form for both
clinicians and patients that would accurately capture
the spectrum of migraine prodromes.
“Migraine prodromes are widely reported, occurring up to
two days before the onset of pain, nausea, vomiting or
other disabling symptoms,” they wrote. “Patients are
often unaware of the significance of the events they are
experiencing, failing to equate them with migraine. With
the long-standing dictum to treat early for best
results, identifying the onset of migraine before the
pain and nausea occurs would offer an opportunity for
more effective acute migraine treatment.”
The authors asked 102 patients to take part in
open-ended interviews with a neurologist specializing in
headache care. All of the patients attended a headache
clinical and all had previously been diagnosed with
migraine by International Headache Society criteria.
The patients were asked to describe the symptoms that
predicted the onset of their migraines, and the authors
used frequency counts to determine the most common,
reproducible, descriptive terms of prodromes and the
time periods during which they occurred.
They found that 72% of patients reported mostly physical
prodromes, while exactly half (50%) had premonitory
emotional symptoms, and 13% had cognitive symptoms.
Irritability, reported by 40% of patients, and fatigue
reported by 29% were the most commonly reported augurs
of migraine.
In all, 79% of patients were able to estimate the timing
of prodromal symptoms. Nearly half (48.5) of all
patients who said they could time the prodrome said that
it occurred from 13 to 24 hours before the onset of
migraine pain, while nine patients (8.7%) said they
could see one coming on from 25 to 48 hours before the
actual event.
In some cases, the patients’ spouses, partners, or
family members were able to read the migraineurs
symptoms and predict that they would soon have a
headache, Dr. Bernstein said in an interview.
“Prodromal physical and emotional symptoms often occur
in the 24-hour period before the onset of migraine
pain,” the authors wrote in their conclusion. “Cognitive
symptoms were distressing and often unrecognized as
being part of the migraine event. Other symptoms, while
identifiable, were not considered as part of the
migraine complex by most patients. We were able to
categorize migraine prodromes in such a way as to create
a clinical tool for both clinician and patient use.” |
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